#like a lot of it IS about infrastructural and structural factors and chronic illness but i can't DO anything about that!

[chicago-geniza]

it really is a "proximity to perceived safety/shelter" thing. the agoraphobia, i mean. like the somatic fear dissipated from my body as though a spirit had been exorcised when i turned the corner from the "main throughfare" (very busy commercial and commuter artery that cuts all the way through chicago, lots of foot traffic and car traffic) onto my comparatively quiet residential artery. there were still quite a lot of people walking home with groceries, or back from work, or out with dogs and children, but hardly any cars, and the sidewalks were narrower, and it was Familiar. i would recognize it from any angle, even at night. i couldn't get lost, and it was at most two blocks from my apartment. "two blocks" seems to be the radius of agoraphobia in all directions. i think it has to do with how far i can walk on a bad day; fear of getting stranded, stuck somewhere i don't Know. my brain is acting like an elderly person with dementia and impaired mobility and in many practical ways that's how i function in the world, even if it doesn't describe the particulars of my cognition with utmost precision.

[picardonhealth]

How will the pandemic end? Not with a moment of triumph we’ll all remember, but with a slow whimper we’ll soon forget

Don’t expect civilization to return to normal in 2021 with a V-Day-like emotional catharsis. Focus on the small signs of hope – and the things we can do to prevent anything like this from happening again

André Picard,  The Globe and Mail

Tuesday, January 05, 2021

André Picard is a health columnist for The Globe and Mail. His new book Neglected No More: The Urgent Need to Improve the Lives of Canada’s Elders in the Wake of a Pandemic will be published in March.

This is the way the pandemic ends: Not with a bang, but a whimper.

Apologies to T.S. Eliot aside, the most likely scenario in the coming months is not world-ending catastrophe, but something more banal: More and more people getting vaccinated, followed by a gradual easing of public health restrictions, a rising tide of indifference and a petering out of one of the worst threats to global health the world has seen in a century.

“There won’t be a V-day where everyone runs into the streets and hugs,” said Ashleigh Tuite, an infectious disease epidemiologist and assistant professor at the Dalla Lana School of Public Health of the University of Toronto. “Just a gradual return to normal, but not normal-normal.”

Casual hugs, public celebrations and other indiscriminate mingling are still a long ways off. Masks, physical distancing, limits on gatherings and travel restrictions will be with us for the foreseeable future.

History tells us that pandemics don’t have Hollywood endings. The denouement tends to be slow and messy and COVID-19 will certainly be no exception.

The two big unknowns are the willingness of the public to get their shots, and the durability of immunity.

A lot will depend on how quickly we can get vaccines into people’s arms – and Canada doesn’t appear to be acting with much urgency on that count. Some provinces, such as Ontario, stopped or slowed the vaccine rollout during the holiday period, and some also held back stock to save it for second doses. Both policies have been reversed.

“The vaccine has given people a lot of hope,” Dr. Tuite said. “But whether we will reach herd immunity is still an open question. And if there’s a hiccup with the vaccines, all bets are off.”

Initially, it was estimated that 60 per cent to 70 per cent of the population would need to be vaccinated to make it difficult for the coronavirus to continue spreading – that elusive target called herd immunity. Now, because of more infectious variants, scientists are saying the target needs to be in the 80 per cent to 90 per cent range – which would be unprecedented with an adult vaccine.

Despite their loud, social-media-amplified voices, few people are actually anti-vaccination, and those who have doubts tend to become less hesitant as they see their peers roll up their sleeves. But there are many structural hurdles.

“The systems we have are designed to vaccinate kids. Getting beyond 50 to 60 per cent of adults will be really, really hard,” said Noni MacDonald, a professor of pediatrics at Dalhousie University in Halifax and vaccinologist who has worked for decades in global health.

The numerous challenges, she said, include vaccine hesitancy, hard-to-reach populations, weak public health infrastructure and the fact that, so far, the vaccines approved in Canada require ultracold storage (the Pfizer vaccine is stored at minus 70 C and the Moderna one at minus 20 C, and both must be used quickly after being thawed). Each of the existing vaccines also requires two shots to be fully effective. The third coronavirus vaccine to hit the market could resolve some of the daunting logistics problems as it can be stored in refrigerators already used for vaccines and may even require only one shot. Canada has ordered 20 million doses from AstraZeneca, but the vaccine has not yet received regulatory approval in Canada.

“We’ve only just begun to vaccinate and it will just get harder,” Dr. MacDonald said. “And, of course, the last mile will be the hardest mile.”

That’s just distribution. The immunology part of the puzzle is just as rife with potential complications.

Among those who are inoculated, the big question is: Will they be protected from infection for life – or at least for a few years? Similarly, are those who were infected by coronavirus at risk of reinfection? No one knows, and the only way to really answer those questions is with time and surveillance. It doesn’t feel like we have a lot of the former, and we’ve not done particularly well at the latter.

We’re all anxious to put 2020, the annus horribilis supremus, behind us. But the reality is that we’ve reached, at best, the halfway point of the pandemic. Not to mention that the collateral damage – everything from lingering mental-health wounds to staggering public debt – will be felt for years to come.

“In my experience with regional epidemics, one of the most important lessons I’ve learned is they always last longer than we think,” said Joanne Liu, a Canadian pediatric emergency physician and former international president of Médecins sans frontières.

“Infectious diseases are humbling at the best of times but what really matters in epidemics, or a pandemic, is the human factor, and no one can predict how people will behave in the coming months,” Dr. Liu said.

We can model different scenarios – how infections, hospitalizations and deaths will evolve over time. But we can’t model human behaviour. It’s the wild card in every prediction and plan.

What we do know is that a good chunk of the public seems to be getting sick and tired of restrictions – eager to return to work in the office, to go to the movies and to resume Tinder dating, while others want stricter rules, at least in the short term. Perhaps “more divided about the necessity of lockdowns” is a better way to put it.

Yet, when it comes to COVID-19, the lessons delivered time and time again have been: Impatience can be deadly. So, too, can hesitating to act.

To date, there have been more than 82 million infections in the world, and roughly 1.8 million deaths.

Canada is closing in on 600,000 cases and COVID-19 has claimed more than 15,000 lives here, making it the third leading cause of death in 2020.

By all appearances, the carnage is going to continue through the winter, whether vaccines are effective or not.

In fact, based on the trend lines of infections, hospitalizations and deaths, there is every reason to believe that the coming months will be the darkest yet – especially if we see a spike in new cases related to holiday gatherings, as occurred after Thanksgiving.

“I hate to say it, but this is far from over,” Dr. MacDonald said. “Many people have fallen ill and died, and many more are going to fall ill and die.”

But if the vaccination rollout goes smoothly, and the vaccine works relatively well, we should be able to breathe a bit by summer – maybe even dream of barbecues and baseball again.

Still, vaccinating 37 million people in Canada will take time, never mind seven billion around the globe.

As vaccination numbers rise, the way coronavirus spreads will also be altered. We can expect fewer large waves of illness, but more sporadic ripples concentrated in unvaccinated populations. Infectious disease experts predict the coronavirus is likely to become endemic, lurking about for years, maybe even sparking seasonal spikes of illness, much like the flu.

Global disparities will become more glaring. Countries with 13 per cent of the world’s population have already gobbled up more than half of all the vaccines available. (Canada alone has purchased 429 million doses of seven vaccines, enough to vaccinate our population six times over, and it isn’t clear how it will distribute the excess.)

“It’s like being invited to a feast but the LMIC [low- and middle-income countries] are at the kids’ table, waiting to get the leftovers,” Dr. Liu said.

She also warned that this “me first” attitude is counterproductive – that until coronavirus spread is tamped down everywhere, the threat remains for everyone.

As much as anything, the pandemic has laid bare disparities in society, even in wealthy countries.

In Canada, the most glaring failure has been in eldercare. More than 10,000 of the 15,000 deaths across the country have been in retirement homes and long-term care facilities, and the way others have been locked away is a testament to the ageism ingrained in social policies.

The pandemic has also hit women – especially working moms – particularly hard, setting back progress against gender inequality by years, if not decades. Correcting this requires, among other things, making accessible, affordable child care a public-policy priority.

COVID-19 has also forced us to recognize the importance of low-paid workers to a functioning society. If we don’t hike wages for essential workers (and not just temporarily), make benefits such as paid sick days mandatory, find ways to extend employment insurance benefits to the gig workers and the self-employed, and improve the work environment more generally, we will have workplace issues that extend well beyond the pandemic.

The Canada Emergency Relief Benefit (CERB), one of the most important initiatives taken by government during this public health crisis, brought some financial relief to 4.7 million workers, making it probably the world’s biggest pilot project on basic income. If it doesn’t spark a serious conversation about reforming social welfare, we will have missed an important opportunity.

The postpandemic period will also seriously test the resiliency of the health system. Surgeries are backed-up, patients with chronic illnesses are feeling ignored and front-line workers are burned out. No one knows what impact COVID-19 stress and trauma will have on the population’s mental health or how our medicare system, which has long neglected mental health, will cope.

“When there is a public health crisis, there is always a huge hangover, especially on health systems,” Dr. Liu said.

Going forward, the biggest political challenge will be addressing the many social and economic wounds that have been exposed.

There is much talk of silver linings, but those will only come to fruition if governments, businesses and individuals act on the lessons learned.

“Hopefully the vaccine will not be an excuse to not do all the things that need doing,” Dr. Tuite said.

Meanwhile, she said, the challenge of coronavirus will remain, maybe for many years. Eradication is unlikely, even with the best vaccines. Let’s not forget that only one human disease, smallpox, has been eradicated, and that happened more than 200 years after a vaccine. (Edward Jenner administered the first smallpox inoculation in 1796, and it was declared eradicated, thanks to vaccination, in 1980.)

The push to eradicate polio has not stalled for lack of vaccines, but because of complex geopolitics and socio-economic realities.

The best-case scenario is that SARS-CoV-2 becomes another seasonal coronavirus (there are seven known to infect humans) that causes only limited illness. A worst-case scenario is that it continues to mutate and returns every fall in different strains, similar to influenza, but more deadly. We’ve not been great in dealing with the coronavirus as an acute illness; would we do any better if it were a chronic problem?

At a certain point the world will also decide, through its actions, what level of death is “acceptable.” Tuberculosis still kills 1.5 million people a year, AIDS 700,000, malaria 400,000, and so on, and we barely bat an eye. When COVID-19 stops being a threat to wealthy countries, will it stop being a public health priority, as is the case with so many other infectious diseases?

As the immediate danger fades, we need to have a national plan beyond “reopen quickly.” It is not sufficient to have a schedule for vaccinating the population; we need to articulate a clear end game and how exactly we are going to “build back better,” as the political rhetoric goes.

When the epidemiological end of the pandemic occurs, likely not until 2022 at the earliest, we will only be starting to deal in earnest with the fallout.

A significant aspect of the recovery needs to include preparing for the next pandemic, which will no doubt pose new challenges. As the World Health Organization cautioned in its year-end briefing: This pandemic is “not necessarily the big one.”

Dr. MacDonald said we’ve learned a lot from COVID-19, but we have to be ready and willing to apply those lessons. “There will be other pandemic threats so we can’t afford to forget too quickly, as we have done in the past.”

The biggest challenge will be our short memories.

[lilywhiteflower-blog]

Enteral Feeding Formulas Market - Recent Trends, Development, Growth & Forecast 2017-2025

Global Enteral Feeding Formulas Market: Snapshot

Enteral feeding implies a direct method of artificially inserting nutrients and supplements into the GI tract. All forms of tube feeding methods, including gastronomy, nasojejunal, nasogastric, and orogastric, are considered to be a part of enteral feeding methods. In most circumstances, children are in a greater need of enteral feeding due to several medical issues that render them to ingest foods in a natural manner. These reasons can include impaired swallowing, structural anomalies or abnormalities in the mouth or the esophagus, anorexia or other eating disorders, chronic illnesses, primary disease management, growth in overall bodily nutrient needs, or congenital abnormalities. Enteral feeding essentially stents the esophagus, allowing the administration of foods, nutrients, and supplements to the stomach by bypassing the mouth and the esophagus. Conversely, it also allows for a free passage for draining the contents in a stomach should the need arise.

Enteral feeding is a growing requirement among the rising geriatric population, and a lot of players providing enteral feeding formulas are accepting this change in order to grow in profitability. The number of elderly patients requiring enteral feeding has grown considerably over the recent past. Their nutritional requirements are different from the conventional formulas intended for children, which allows enteral feeding formulas for adults to be an entirely different market segment from the formulas used to feed children. Various types of enteral feeding formulas are being commercially sold across key regions, which include isolated nutrient sources, formulas for diabetics, and formulas high in fiber.

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Global Enteral Feeding Formulas Market: Overview

Enteral feeding gets the required nutrition containing carbohydrate, protein, fat, water, minerals, carbohydrate, and vitamins, directly to the stomach. In many cases, proper nutrition is not supplied to the body due to various reasons, here enteral feeding formulas plays a crucial role.

On the basis of products, the market can be classified into standard and disease-specific formulas. By stage, the global enteral feeding formulas market can be segmented into adults and pediatrics. In terms of application, the market can be divided into neurology, oncology, gastroenterology, diabetes, critical care, and other applications. Based on end user, the market can be categorized into hospitals and long-term care facilities. Long-term care facilities can be further segmented into nursing homes, homecare agencies, and assisted living facilities

The report offers a comprehensive overview of various factors contributing to the expansion of the global enteral feeding formulas market. It also provides insights into challenges that the market could face over the forecast period. The prevailing trends in overall market operations are also studied in the report in detail.

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Global Enteral Feeding Formulas Market: Trends and Prospects

The growth of the global enteral feeding formulas market is driven by factors such as growing geriatric population, increase in various chronic diseases, and overall increase in healthcare expenditure.

In terms of product, the standard formulas segment held a large market share, and this segment is expected to grow in the forecast period as it is known to offer a complete and balanced nutrition. The specialized formulae segment is projected to grow faster in the said period due to the high demand for these products used by patients who face difficulty in digestion of complex proteins.

Based on stage, the adults market segment is expected to account for large share of the said market. Escalating large base of geriatric population in developed economies is one of the key reasons for high demand.

By application, the oncology segment is expected to largely contribute to the market. Due to due to high prevalence of malnutrition among the cancer patients, this segment will continue to lead in the years ahead. Hospitals, the end user segment of the market held a major share of the market. Vast use of inpatient services, such as surgical intervention, extended post-surgery stays, and intensive care are some of the key factors supplementing the growth of this segment.

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Global Enteral Feeding Formulas Market: Regional Analysis

Geographically, the global enteral feeding formulas market can be segmented into North America, Europe, Asia Pacific, and Rest of the World. Among the mentioned regions, North America is expected to lead the pack. Due to escalating rate of chronic diseases, large pool of geriatric population, coupled with large availability of home care service providers, this region is likely to continue contributing to the market growth over the forecast period.

Another promising regional market for feeding formulas is Asia Pacific. It is projected to account for a large market share during the said period. With rise in economic development of countries such as India, China, Philippines, and Indonesia, the per capita healthcare expenditure has also seen a tremendous increment. Numerous WHO and UNICEF initiatives to lower malnourishment, coupled with growth of medical tourism and better healthcare infrastructure have supplemented the growth of the market.

Global Enteral Feeding Formulas Market: Competitive Landscape

Some of the leading players in the global enteral feeding formulas market are Abbott Corporation, Global Health Products, Inc., Fresenius Kabi AG, Victus Mead Johnson & Company, LLC, Danone S.A, Hormel Food Corporation, Nestle S.A, B. Braun Melsungen AG, and Meiji Holdings Co.

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