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How mental health conditions can raise COVID risk : Shots

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Digital generated image of cut out male head multi layered with covid-19 cells inside on blue background.

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Digital generated image of cut out male head multi layered with covid-19 cells inside on blue background.

Andriy Onufriyenko/Andriy Onufriyenko/Getty Images

Even before the federal government’s recent decision last week to authorize COVID boosters all adults, it had already recommended them in October for people with certain high-risk conditions. Along with with illnesses like diabetes and heart disease, that list included mental health conditions.

The decision to prioritize people with psychiatric diagnoses in the early rollout of boosters came after after a growing number of studies linked mental health disorders with higher risk of both COVID-19 infection and of serious outcomes.

Last year, researchers analyzed data from five hospitals in the Yale New Haven Health System to see how people with a mental health diagnosis who were hospitalized with COVID-19 fared compared to others.

“What we found was we had a higher level of mortality for those that had a prior psychiatric history,” says psychiatrist Dr. Luming Li, who was working on her Master’s degree at Yale University at the time.

The risk of death from COVID-19 went up by 50% for those with a history of mental illness compared to those with no such history, says Li, who is now the Chief Medical Officer at the Harris Center for Mental Health and IDD in Texas.

Another study published last year looked at a nationwide database of electronic health records with information on people who’d tested positive for COVID-19 and those who were hospitalized.

If an individual had a history of a mental disorder, they were more likely to get infected,” says study author Dr. Nora Volkow, director of the National Institute on Drug Abuse. “And if they got infected, then they were more likely to have negative outcomes, such as hospitalization and death.”

There are several things going on that explain this, she says.

For one, mental illnesses change people’s behaviors which can make them less likely to protect themselves from an infection, with measures like social distancing or wearing masks.

Second, people with mental illness tend to have poorer overall health and many chronic health problems, like diabetes, cardiovascular problems, kidney disease.

“It is this very high prevalence of comorbid medical conditions that’s likely to actually be putting them at greater risk for negative outcomes [from COVID-19],” says Volkow.

It’s well known that people with mental illness on average live shorter lives and die of health conditions other than their psychiatric diagnosis.

“They suffer prematurely from chronic illnesses, medical neglect,” says Dr. Ashwin Vasan is the president and CEO of Fountain House, a mental health non-profit.

They are also among the most isolated in society, he says, and that isolation takes an immense toll on their bodies putting them at a higher risk of chronic illnesses.

“There have been study after study showing that it leads to inflammation, immunologic stress, neurodegenerative decline, immunologic impairment, endocrinological impairment,” says Vasan. It’s equivalent to smoking 15 cigarettes a day, he notes.

And many medications used to treat mental illnesses, particularly antipsychotics also increase risk of these chronic health problems, says Volkow.

“This has been one of the main challenges that we have with the use of antipsychotics overall, which help control certain symptoms in schizophrenia but are negatively associated with a much higher risk of diabetes and hypertension and metabolic diseases,” she says.

Certainly the risk isn’t the same for all psychiatric diagnoses. It’s higher for people with serious mental illness, than say mild depression. But as Vasan pointed out, mental illness is not a static thing.

“People’s severity of mental illness and impairment can ebb and flow depending on the amount of care and support they’re getting,” he says. “Whether or not you’re in the throes of a crisis or managing your chronic mental illness, we know on balance, at a population health epidemiologic level, that you’re at greater risk.”

There’s also a clear overlap between serious mental illness and homelessness and substance abuse, which are also linked to high risk of infection and severe COVID-19.

“About 40% of our chronically homeless population has serious mental illness and addiction,” says Vasan.

Most of the 13 million people with serious mental illness in the US are on Medicaid, he says, but 40% have no access to care at all.

“This is a systematically marginalized, sicker population that has less access to care and supports,” he says.

For all these reasons, Vasan and other mental health experts were glad to see that CDC prioritized people with mental illness for COVID-19 vaccination, something they say should have happened long before.

But many people with mental illness, especially those with serious mental illness (people with significant impairments in their daily functioning) may not be aware of their own risks, or the new recommendations, says Li.

It’s important for both health care workers and family members to also be aware of the risks of serious COVID-19 faced by people with mental health diagnoses, and help make sure they are vaccinated, says Li.

“It’s going to be a very important first step to make sure that they have their vaccines to start out with and then, second, to be able to get the boosters,” she says.

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January 6 Trump documents case: Takeaways from the appeals court hearing

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The case is before the US Court of Appeals for the DC Circuit, after a federal judge earlier this month declined to halt the release of the Trump documents from the National Archives. President Joe Biden is declining to assert executive privilege on the documents, so Trump is asking the court to consider his assertion of privilege instead.

The case touches on some unsettled law around whether a former president can litigate executive privilege claims when the incumbent sides with transparency. And the three judges on the appellate panel — all Democratic appointees — signaled that they found some of the case’s questions difficult, even as they expressed doubt about Trump’s claims.

It’s nearly guaranteed that, however they rule, the case will end up appealed to the Supreme Court.

Judges ask why a former president should get to overrule the current one

The appeals court showed little sympathy for Trump’s arguments for blocking the documents’ release.

“Why should the former president be the one to make that determination when you’re talking about accommodating another branch of government?” Judge Ketanji Brown Jackson said while the Trump team was arguing its case.

“It would seem that the current president has not only the confidentiality factor that he’s thinking about, but the current duty to the interests of the United States even broader than those that the former president would be concerned about,” she added.

Judge Patricia Millett grilled Trump lawyer Justin Clark on what else the court is supposed to weigh in considering these kinds of disputes.

“You’re going to have to come up with something with more power to outweigh the incumbent president’s decision to waive,” Millett said. “You’re going to have to change the score on that scoreboard,” which, the judge said, would already be stacked with points in the president’s favor according to Supreme Court precedent.

The court appeared very uninterested in reviewing the White House records document by document.

In a series of troubling signs for Trump, the judges pushed back strongly on a request from the former President’s legal team that the court review records from his presidency, document by document, to determine whether they should be withheld from Congress.

Trump’s approach would have likely dragged out court proceedings — effectively blocking the House from access for an extended time. The trial-level judge previously rejected this suggestion.

“The issue, as I understood, before us was not about the content of the documents or when you look at them, but simply what happens when the current incumbent president says I’m not going to invoke executive privilege as to these documents with respect to this particular request,” Millett said early in Tuesday’s hearing.

Judge Robert Wilkins said Trump’s arguments for a document-by-document review were “inconsistent” with Nixon-era court precedent.

“That’s not the way we say we do this, at least the way I read those cases,” Wilkins said. He pointed out that the court considering Nixon’s case didn’t listen to the Watergate tapes one by one.

There are big questions this court may need to address if a former president and current president disagree

As rocky as the hearing went for the Trump side, the panel’s judges signaled that they were struggling with what a court could ultimately do to settle a standoff between former and current presidents.

“We don’t just flip a coin or draw straws or something. What, what tests are we supposed to use?” Wilkins asked Doug Letter, the lawyer representing the House January 6 committee.

The judges pointed out that the law governing historical records going to Congress doesn’t spell out what should happen if a former president keeps pushing a challenge against the current president on a privilege decision.

They also challenged the lawyers with several hypothetical scenarios — a current president releasing documents to “avenge” his predecessor, a former president claiming a release of his White House documents would endanger the lives of US agents abroad, or four former presidents imploring a current president to keep sensitive information private — to grill Trump’s opponents on whether there was any situation in which an incumbent’s privilege determination could be second-guessed by a court.

The judges also asked whether the court could stop Congress from publicly releasing White House documents it obtained from the National Archives. In this case, Congress couldn’t guarantee absolute secrecy, Letter, the House lawyer, pointed out.

Letter brushed off the hypothetical scenarios, describing them as far afield from the case before the court. He stressed that in this dispute there was no clash between the legislative and executive branches, so there was no separation-of-powers question that the court needed to resolve.

Brian Boynton, a lawyer for the Justice Department, took a different approach to helping the court navigate those questions. He suggested that it avoid making any sweeping conclusion about whether courts can ever side with a former president in privilege disputes with incumbents.

“We don’t think you need to or should issue a ruling that says the incumbent always wins, because this is an unsettled area of the law and there’s no need to reach that conclusion here,” Boynton said.

Still, Boynton maintained that few scenarios exist where a former president could override the decisions of the current office-holder.

A request that the Supreme Court get involved could be coming very soon

Since Trump brought the lawsuit last month, he’s had to act quickly in seeking court orders that would stop the documents’ disclosure, as the National Archives had originally planned to release the first tranche of the hundreds of pages in question on November 12.

US District Judge Tanya Chutkan, who oversaw the first round of the litigation, ruled against Trump before that deadline, but the appeals court put an administrative hold on the documents’ release and so far has moved very quickly to advance the case.

The pause was already affecting the House’s investigation, with subpoenaed witnesses such as Steve Bannon and former Trump White House chief of staff Mark Meadows pointing to the ongoing court case to either avoid or delay cooperating with the House.

As Tuesday’s hearing was wrapping up, Millett acknowledged that the case was “very, very urgent and everyone needs to proceed on a very tight timeline.” She suggested that if the court were to rule against Trump, it could still put in place a two-week hold preventing he National Archives from releasing the documents, so the case could be appealed to the Supreme Court.

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Covid impact: NCRB data shows over 29% jump in suicides by businesspersons – India Today

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Covid impact: NCRB data shows over 29% jump in suicides by businesspersons  India Today

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Pragati Mehra treats the cast and crew of YRKKH on her birthday, Rajan Shahi calls it a ‘sweet gesture’

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