New publication: “Impact of the COVID-19 pandemic on temporal patterns of mental health and substance abuse related mortality in Michigan: An interrupted time series analysis” (Lancet Regional Health – Americas)
Great news! I published a new paper today (yay!) with my colleague Dr. Rachel Bergmans from the School of Medicine at the University of Michigan. It appears in one of the Lancet journals (Regional Health – Americas) and describes how patterns of suicide, alcohol related liver failure and drug overdoses changed at the onset of the pandemic. (Spoiler: suicides declined after following an increasing trend, liver failure went WAY up over past years, overdoses got weird.)
I’m intensely proud of this work. Mental health related public health research is my favorite topic of study (hello darkness my old friend) and it was amazing to be able to bring these results to the public.
Figure legend: Figure 1. Cumulative mortality for all days in all years, 2006–2020. Bold, red line represents cumulative mortality in 2020. Cumulative mortality plots presented for mortality from all causes: suicide, alcohol related liver failure, and drug overdose. Red vertical line represents the date of the announcement of the State of Emergency order (March 13, 2020) and the beginning of the pandemic in Michigan. Blue line represents the date of the first peak of COVID-19 deaths in Michigan (April 16, 2020).
The emergence of SARS-CoV2 (COVID-19) had wide impacts to health and mortality and prompted unprecedented containment efforts. The full impact of the COVID-19 pandemic and resulting responses on mental health and substance abuse related mortality are unknown.
We obtained records for deaths from suicide, alcohol related liver failure, and overdose from the Michigan Department of Health and Human Services (MDHHS) for 2006 to 2020. We compared mortality within sex, age, marital, racial and urban/rural groups using basic statistical methods. We compared standardized mean daily mortality incidence before and after the onset of the pandemic using t-tests. We used an interrupted time series approach, using generalized additive Poisson regression models with smoothed components for time to assess differences in mortality trends before and after the onset of the pandemic within demographic groups.
There were 19,365 suicides, 8,790 deaths from alcohol related liver failure, and 21,778 fatal drug overdoses. Compared with 2019, suicides in 2020 declined by 17.6%, overdose mortality declined by 22.5%—while alcohol deaths increased by 12.4%. Crude comparisons suggested that there were significant declines in suicides for white people, people 18 to 65 and increases for rural decedents, overdoses increased for Black people, females and married/widowed people, and alcohol mortality increased for nearly all groups. ITS models, however, suggested increased suicide mortality for rural residents, significantly increased alcohol related mortality for people ≥65 and increased overdose mortality in men.
The onset of the pandemic was associated with mixed patterns of mortality between suicide, alcohol and overdose deaths. Patterns varied within demographic groups, suggesting that impacts varied among different groups, particularly racial and marital groups.
Currently, I am a part of a project looking at climate change impacts on the distribution of tree and grass pollens in the US and associations with allergy and asthma related emergency room visits
As part of that, we are collecting baseline data on symptomatic profiles of patients who are sensitive to tree and grass pollens and are currently undergoing immunotherapy in local clinics.
Our survey is two fold, the first a baseline survey of types of demographics, types of allergies, seasonal sensitivities, general symptoms and lifestyle impacts, the second a three week survey of sleep quality and allergy and asthma related events.
We hope to gather data to see how the ragweed season might impact general health and well being using a coarse raster of predicted pollen distribution.
The survey is being conducted at the University of Michigan Allergy Specialty Clinic and Food Allergy Clinic at Domino’s Farms and will include approximately 50 people.
I didn’t hear about this until the very last minute, but was lucky enough to get the invitation letter in time to at least make it to the last day.
The Kenya Medical Research Institute (KEMRI) has, for the past five years, held a research dissemination event intended to highlight KEMRI sponsored and Kenya based research.
Research led by Africans is sadly scarce. R&D funding in SSA is the lowest in the world. In a context where so few people are able to receive an education of sufficient quality to allow post graduate studies, African researchers are few and the resources available to them are low.
Kenya has committed 2% of GDP to R%D. Contrast this with South Korea, which at one point committed 23% of GDP to R&D efforts. While KEMRI is truly a leader in the context of African research, the low level of commitment on the part of the national government makes it tiny in the context of worldwide research.
The presentations I have seen so far have been excellent, but of course, much of this research survives on the good graces of international funding and training. Most of the research presented was performed within the CDC.
So this begs the question, when will and can African countries take ownership of their research? Is this even possible given the dysfunctional nature of politics here?
The story of Africa and African identity (in a global context) is written by the rest of the world. As a foreign researcher, I quite aware that I am part of this phenomenon.
Presenters have pointed to two main issues (which I agree with). First, African countries cannot proceed to develop their research sectors (or any other sector really) unless Africans take charge of in country and continent wide research priorities. It is important to note that foreign research often takes on issues which were of importance in the colonial period (childhood infectious diseases) despite a growing burden of chronic diseases and diseases of aging which will break the budgets and economies of African countries.
While I do not suggest that attention be diverted from the incredible burden of infectious disease in African countries, it is telling that research priorities are still driven by the international community. Central Province in Kenya is quite well developed. Even my taxi drivers ask me why we don’t do research in Central, given the incredible problems of heart disease, cancer and alcoholism up there. Unless Kenyans spearhead the main issues impacting their country, these problems will go unadressed.
Second, as noted before, governments have to make firm commitments to support domestic research. As of now, African countries wait for international funding to support their projects, which shifts the conversation away from domestic priorities to international priorities. This is a tall order here, of course.
Of interest, though, besides the macro level problems of funding and support, presenters passionately call for people with Masters and PhD to use the degrees. “Why don’t you do research? What is wrong with you?”
I can’t speak to this issue effectively. But my sense is that many capable people don’t sense the urgency of doing research and lack the personal initiative to make it happen. I’ve seen it happen that researchers wait to have foreigners write their research for them, and simply wait to have their name rubber stamped on the paper, taking credit for work that they did not do. This is an unacceptable situation that we, unfortunately, enable. Certainly there are issues of experience and capability, but we shouldn’t handle capable African researchers with kid gloves, particularly this well educated young generation.
Sadly, the history of aid and foreign involvement here has set this precedent. This is an era that needs to come to an end. In the private sector, it has. In the public sector, these problems persist. Older researchers, many of whom came of age during the beginnings of the post-independence era, here are screaming that point at the top of their lungs.
Called “hearsay ethnography,” it makes ethnographers out of non-professional folks who are already embedded within the community. To date, it has been used in understanding the cultural understanding of HIV in Malawi.
We are turning local young people into anthropologists.
Through this technique, we can minimize the observer effect, i.e. the problem of influencing the data collection environment by being the odd, linguistically challenged white people of ambiguous intent. The writers have to write in English, in a manner assumed to be understood by educated folks, which presents problems of its own, but it’s a somewhat more flexible methodology.
It’s a valuable tool for medical anthropology. Through this study, we hope to begin to understand how people in this area conceptualize malaria, malaria treatment and health delivery.
I hired these guys last May, the money ran out, and I thought that the project was just a bust. To my surprise and delight, the data collectors are still writing in their journals and I was finally able to see the results.
Here’s a sample:
I attended the funeral of a child below five years old at Kamyeri. There were so many people who attended irrespective of their age or gender. The discussion about malaria broke out when the child’s father was narrating the cause of her death. He said that many people may think that his daughter had been bewitched but according to him, her death was as a result of his wife’s negligence.
He went on saying that he wasn’t at home when he received the news about her daughter’s illness. He told his wife to take the child to the hospital. However, he arrived home after two days to find out that the child had not been taken to hospital and have not received any kind of medication. He rushed her to the hospital but it was too late because the child died dew hours after the doctor had confirmed that she had serious malaria.
He went on saying if she would have diagnosed early enough, maybe she could have not died.
He added that before someone make or jump to any conclusions about the cause of any illness, he/she should go to the hospital and get tested in order to know the real cause of a disease he/she must be suffering from.
Then an old woman who was just in front of me said that she had informed the child’s mother to take to her the child so that she could treat her through “frito” and “suro.” ”Frito” means a method in which powder traditional herbs are administered to a patient through snifting, while “suro” means a method in which herbs in a powdered form is put on small cuts made using a knife. However, the woman did not turn up instead she went to a preacher to seek divine healing.
The old woman continued saying that the shivering and headache could have been treated using traditional herbs.
as one would expect. The Institute of Medicine within the National Academies of Sciences recently produced a 230 page report addressing the concerns of parents that the current recommended vaccine schedule is too “crowded” and thus puts children at excessive risk.
Upon reviewing stakeholder concerns and scientific literature regarding the entire childhood immunization schedule, the IOM committee finds no evidence that the schedule is unsafe. The committee’s review did not reveal an evidence base suggesting that the U.S. childhood immunization schedule is linked to autoimmune diseases, asthma, hypersensitivity, seizures, child developmental disorders, learning or developmental disorders, or attention deficit or disruptive disorders.
Existing mechanisms to detect safety signals — including three major surveillance systems of FDA-approved products maintained by the CDC and a supplemental vaccine safety monitoring initiative by the FDA—provide further confidence that the current childhood immunization schedule is safe.
It’s quite a tempting narrative. Small defenseless children are jabbed multiple times, allowing harmful foreign substances to enter the body, all with the nefarious intent of making profits for large pharma giants. However, children are assaulted by pathogens from the second they exit the birth canal, and continue to be throughout the course of their lives.
The inactivated versions of the pathogens they might otherwise come into contact with should present no extra burden to an immune system that already anticipates invasion. Of course, coming into contact with a dead version of a pathogen is far preferable to coming into contact with the live version. The assertion that the schedule is “crowded”, given daily attacks on the immune system, is completely absurd.
Moreover, the report found that States with loose vaccine policy, have higher incidence of disease, in this case Pertussis:
While parents generally worry about children’s health and well-being, and their concerns about immunization safety can be viewed in that context, delaying or declining vaccination has led to outbreaks of such vaccine-preventable diseases as measles and whooping cough that may jeopardize public health, particularly for people who are under-immunized or who were never immunized. States with policies that make it easy to exempt children from immunizations were associated with a 90 percent higher incidence of whooping cough in 2011.
Of course, we are experiencing record numbers of Pertussis cases. It must be noted, that like influenza, most cases of Pertussis are asymptomatic. In fact, it is estimated that 5 out of 6 cases of Pertussis come without symptoms, yet transmission occurs. (2 out of every 3 influenza cases are asymptomatic. Next time someone tells you they never get the flu, don’t believe them.) Unvaccinated people may still contract the disease, not experience symptoms, and still pass it one to an unvaccinated person, who, of course, could very well die.
Many of the diseases on the vaccine schedule are very much still in circulation. One excellent example is tetanus, a bacteria which lives happily in soil (not rust, as commonly believed). Tetanus passes through our digestive tract regularly through food, but when the bacteria enter the other parts of the body, particularly the low-oxygen environment of the muscles, the usual outcome is to suffer for months and often die a truly horrible death. Nearly all cases of tetanus in the US occur in unvaccinated individuals.
Given tetanus’ ubiquity in the environment, I often scratch my head when parents tell me they don’t vaccinate their children as the risks of the disease far outweigh the risks of the vaccine. Here, of course, it isn’t the vaccine that’s killing kids, but politics and self-serving conspiracy hacks.