Tag: covid

Categories : COVIDTags :

NICD Tracking Rise of COVID Cases

On By ModernMedia

Following a steep rise in COVID cases in three provinces, The National Institute for Communicable Diseases (NICD) is working with teams in those areas to monitor the situation.

Increases in the Northern Cape, North West and Free State have been observed by the NICD. The Northern Cape has over 3000 active cases, the North West over 2600 and the Free State over 2200.

The NICD said that it was working with provinces to ascertain whether the rise in cases could be attributed to cluster outbreaks and has recommend increased testing and contact tracing to contain the situation.

Acting executive director of the NICD, Professor Adrian Puren, said: “We want to reassure South Africans that we are actively monitoring the situation in these provinces and will keep the community informed of any new developments.”

The NICD said that with the April school holiday season soon starting and many people making plans for travel and social gatherings, it was still vital to continue to comply with COVID preventative health measures.

Earlier this month, Discovery Health described possible scenarios for COVID in South Africa. Poor social distancing and masking behaviours, superspreader events and a lack of early vaccinations, a third wave could claim as many as 76 000 lives, the insurance company estimated. However, by maintaining good nonpharmaceutical interventions and engaging in a prompt vaccination rollout, deaths would fall to 9000 by the end of the year.

The NICD monitors the number of confirmed COVID-19 cases and tests performed on a daily basis and associated resurgence metrics.

Source: Eyewitness News

Categories : Diseases, Syndromes and ConditionsTags :

Predicting the Next Viral Pandemic

On By ModernMedia

A group of experts has argued that trying to survey all of the viruses in the animal kingdom is a futile effort, and that we should rather focus on those most likely to cross over at the interface of humans and animals.

The observation that most of the viruses that cause human disease come from other animals has led some researchers to attempt “zoonotic risk prediction” to second-guess the next virus to cause a global pandemic. 
Zoonotic viruses, those that cross over from animal species into humans, have caused epidemics and pandemics in humans for centuries. This is exactly what is occurring today with the COVID pandemic: SARS-CoV-2—the coronavirus that causes the disease—emerged from an animal species, albeit which one is not yet known.

An essay published April 20th in the open access journal PLOS Biology, led by Dr Michelle Wille at the University of Sydney, Australia with co-authors Jemma Geoghegan and Edward Holmes outlines the great challenges in zoonotic risk prediction.

The authors argue that these zoonotic risk predictions are of limited value, and will not be able to predict which virus will cause the next great pandemic. Instead, they reason, the human-animal interface should be the target for intensive viral surveillance.

A key question is whether it is possible to predict which animal or which virus group will most likely cause the next pandemic. This has led to “zoonotic risk prediction,” in which researchers attempt to determine which virus families and host groups are most likely to carry potential zoonotic and/or pandemic viruses.

Dr Wille and her colleagues identified several key problems with zoonotic risk prediction attempts.

Firstly, they’re based on very small data sets. Despite decades of work, less than 0.001% of all viruses have likely been identified, even from the mammalian species from which the next pandemic virus is expected to emerge.

Second, these data are also already highly biased in favour of those the most infectious viruses  of humans or agricultural animals, or are already known to be zoonotic. Most animals have in fact not been surveyed for viruses, and that viruses evolve so quickly that any such surveys will soon be out of date and therefore be of limited value.

The authors instead argue that a new approach is needed, not trying to futilely survey all the viruses in the wild but instead undertaking extensive sampling at the animal-human interface. This would enable the detection of novel viruses as soon as they appear in humans. This kind of enhanced surveillance could help us forestall the next pandemic.

Source: Phys.Org

Journal information: Wille M, Geoghegan JL, Holmes EC (2021) How accurately can we assess zoonotic risk? PLoS Biol 19(4): e3001135. doi.org/10.1371/journal.pbio.3001135

Categories : COVIDTags :

Human to Pet Transmission of COVID Virus Common

On By ModernMedia
Girl in a park, wearing mask with two pet dogs. Photo by Helena Lopes from Pexels


A US study uploaded onto the bioRxiv preprint server showed that pets with SARS-CoV-2 likely acquired the virus from humans. 

This suggests that human-animal infection may actually occur much more frequently than previously thought – implying that infected individuals should limit their contact with animals. The paper is currently available on the bioRxiv* preprint server.

Both natural and experimental infections with SARS-CoV-2 have been demonstrated in various species of pets, which includes dogs, cats, hamsters, rabbits, and ferrets. Hamsters, cats and ferrets have been shown to transmit the virus to each other, and dogs are still weakly susceptible to the virus. However, natural infections of pets have almost always resulted from contact with a COVID-infected person.

Since pets share so much space with humans, this is a good use of the One Health approach, a transdisciplinary collaboration aiming for health outcomes through awareness of the interconnectedness between people, animals, plants and their mutual environment.

As part of a COVID household transmission investigation, researchers in the US conducted a One Health appraisal of SARS-CoV-2 infection in pet cohabitants as one of the earliest research endeavours in assessing risk and behavioral factors shared between people and pets.

The study was conducted between April and May of 2020, and mammalian pets from households with at least one individual with confirmed COVID were eligible for inclusion. Detailed descriptions of each animal’s residence were made.

Demographic and exposure information was obtained from all household members. At the same time, the pets were tested with the use of real-time reverse transcription-polymerase chain reaction (rRT-PCR) and neutralisation assays from oropharyngeal, nasal, rectal, fur, faecal, and blood samples.

The small sample size of this study made it difficult to analyse prevention measures in the home, so additional investigations are needed in order to determine the best methods to prevent human-pet COVID transmission.

All oropharyngeal, nasal, and rectal swabs from the tested animals tested negative when rRT-PCR was conducted; however, fur swabs from the one dog tested positive with the use of this molecular method at the first animal sampling. This is actually the first study to detect RNA of a virus from an animal’s fur.

Furthermore, in households where owners withs COVID lived with their pets, 20% had pets with serological evidence of prior SARS-CoV-2 infection, implying some secondary viral transmission. Four dogs and four cats from six households were found to have detectable neutralising antibodies against the virus.

In households with higher rates of human COVID infections, SARS-CoV-2 was more likely to be seen in pets, while much less common when owners limited interactions with their pets after they had developed COVID symptoms.

The authors stressed that it is still important for decision-makers to understand the role of animals in the epidemiology of the pandemic

“Our findings add to the growing body of evidence demonstrating SARS-CoV-2 transmission can occur between people and pets – most often from people to pets – and suggest this transmission may occur more frequently than previously recognized”, wrote the authors of the bioRxiv paper.

Source: News-Medical.Net

Journal information: Goryoka, G.W. et al. (2021). One Health Investigation of SARS-CoV-2 Infection and Seropositivity among Pets in Households with Confirmed Human COVID-19 Cases — Utah and Wisconsin, 2020. bioRxiv. https://doi.org/10.1101/2021.04.11.439379, https://www.biorxiv.org/content/10.1101/2021.04.11.439379v1

Categories : COVIDTags :

Experts Urge a Re-think on Olympic Games

On By ModernMedia

With 100 days remaining until the Tokyo Olympic and Paralympic games, experts urge that the organisers must urgently reconsider plans to hold the games this summer.

Writing in The BMJ, Kazuki Shimizu at the London School of Economics and Political Science and colleagues said that the trajectory of the pandemic is still highly uncertain, warning that international mass gathering events such as Tokyo 2020 “are still neither safe nor secure”.

They say instead that “we must accelerate efforts towards containing and ending the pandemic by maintaining public health and social measures, promoting behavior change, disseminating vaccines widely, and strengthening health systems.”

While considerable scientific advancements have taken place over the past year, they said that vaccine roll-out has been inequitable, with many low and middle income countries having reduced access.

While a special scheme for vaccinating athletes orchestrated by the Olympics Organising Committee may help save lives, they argued that “it could also encourage vaccine diplomacy, undermine global solidarity (including the Covax global access scheme), and promote vaccine nationalism.”

Another concern that they highlighted was the fact that Japan, unlike neighbouring countries in the Asia-Pacific region, still has not achieved COVID containment.

“Even healthcare workers and other high risk populations will not have access to vaccines before Tokyo 2020, to say nothing of the general population,” they write.

In order to effectively protect participants from COVID, “Japan must develop and implement a clear strategy to eliminate community transmission within its borders, as Australia did before the Australian Open tennis tournament.”

Japan and the International Olympic Committee must also agree to operational plans based on robust science and share them with the international community, they added.

Waiving quarantine for incoming athletes, officials, broadcasters, press, and marketing partners “risks importing and spreading covid-19 variants of concern” and while international spectators will be excluded from the games, “cases could rise across Japan and be exported globally because of increased domestic travel – as encouraged by Japan’s official campaigns in 2020.”
However, a recent survey indicated that 70% of Japanese would not want to attend the Olympic Games, due to COVID.

An overwhelmed healthcare system combined with an ineffective test trace and isolate scheme “could seriously undermine Japan’s ability to manage Tokyo 2020 safely and contain any outbreak caused by mass mobilization,” they write.

They also highlight the fact that there has been very little about the Paralympic games through official channels, and how the health and rights of disabled people will be protected during international competition.
“The whole global community recognizes the need to contain the pandemic and save lives. Holding Tokyo 2020 for domestic political and economic purposes – ignoring scientific and moral imperatives – is contradictory to Japan’s commitment to global health and human security,” they argued.

“We must reconsider this summer’s games and instead collaborate internationally to agree a set of global and domestic conditions under which international multisport events can be held in the years ahead. These conditions must embody both Olympic and Paralympic values and adhere to international principles of public health,” they concluded.

Source: News-Medical.Net

Journal information: Shimizu, K., et al. (2021) Reconsider this summer’s Olympic and Paralympic games. BMJ. doi.org/10.1136/bmj.n962.

Categories : COVIDTags :

Department of Health COVID Vaccine Rollout Phase 2 Outlined

On By ModernMedia

The Department of Health’s COVID vaccine rollout has been fleshed out in a presentation, including details on how the vaccines will be distributed, and the jobs earmarked for the shots.

A presentation from the department indicates that the government has secured around 51 million vaccine doses, with 20 million from Pfizer and 30 million from Johnson & Johnson (J&J). However, it is unclear how the current pause in J&J administration in South Africa due to concerns about rare blood clots will affect immunisation schedules.

However, health minister Dr Zweli Mkhize announced that South Africa has secured a further 10 million Pfizer vaccines.

“We can now guarantee that the number of people that will be vaccinated with Pfizer has increased from 10 to 15 million,” he said.

With the 30 million of the single-dose shots from J&J, the current planned rollout will cover about 45 million South Africans.

Dr Mkhize said that both the Pfizer and J&J agreements cost around $10 (R145) per vaccine, with non-refundable clauses.

“The agreements state that down-payments that have been made in advance by the department shall not be refundable by the manufacturer to us in any circumstances. This is another onerous term that we had to settle for,” Dr Mkhize told the committee.

Meanwhile, government was sent an email from J&J, which stated that the company will not sign off the 20 million doses until they receive a letter from the Trade, Industry and Competition Minister, expressing support for the local investment that they made in Aspen Pharmacare.

“We’ve been taken aback by this, as there are clauses in the agreement that express this support and acknowledge that this production will not just be limited to South Africa and the continent, but also targeted for the global market,” said Dr Mkhize.

The department indicated that the Pfizer vaccine will likely go to major metropolitans due to its larger pack size and refrigeration requirements, while the J&J vaccine with its less stringent refrigeration needs would be allocated to rural areas.

South Africa’s Phase 2 of the vaccine rollout is planned to begin in May and run until October, with essential workers over 40 and the elderly to be targeted in the programme. This is to include a focus on old age homes and care facilities, plus identifying those with co-morbidities.

The department provided an overview of occupations covered under the vaccine rollout, to include, among others, the police, army, social and municipal workers, and faith and traditional leaders. Private sectors could include mining, retail, transport, and manufacturing.

Source: BusinessTech

Categories : Exercise Mental HealthTags :

Mental Health and Physical Activity Impacted by Pandemic

On By ModernMedia

A study from McMaster University suggests that mental health has become both a barrier to and a motivator for physical activity.

Surveying over 1600 subjects, the researchers sought to understand the ways mental health, physical activity and sedentary behaviour have changed throughout the course of the pandemic and why. Their findings show that people want to be active to improve their mental health but find exercise difficult because of stress and anxiety. Previous research indicates that physical activity can contribute to the treatment of depression, while sedentary behaviour has a strong negative impact.
“Maintaining a regular exercise program is difficult at the best of times and the conditions surrounding the COVID-19 pandemic may be making it even more difficult,” said lead author Jennifer Heisz, associate professor at the Department of Kinesiology, McMaster University.

“Even though exercise comes with the promise of reducing anxiety, many respondents felt too anxious to exercise. Likewise, although exercise reduces depression, respondents who were more depressed were less motivated to get active, and lack of motivation is a symptom of depression,” she said.

The survey respondents reported higher psychological stress and moderate levels of anxiety and depression due to the pandemic. Their weekly aerobic activity reduced about 20 minutes, strength training down roughly 30 minutes, and sedentary time per day was up about 30 minutes per day compared to six months prior to the pandemic. Physical activity may have exerted a protective effect, as those with the greatest drops in physical activity had the worst mental health outcomes, while those who kept their physical activity levels the same level fared better in terms of mental health. 
Notably, economic disparities played a role, the researchers found, especially among younger adults.

“Just like other aspects of the pandemic, some demographics are hit harder than others and here it is people with lower income who are struggling to meet their physical activity goals,” said co-lead author Maryam Marashi, a graduate student in the Department of Kinesiology. “It is plausible that younger adults who typically work longer hours and earn less are lacking both time and space which is taking a toll.”

After the researchers analysed the data, the researchers produced a guideline to help people become more physically active:

  • Adopt a mindset: Some exercise is better than none.
  • Lower exercise intensity if feeling anxious.
  • Move a little every day.
  • Break up sedentary time with standing or movement breaks.
  • Plan your workouts like appointments by blocking off the time in your calendar.

“Our results point to the need for additional psychological supports to help people maintain their physical activity levels during stressful times in order to minimize the burden of the pandemic and prevent the development of a mental health crisis,” concluded Heisz.

Source: News-Medical.Net

Journal information: Marashi, M. Y., et al. (2021) A mental health paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic. PLOS ONE. doi.org/10.1371/journal.pone.0239244.

Categories : COVIDTags :

Smartphone Tracking in COVID Shows Movement Linked to Case Rise

On By ModernMedia

According to a new study which used mobility tracking of cell phone data, a greater movement of people is a strong predictor of increased COVID cases rates.

Until people are widely vaccinated against SARS-CoV-2, the array of nonpharmaceutical public health interventions such as physical distancing and limiting travel and social contacts will remain the most effective means of controlling COVID. Capturing the interrelationship between human behaviour and infectious diseases is one of the hardest problems in epidemiology.

“Mobility measures capturing human activity through anonymized tracking of smartphones are believed to be reasonable proxies of contact rates outside of one’s own home; these measures can provide more timely and reliable sources of information on contact rates compared with time-use surveys or contact tracing,” the authors wrote.

Researchers looked at anonymised smartphone mobility data from nearly 12 months from March 2020 to March 2021, both at a national and provincial level, while controlling for date and temperature. A 10% increase in the mobility of Canadians outside their homes was found to be associated with a 25% increase in subsequent SARS-CoV-2 weekly growth rates. They investigated at the mobility threshold (the level needed to control the virus) and the mobility gap (the difference between the threshold and actual movement).

“The mobility threshold and mobility gap can be used by public health officials and governments to estimate the level of restrictions needed to control the spread of SARS-CoV-2 and guide, in real-time, the implementation and intensity of nonpharmaceutical public health interventions to control the COVID-19 pandemic,” wrote the authors.

Source: News-Medical.Net

Journal information: Brown, K. A., et al. (2021) The mobility gap: estimating mobility thresholds required to control SARS-CoV-2 in Canada. Canadian Medical Association Journal. doi.org/10.1503/cmaj.210132.

Categories : COVIDTags :

Sunlight Vulnerability of SARS-CoV-2 not Just from UV-B

On By ModernMedia

A team of researchers have found that the sunlight vulnerability of SARS-CoV-2 cannot be explained by the effect of UV-B rays alone.

Most of the COVID management concepts remain as true as in the first days of the pandemic, such as handwashing with soap and social distancing, though some have changed such as the notion of the virus mainly transmitted through droplets whereas evidence showed it can linger suspended in aerosol.

The researchers, from UC Santa Barbara, Oregon State University, University of Manchester and ETH Zurich. examined the well-known vulnerability of SARS-CoV-2 to sunlight. They concluded that exposure to UV-B radiation doesn’t completely account for its inactivation by sunlight.

The idea that an additional mechanism might be in play came when the team compared data from a July 2020 study that reported rapid sunlight inactivation of SARS-CoV-2 in a lab setting, with a theory of coronavirus inactivation by solar radiation that was published just a month earlier.

“The theory assumes that inactivation works by having UV-B hit the RNA of the virus, damaging it,” said lead author Paolo Luzzatto-Fegiz, UC Santa Barbara mechanical engineering professor. “Judging from the discrepancies between the experimental results and the predictions of the theoretical model, however, the research team felt that RNA inactivation by UV-B “might not be the whole story.”

Experimentation showed 10-20 minutes to reach virus inactivation—much faster than the theory’s predictions. Viruses in simulated saliva were inactivated over eight times faster when irradiated by UV-B lamps than would have been predicted by the theory, while those cultured in a complete growth medium before exposure to UV-B were inactivated over three times faster. In order to match theory, SARS-CoV-2 would then have greater UV-B sensitivity than any currently known virus.

“The theory predicts that inactivation should happen an order of magnitude slower,” Prof Luzzatto-Fegiz said.

There might be another mechanism involved besides UV-B effects on RNA; such as the synergistic effect of the less energetic UV-A rays.

“People think of UV-A as not having much of an effect, but it might be interacting with some of the molecules in the medium,” he said. Such reactive intermediate molecules could be hastening virus inactivation, a concept known in wastewater treatment and other environmental science fields.

“So, scientists don’t yet know what’s going on,” Luzzatto-Fegiz said. “Our analysis points to the need for additional experiments to separately test the effects of specific light wavelengths and medium composition.”

These findings could help develop ways to control the virus with widely available UV-A and UV-B sources. Sources which emit UV-C, which is otherwise blocked by the atmosphere, has proven effective in certain settings such as air filtration but its high energy limits applications and raises safety concerns.

“UV-C is great for hospitals,” said co-author Julie McMurry. “But in other environments—for instance kitchens or subways—UV-C would interact with the particulates to produce harmful ozone.”

Co-author and UCSB mechanical engineering professor Yangying Zhu added that UV-A’s possible effectiveness meant that inexpensive UV-A LEDs many times brighter than UV-A in normal sunlight could be used. UV-A could be used more for air filtration for example, but the specifics of each setting warrant consideration, said co-author Fernando Temprano-Coleto.

Source: Medical Xpress

Journal information: Paolo Luzzatto-Fegiz et al. UVB Radiation Alone May Not Explain Sunlight Inactivation of SARS-CoV-2, The Journal of Infectious Diseases (2021). DOI: 10.1093/infdis/jiab070

Categories : COVID General InterestTags :

CDC Director Fears ‘Impending Doom’ as COVID Cases Rise Again

On By ModernMedia

Rochelle Walensky, MD, the Centers for Disease Control (CDC) Director, says that she fears “impending doom” as COVID deaths in the US edge upwards as people increasingly ignore health restrictions and start to travel.

Beginning her usual COVID status update,  Dr Walensky spoke as she often did of “concerning trends in the data.”

Dr Walensky spoke about the country surpassing 30 million COVID cases; of a 10% increase in the 7-day average of COVID-19 cases over the past week, to slightly below 60 000 cases; and of an uptick in hospitalisations, from a 7-day average of around 4600 per day to around 4800 per day.

“And deaths, which typically lag behind cases and hospitalizations, have now started to rise,” she said, pointing to a nearly 3% increase to a 7-day average of “approximately 1000 deaths per day.”

“I’m going to pause here,” she said. “I’m going to lose the script and I’m going to reflect on the recurring feeling I have of impending doom.”  

At the start of her tenure, Walensky said she had pledged to always tell the truth even if it wasn’t something Americans wanted to hear.

“We have so much to look forward to, so much promise and potential of where we are, and so much reason for hope. But right now I’m scared,” she said.

She recalled her time caring for COVID patients, saying: “I know what it’s like as a physician to stand in that patient room, gowned, gloved, masked, shielded and to be the last person to touch someone else’s loved one because their loved one couldn’t be there.

“I know what it’s like when you’re the physician, when you’re the healthcare provider, and you’re worried that you don’t have the resources to care for the patients in front of you.” 

She also recalled “that feeling of nausea, when you read the ‘Crisis Standards of Care’ and you wonder whether there are going to be enough ventilators to go around and who’s going to make that choice.”

She emphasised that she was speaking “not only as your CDC director, but as a wife, as a mother, as a daughter, to ask you to just please hold on a little while longer.”

She sympathised, she said, with those “wanting to be done” with the pandemic.

“We are just almost there, but not quite yet. And so I’m asking you to just hold on a little longer, to get vaccinated when you can. So that all of those people that we all love will still be here when this pandemic ends.”

Dr Walensky warned that the US pandemic trajectory was looking dangerously similar to that of European countries like Germany that were still struggling to contain the virus.

“We are not powerless. We can change this trajectory of the pandemic,” she said.

“But it will take all of us recommitting to following the public health prevention strategies consistently while we work to get the American public vaccinated.”

According to the New York Times’  COVID vaccination tracker, 146 million vaccinations have been administered in the US to date, with 2.76 million doses being given daily. At this rate, 70% of the adult population will have been vaccinated by June 16.

She urged community and religious leaders, officials, and other influencers to help support the vaccination programme.

“For the health of our country, we must work together now to prevent a fourth surge.”

Source: MedPage Today

Categories : Cancer COVIDTags :

Despite COVID, Cancer Screenings in the US Picked Up

On By ModernMedia
Woman Receives Mammogram. An Asian female technician positions an African-American woman at an imaging machine to receive a mammogram. Creator: Rhoda Baer

In an encouraging sign, the RAND corporation reports that despite COVID, cancer screenings in the United States rebounded in the wake of the first wave.

There has been concern since the COVID pandemic was keeping people from going in for routine cancer screening, resulting in more undetected cancers to progress unchecked and an increase in cancer deaths. As some 600 000 Americans were expected to die of cancer in 2020, any impact on screening is a considerable health concern.

In a statement, Ryan McBain, PhD, of the RAND Corp. in Santa Monica, California, said: “These are the first findings to show that, despite real fears about the consequences of drop off in cancer screens, health facilities figured out how to pick this back up after the initial pandemic restrictions. Our study shows that health systems were able to recalibrate resources and protocols in a relatively short interval to deliver these important services.”

In Spain, cancer diagnoses were down 38% in the first half of 2020, according to one study. The pandemic’s impact on cancer screening that required in-person examinations, such as mammography and colonoscopy, were a particular concern, McBain and co-authors noted. Moreover, little was known about the magnitude of the decline in screening rates or longer-term trends in screen.

Using data on Castlight Health beneficiaries from January 15 to July 31, 2020, the researchers calculated weekly screening rates per 10 000 eligible beneficiaries. Before the declaration of national emergency in the US on March 13, screening mammography weekly rate was 87.8 per 10 000, falling to a low of 6.9 per 10 000 in April. Thereafter, screening rates began a steady recovery, to 88.2 per 10 000 at the end of July.

Over the same time period, weekly colonoscopy screenings fell from 15.1 to 0.9 per 10 000, before rebounding to a weekly median of 12.6 per 10 000 by July 31, 2020.

Multivariable regression analyses confirmed the significant declines in screening mammography and colonoscopy. A larger decline in colonoscopy was observed in high-income counties. Otherwise, the analyses showed no significant demographic variations.

Laura Makaroff, DO, of the American Cancer Society in Atlanta, said that the pandemic’s ultimate impact on cancer screening and cancer care is still largely unknown.

“We have seen similar data showing some rebound in cancer screening rates last summer and fall, but even those turnarounds show an approximate 30% decrease in cancer screening compared with pre-pandemic rates,” she said to MedPage Today in an email. “We also don’t yet know the full impact of the late fall and winter surges on disruptions in cancer screening and diagnosis.”

“The COVID-19 pandemic has had numerous consequences secondary to the disease itself, including reduced access to care for other illnesses,” Dr Makaroff added. “While these measures were necessary, delays in cancer screening, diagnosis, and treatment due to reduced healthcare access will likely result in a short-term drop in cancer diagnoses followed by increases in late-stage diagnoses and preventable cancer deaths.

“The full impact of the COVID-19 pandemic on cancer prevention and early detection will not be known until population-based nationwide data become available in the years to come,” she said.

Source: MedPage Today

Journal information: McBain RK, et al “Decline and rebound in routine cancer screening rates during the COVID-19 pandemic” J Intern Med 2021; DOI: 10.1007/s11606-021-06660-5.