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Coronavirus in Europe: Thousands of Health Workers Out of Action – The New York Times

Posted: March 30, 2020 at 7:48 pm


MADRID Across Western Europe, health care professionals have used the language of war to describe the struggle against the coronavirus, which has left some hospitals on the brink of collapse.

And health care workers are the soldiers on the front lines.

Out of Spains 40,000 confirmed coronavirus cases, 5,400 nearly 14 percent are medical professionals, the health ministry said on Tuesday. No other country has reported health care staff accounting for a double-digit percentage of total infections.

But the problem is widespread throughout Europe. In Italy, France and Spain, more than 30 health care professionals have died of the coronavirus, and thousands of others have had to self-isolate.

In Brescia province, the center of Italys outbreak, 10 to 15 percent of doctors and nurses have been infected and put out of commission, according to a doctor there.

In France, the public hospital system in Paris has tallied 490 infected staff members, a small but growing proportion of the systems 100,000 or so employees.

The same dynamics are starting to take hold in Britain and the United States, where the contagion is bearing down but has yet to fully bite.

At the La Paz hospital in Madrid, one of the largest in Spains capital, 426 employees 6 percent of the medical staff are isolated at home, after testing positive or showing possible symptoms of the coronavirus, according to internal numbers provided by a labor union that represents doctors in Madrid.

At the smaller Igualada hospital in Catalonia, a third of the 1,000 hospital staff has been sent home.

The virus was already among us when we were really only testing those who came from Wuhan and then from Italy, said ngela Hernndez Puente, a doctor who is the deputy secretary general of the doctors union. Some of our doctors unfortunately worked without adequate protection and acted as vectors.

As doctors, nurses and other practitioners fall sick, the burdens increase on health care systems already groaning under the strain of an expanding epidemic. And infected workers and their hospitals are increasingly being recognized as vectors for the spread of the virus.

The number of cases in Spain has been doubling every four days, and the country is fast shaping up as Europes next epicenter of the contagion. On Tuesday, Spains coronavirus toll reached 2,700 dead, the second-highest in Europe after Italy.

In Madrid, the focus of Spains outbreak, so many are dying that bodies are being placed in an Olympic-sized ice skating rink that has been converted into an emergency morgue.

In some retirement homes, soldiers deployed to disinfect the premises found elderly people abandoned, or dead in their beds, prompting Spains public prosecutors to open an investigation.

It has not helped that Spains population, on average, is among the worlds oldest. But the government was also late to impose restrictions on the movement of people.

Even as a tragedy unfolded in northern Italy, mass events went ahead earlier this month in Madrid, and the government waited until March 14 to declare a state of emergency that has since forced people to stay indoors, barring exceptional circumstances.

Spain also did not shore up its stock of medical equipment early on. Doctors and nurses have had to work with a dangerous shortage of masks, gloves and other essential gear that has proved disastrous for them.

The grim situation has left many of Spains health care professionals overwhelmed and pleading for more equipment, doctors, nurses and ambulance crews have told The New York Times. For those who have been infected, a feeling of powerlessness has sunk in.

You are used to taking care of others and now youre being asked to stay home and take care of yourself, said Marc Arnaiz, a doctor in the internal medicine unit of the Igualada hospital, who tested positive earlier this month.

For most of us this job is a vocation, so its shocking and frustrating, he said.

Mr. Arnaiz, 31, said he had likely been infected by a patient. He noticed the first symptoms on March 9, the day his patient was confirmed positive, among the first in the hospital, which has since become one of the worst infection clusters in northeastern Spain.

While its impossible to know how many patients infected doctors and vice versa, the alarming spread within hospitals has forced the government to struggle with a shortage of both professionals and equipment.

Last week, the government launched an emergency recruitment plan to add 50,000 health care workers, ranging from medical students to retired doctors.

After employees began complaining openly about the stresses on the system, some Madrid hospitals told their staff not to speak out. Many of those interviewed by The New York Times were not authorized to comment publicly and asked that their full names not be used for fear of retribution.

One, Yolanda, has been a nurse for 30 years, working in a public hospital in Madrid. But earlier this month, as the outbreak worsened in Spain, she said she was moved instead to a makeshift emergency ward, where she had to learn new skills on the job while working without decent protective gear.

Weve been put on the front line not only without enough protection, but also sometimes with the stress of a very different work environment, she said, noting that she had never before handled intubated patients. The nurses in her unit wore face masks and gowns, but they had to reuse them because of a shortage.

Putting on a face mask again and again is as useless as sticking a piece of paper on your face, she said.

Last Thursday, Yolanda went home feeling feverish. On Sunday, she tested positive for coronavirus, along with about 30 colleagues. We have done our best, but some of us sadly became part of the contamination chain, she said.

Hospital workers unions were less hesitant to point fingers.

When we already knew that the virus was circulating in hospitals, we were still being told that the usage of protective gear should be limited to specific circumstances, said Juanjo Menndez, the communications director of SATSE Madrid, a nurses union. Its the kind of basic error that a student learns to avoid in the first year of medical school.

In Spain, France and Italy, officials and health care professionals said they were shocked by equipment shortages.

Giorgio Gori, the mayor of Bergamo, one of the hardest hit towns in Italy, said the doctors werent protected, and lacked the sufficient defenses, adding that he was still receiving requests for masks and gloves from doctors making home visits.

Jean-Paul Hamon, the president of one of Frances biggest doctor unions, told the LCI television broadcaster on Tuesday that he was particularly worried about workers who are not in hospitals but are still in close contact with patients, like general practitioners or retirement home employees.

Three of the five doctors who have died of Covid-19 so far in France were general practitioners, and one was a gynecologist. The state is absolutely unprepared, said Mr. Hamon, who is himself infected. The state is going to owe an explanation.

In Spain, doctors warned that hospitals were now paying the price of the loose measures announced in the early days of the outbreak.

The lack of protection is everywhere, the improvisation seems to be widespread, said Antonio Antela, a doctor who coordinates the infectious disease unit at the university hospital of Santiago de Compostela, in northwestern Spain. He has been hospitalized for a week after developing pneumonia and testing positive.

The lesson is: take care of your public health care system, because there will be other epidemics and we ought to be better prepared, he added in a telephone interview from his hospital bed.

At a medical center in the heart of Madrid, Mara, another nurse who is now isolated at home with coronavirus, said that she spent several days working without a face mask and gloves, handing out masks only to visitors who reported breathing problems or had recently been in Italy.

On March 11, the day she first felt fever, her medical center finally ordered all staff to wear masks. We probably didnt have enough face masks, but we also acted for far too long as if this was a limited problem, mostly imported from Italy, she said.

The Spanish government is now stepping up efforts to buy medical equipment, as well as distributing about 650,000 new test kits across the country. Two Chinese cargo planes filled with face masks and other gear landed in Madrid and Zaragoza on Tuesday.

We are a target like everybody else, but we are also a threat to other co-workers, said Juan, a 37-year-old doctor in a Madrid public hospital. Also, if you test everyone and theres no health care workers left in the hospitals, what can you do?

Raphael Minder reported from Madrid and Elian Peltier from Barcelona. Reporting was contributed by Jason Horowitz in Rome and Aurelien Breeden in Paris.

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Coronavirus in Europe: Thousands of Health Workers Out of Action - The New York Times

How the Pandemic Will End – The Atlantic

Posted: at 7:47 pm


Editors Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.

Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nations psyche.

To hear more feature stories, get the Audm iPhone app.

A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. In October, the Johns Hopkins Center for Health Security war-gamed what might happen if a new coronavirus swept the globe. And then one did. Hypotheticals became reality. What if? became Now what?

So, now what? In the late hours of last Wednesday, which now feels like the distant past, I was talking about the pandemic with a pregnant friend who was days away from her due date. We realized that her child might be one of the first of a new cohort who are born into a society profoundly altered by COVID-19. We decided to call them Generation C.

As well see, Gen Cs lives will be shaped by the choices made in the coming weeks, and by the losses we suffer as a result. But first, a brief reckoning. On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5the worlds highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.

Anne Applebaum: The coronavirus called Americas bluff

No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems, says Nahid Bhadelia, an infectious-diseases physician at the Boston University School of Medicine. More transmissible and fatal than seasonal influenza, the new coronavirus is also stealthier, spreading from one host to another for several days before triggering obvious symptoms. To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those theyve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.

As my colleagues Alexis Madrigal and Robinson Meyer have reported, the Centers for Disease Control and Prevention developed and distributed a faulty test in February. Independent labs created alternatives, but were mired in bureaucracy from the FDA. In a crucial month when the American caseload shot into the tens of thousands, only hundreds of people were tested. That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. Im not aware of any simulations that I or others have run where we [considered] a failure of testing, says Alexandra Phelan of Georgetown University, who works on legal and policy issues related to infectious diseases.

The testing fiasco was the original sin of Americas pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases. None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country. Overstretched hospitals became overwhelmed. Basic protective equipment, such as masks, gowns, and gloves, began to run out. Beds will soon follow, as will the ventilators that provide oxygen to patients whose lungs are besieged by the virus.

Read: The people ignoring social distancing

With little room to surge during a crisis, Americas health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency. That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition; some worried hospitals have bought out large quantities of supplies, in the way that panicked consumers have bought out toilet paper.

Partly, thats because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to act now to prevent an American epidemic, and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the presidents ear. Instead of springing into action, America sat idle.

Derek Thompson: America is acting like a failed state

Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert Ive spoken with had feared. Much worse, said Ron Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014. Beyond any expectations we had, said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. As an American, Im horrified, said Seth Berkley, who heads Gavi, the Vaccine Alliance. The U.S. may end up with the worst outbreak in the industrialized world.

Having fallen behind, it will be difficultbut not impossiblefor the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April. As of last weekend, the nation had 17,000 confirmed cases, but the actual number was probably somewhere between 60,000 and 245,000. Numbers are now starting to rise exponentially: As of Wednesday morning, the official case count was 54,000, and the actual case count is unknown. Health-care workers are already seeing worrying signs: dwindling equipment, growing numbers of patients, and doctors and nurses who are themselves becoming infected.

Italy and Spain offer grim warnings about the future. Hospitals are out of room, supplies, and staff. Unable to treat or save everyone, doctors have been forced into the unthinkable: rationing care to patients who are most likely to survive, while letting others die. The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one. By the end of the summer, the pandemic will have directly killed 2.2 million Americans, notwithstanding those who will indirectly die as hospitals are unable to care for the usual slew of heart attacks, strokes, and car accidents. This is the worst-case scenario. To avert it, four things need to happenand quickly.

Read: All the presidents lies about the coronavirus

The first and most important is to rapidly produce masks, gloves, and other personal protective equipment. If health-care workers cant stay healthy, the rest of the response will collapse. In some places, stockpiles are already so low that doctors are reusing masks between patients, calling for donations from the public, or sewing their own homemade alternatives. These shortages are happening because medical supplies are made-to-order and depend on byzantine international supply chains that are currently straining and snapping. Hubei province in China, the epicenter of the pandemic, was also a manufacturing center of medical masks.

In the U.S., the Strategic National Stockpilea national larder of medical equipmentis already being deployed, especially to the hardest-hit states. The stockpile is not inexhaustible, but it can buy some time. Donald Trump could use that time to invoke the Defense Production Act, launching a wartime effort in which American manufacturers switch to making medical equipment. But after invoking the act last Wednesday, Trump has failed to actually use it, reportedly due to lobbying from the U.S. Chamber of Commerce and heads of major corporations.

Some manufacturers are already rising to the challenge, but their efforts are piecemeal and unevenly distributed. One day, well wake up to a story of doctors in City X who are operating with bandanas, and a closet in City Y with masks piled into it, says Ali Khan, the dean of public health at the University of Nebraska Medical Center. A massive logistics and supply-chain operation [is] now needed across the country, says Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That cant be managed by small and inexperienced teams scattered throughout the White House. The solution, he says, is to tag in the Defense Logistics Agencya 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.

This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests. Those tests have been slow to arrive because of five separate shortages: of masks to protect people administering the tests; of nasopharyngeal swabs for collecting viral samples; of extraction kits for pulling the viruss genetic material out of the samples; of chemical reagents that are part of those kits; and of trained people who can give the tests. Many of these shortages are, again, due to strained supply chains. The U.S. relies on three manufacturers for extraction reagents, providing redundancy in case any of them failsbut all of them failed in the face of unprecedented global demand. Meanwhile, Lombardy, Italy, the hardest-hit place in Europe, houses one of the largest manufacturers of nasopharyngeal swabs.

Read: Why the coronavirus has been so successful

Some shortages are being addressed. The FDA is now moving quickly to approve tests developed by private labs. At least one can deliver results in less than an hour, potentially allowing doctors to know if the patient in front of them has COVID-19. The country is adding capacity on a daily basis, says Kelly Wroblewski of the Association of Public Health Laboratories.

On March 6, Trump said that anyone who wants a test can get a test. That was (and still is) untrue, and his own officials were quick to correct him. Regardless, anxious people still flooded into hospitals, seeking tests that did not exist. People wanted to be tested even if they werent symptomatic, or if they sat next to someone with a cough, says Saskia Popescu of George Mason University, who works to prepare hospitals for pandemics. Others just had colds, but doctors still had to use masks to examine them, burning through their already dwindling supplies. It really stressed the health-care system, Popescu says. Even now, as capacity expands, tests must be used carefully. The first priority, says Marc Lipsitch of Harvard, is to test health-care workers and hospitalized patients, allowing hospitals to quell any ongoing fires. Only later, once the immediate crisis is slowing, should tests be deployed in a more widespread way. This isnt just going to be: Lets get the tests out there! Inglesby says.

These measures will take time, during which the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. Its courseand the nations fatenow depends on the third need, which is social distancing. Think of it this way: There are now only two groups of Americans. Group A includes everyone involved in the medical response, whether thats treating patients, running tests, or manufacturing supplies. Group B includes everyone else, and their job is to buy Group A more time. Group B must now flatten the curve by physically isolating themselves from other people to cut off chains of transmission. Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediately, before they feel proportionate, and they must continue for several weeks.

Juliette Kayyem: The crisis could last 18 months. Be prepared.

Persuading a country to voluntarily stay at home is not easy, and without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps. Some states have banned large gatherings or closed schools and restaurants. At least 21 have now instituted some form of mandatory quarantine, compelling people to stay at home. And yet many citizens continue to crowd into public spaces.

In these moments, when the good of all hinges on the sacrifices of many, clear coordination mattersthe fourth urgent need. The importance of social distancing must be impressed upon a public who must also be reassured and informed. Instead, Trump has repeatedly played down the problem, telling America that we have it very well under control when we do not, and that cases were going to be down to close to zero when they were rising. In some cases, as with his claims about ubiquitous testing, his misleading gaffes have deepened the crisis. He has even touted unproven medications.

Away from the White House press room, Trump has apparently been listening to Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. Fauci has advised every president since Ronald Reagan on new epidemics, and now sits on the COVID-19 task force that meets with Trump roughly every other day. Hes got his own style, lets leave it at that, Fauci told me, but any kind of recommendation that I have made thus far, the substance of it, he has listened to everything.

Read: Grocery stores are the coronavirus tipping point

But Trump already seems to be wavering. In recent days, he has signaled that he is prepared to backtrack on social-distancing policies in a bid to protect the economy. Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a persons risk, and to somehow wall off the high-risk people from the rest of society. It underestimates how badly the virus can hit low-risk groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.

A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care. There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.

Read: Americas hospitals have never experienced anything like this

If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it wont be quick. It could be anywhere from four to six weeks to up to three months, Fauci said, but I dont have great confidence in that range.

Even a perfect response wont end the pandemic. As long as the virus persists somewhere, theres a chance that one infected traveler will reignite fresh sparks in countries that have already extinguished their fires. This is already happening in China, Singapore, and other Asian countries that briefly seemed to have the virus under control. Under these conditions, there are three possible endgames: one thats very unlikely, one thats very dangerous, and one thats very long.

The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.

The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This herd immunity scenario would be quick, and thus tempting. But it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems. The United Kingdom initially seemed to consider this herd-immunity strategy, before backtracking when models revealed the dire consequences. The U.S. now seems to be considering it too.

Read: What will you do if you start coughing?

The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.

It depends, for a start, on making a vaccine. If this were a flu pandemic, that would be easier. The world is experienced at making flu vaccines and does so every year. But there are no existing vaccines for coronavirusesuntil now, these viruses seemed to cause diseases that were mild or rareso researchers must start from scratch. The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the viruss genes for the first time and doctors injecting a vaccine candidate into a persons arm. Its overwhelmingly the world record, Fauci said.

But its also the fastest step among many subsequent slow ones. The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. Theyll need to do animal tests and large-scale trials to ensure that the vaccine doesnt cause severe side effects. Theyll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.

Even if it works, they dont have an easy way to manufacture it at a massive scale, said Seth Berkley of Gavi. Thats because Moderna is using a new approach to vaccination. Existing vaccines work by providing the body with inactivated or fragmented viruses, allowing the immune system to prep its defenses ahead of time. By contrast, Modernas vaccine comprises a sliver of SARS-CoV-2s genetic materialits RNA. The idea is that the body can use this sliver to build its own viral fragments, which would then form the basis of the immune systems preparations. This approach works in animals, but is unproven in humans. By contrast, French scientists are trying to modify the existing measles vaccine using fragments of the new coronavirus. The advantage of that is that if we needed hundreds of doses tomorrow, a lot of plants in the world know how to do it, Berkley said. No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into peoples arms.

Read: COVID-19 vaccines are coming, but theyre not what you think

Its likely, then, that the new coronavirus will be a lingering part of American life for at least a year, if not much longer. If the current round of social-distancing measures works, the pandemic may ebb enough for things to return to a semblance of normalcy. Offices could fill and bars could bustle. Schools could reopen and friends could reunite. But as the status quo returns, so too will the virus. This doesnt mean that society must be on continuous lockdown until 2022. But we need to be prepared to do multiple periods of social distancing, says Stephen Kissler of Harvard.

Much about the coming years, including the frequency, duration, and timing of social upheavals, depends on two properties of the virus, both of which are currently unknown. First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect. Much of the world is waiting anxiously to see whatif anythingthe summer does to transmission in the Northern Hemisphere, says Maia Majumder of Harvard Medical School and Boston Childrens Hospital.

Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer. Assuming that SARS-CoV-2 lies somewhere in the middle, people who recover from their encounters might be protected for a couple of years. To confirm that, scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. Theyll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.

Scientists can use the periods between those bouts to develop antiviral drugsalthough such drugs are rarely panaceas, and come with possible side effects and the risk of resistance. Hospitals can stockpile the necessary supplies. Testing kits can be widely distributed to catch the viruss return as quickly as possible. Theres no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be. As Aaron E. Carroll and Ashish Jha recently wrote, We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.

Whether through accumulating herd immunity or the long-awaited arrival of a vaccine, the virus will find spreading explosively more and more difficult. Its unlikely to disappear entirely. The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. But my hope and expectation is that the severity would decline, and there would be less societal upheaval, Kissler says. In this future, COVID-19 may become like the flu is todaya recurring scourge of winter. Perhaps it will eventually become so mundane that even though a vaccine exists, large swaths of Gen C wont bother getting it, forgetting how dramatically their world was molded by its absence.

The cost of reaching that point, with as few deaths as possible, will be enormous. As my colleague Annie Lowrey wrote, the economy is experiencing a shock more sudden and severe than anyone alive has ever experienced. About one in five people in the United States have lost working hours or jobs. Hotels are empty. Airlines are grounding flights. Restaurants and other small businesses are closing. Inequalities will widen: People with low incomes will be hardest-hit by social-distancing measures, and most likely to have the chronic health conditions that increase their risk of severe infections. Diseases have destabilized cities and societies many times over, but it hasnt happened in this country in a very long time, or to quite the extent that were seeing now, says Elena Conis, a historian of medicine at UC Berkeley. Were far more urban and metropolitan. We have more people traveling great distances and living far from family and work.

After infections begin ebbing, a secondary pandemic of mental-health problems will follow. At a moment of profound dread and uncertainty, people are being cut off from soothing human contact. Hugs, handshakes, and other social rituals are now tinged with danger. People with anxiety or obsessive-compulsive disorder are struggling. Elderly people, who are already excluded from much of public life, are being asked to distance themselves even further, deepening their loneliness. Asian people are suffering racist insults, fueled by a president who insists on labeling the new coronavirus the Chinese virus. Incidents of domestic violence and child abuse are likely to spike as people are forced to stay in unsafe homes. Children, whose bodies are mostly spared by the virus, may endure mental trauma that stays with them into adulthood.

Read: The kids arent all right

After the pandemic, people who recover from COVID-19 might be shunned and stigmatized, as were survivors of Ebola, SARS, and HIV. Health-care workers will take time to heal: One to two years after SARS hit Toronto, people who dealt with the outbreak were still less productive and more likely to be experiencing burnout and post-traumatic stress. People who went through long bouts of quarantine will carry the scars of their experience. My colleagues in Wuhan note that some people there now refuse to leave their homes and have developed agoraphobia, says Steven Taylor of the University of British Columbia, who wrote The Psychology of Pandemics.

But there is also the potential for a much better world after we get through this trauma, says Richard Danzig of the Center for a New American Security. Already, communities are finding new ways of coming together, even as they must stay apart. Attitudes to health may also change for the better. The rise of HIV and AIDS completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic, Conis says. The use of condoms became normalized. Testing for STDs became mainstream. Similarly, washing your hands for 20 seconds, a habit that has historically been hard to enshrine even in hospitals, may be one of those behaviors that we become so accustomed to in the course of this outbreak that we dont think about them, Conis adds.

Pandemics can also catalyze social change. People, businesses, and institutions have been remarkably quick to adopt or call for practices that they might once have dragged their heels on, including working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements. This is the first time in my lifetime that Ive heard someone say, Oh, if youre sick, stay home, says Adia Benton, an anthropologist at Northwestern University. Perhaps the nation will learn that preparedness isnt just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose Americas social immune system, and that this system has been suppressed.

Aspects of Americas identity may need rethinking after COVID-19. Many of the countrys values have seemed to work against it during the pandemic. Its individualism, exceptionalism, and tendency to equate doing whatever you want with an act of resistance meant that when it came time to save lives and stay indoors, some people flocked to bars and clubs. Having internalized years of anti-terrorism messaging following 9/11, Americans resolved to not live in fear. But SARS-CoV-2 has no interest in their terror, only their cells.

Years of isolationist rhetoric had consequences too. Citizens who saw China as a distant, different place, where bats are edible and authoritarianism is acceptable, failed to consider that they would be next or that they wouldnt be ready. (Chinas response to this crisis had its own problems, but thats for another time.) People believed the rhetoric that containment would work, says Wendy Parmet, who studies law and public health at Northeastern University. We keep them out, and well be okay. When you have a body politic that buys into these ideas of isolationism and ethnonationalism, youre especially vulnerable when a pandemic hits.

Graeme Wood: The Chinese virus is a test. Dont fail it.

Veterans of past epidemics have long warned that American society is trapped in a cycle of panic and neglect. After every crisisanthrax, SARS, flu, Ebolaattention is paid and investments are made. But after short periods of peacetime, memories fade and budgets dwindle. This trend transcends red and blue administrations. When a new normal sets in, the abnormal once again becomes unimaginable. But there is reason to think that COVID-19 might be a disaster that leads to more radical and lasting change.

The other major epidemics of recent decades either barely affected the U.S. (SARS, MERS, Ebola), were milder than expected (H1N1 flu in 2009), or were mostly limited to specific groups of people (Zika, HIV). The COVID-19 pandemic, by contrast, is affecting everyone directly, changing the nature of their everyday life. That distinguishes it not only from other diseases, but also from the other systemic challenges of our time. When an administration prevaricates on climate change, the effects wont be felt for years, and even then will be hard to parse. Its different when a president says that everyone can get a test, and one day later, everyone cannot. Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines, testing positive, and losing loved ones. Senators are falling sick. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are no longer manifesting as angry opinion pieces, but as faltering lungs.

After 9/11, the world focused on counterterrorism. After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies. Expect pandemics to top the agenda at the United Nations General Assembly. Anthony Fauci is now a household name. Regular people who think easily about what a policewoman or firefighter does finally get what an epidemiologist does, says Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.

Such changes, in themselves, might protect the world from the next inevitable disease. The countries that had lived through SARS had a public consciousness about this that allowed them to leap into action, said Ron Klain, the former Ebola czar. The most commonly uttered sentence in America at the moment is, Ive never seen something like this before. That wasnt a sentence anyone in Hong Kong uttered. For the U.S., and for the world, its abundantly, viscerally clear what a pandemic can do.

The lessons that America draws from this experience are hard to predict, especially at a time when online algorithms and partisan broadcasters only serve news that aligns with their audiences preconceptions. Such dynamics will be pivotal in the coming months, says Ilan Goldenberg, a foreign-policy expert at the Center for a New American Security. The transitions after World War II or 9/11 were not about a bunch of new ideas, he says. The ideas are out there, but the debates will be more acute over the next few months because of the fluidity of the moment and willingness of the American public to accept big, massive changes.

One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trumps approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero. During the second term of his presidency, the U.S. turns further inward and pulls out of NATO and other international alliances, builds actual and figurative walls, and disinvests in other nations. As Gen C grows up, foreign plagues replace communists and terrorists as the new generational threat.

One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of America first politics. The nation pivots, as it did after World War II, from isolationism to international cooperation. Buoyed by steady investments and an influx of the brightest minds, the health-care workforce surges. Gen C kids write school essays about growing up to be epidemiologists. Public health becomes the centerpiece of foreign policy. The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.

In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.

Listen to Ed Yong discuss this story on an episode of Social Distance, The Atlantics podcast about living through a pandemic:

Subscribe to Social Distance on Apple Podcasts or Spotify (How to Listen)

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How the Pandemic Will End - The Atlantic

Trump Considers Reopening Economy, Over Health Experts Objections – The New York Times

Posted: at 7:47 pm


michael barbaro

From The New York Times, Im Michael Barbaro. This is The Daily.

Today: So far, the United States is losing the battle against the coronavirus. Donald G. McNeil Jr. on what it would take to turn the corner.

Its Tuesday, March 24.

Donald, it is now about 4:20 on Monday. Where are we in this pandemic in the United States? How would you characterize it at this moment?

I would say its wildly out of control, but we have not recognized it yet.

Certainly wildly out of control in New York State.

The epicenter in the U.S. is now clearly New York, with more than 12,000 cases, most of them here in New York City.

In Washington.

The state of Washington has the second highest number, with almost 1,000 cases. And then theres California. We have the third highest number.

In northern California, in South Florida.

We saw pictures of Disney World jam-packed with people, aerial photos of beaches in Florida jammed with people. There are still so many Americans that dont understand they are spreading the virus.

Weve just begun to do tests, really. Weve got 42,000 positive cases. Weve got 513 deaths.

Mm-hm.

You know, some people have said this is like a war. And its as if your army has been marching forward, and the enemy has been shooting at you for two to three weeks now, and nobody has yet looked down to see whether or not theyre bleeding.

Mm-hm.

But very soon, we will see how many people have been hit.

Because, you know, you get sick within four, five, six, seven days of getting infected. But usually you dont need hospitalization if youre going to need hospitalization until about 10 days to two weeks in. Its known as the second week crash. And some people crash even after they thought they were starting to get better. So were facing something like that. A lot of people are sick, huge numbers of people are about to fall seriously ill.

Mm-hm.

But it just hasnt happened yet.

Well, I want to talk about what the U.S. government and states have done so far. How would you describe what has been done to try to mitigate this?

Its a giant patchwork across the country.

This is a moment we need to make tough decisions. This is a moment where we need some straight talk, and we need to tell people the truth.

I mean, you see California ordering people to stay inside their houses.

Mm-hm.

So were going to put out an executive order today, New York State on pause.

New York requesting that people stay inside their houses and closing down all nonessential businesses.

A stay at home order for all of Ohio.

You have Ohio and Louisiana

Today, Im issuing a stay-at-home at home water for the entire state of Louisiana.

moving in the same direction.

Which will become effective tomorrow Monday, March 23 at 5 p.m.

The federal government has recommended no gatherings of more than 10 people. Some states are enforcing that even more harshly than that, like California. Other states are setting their own policies.

Right, and as patchy and inconsistent as this approach may be, there is beginning to be real blowback to this government-mandated social distancing and shutting down our society, given that it is putting people out of work. Its closing businesses. The president has said just in the past few hours

We cannot let the cure be worse than the problem itself. Were not gonna let the cure be worse than the problem.

He doesnt want the cure to be worse than the illness itself. So I want to understand why were pursuing this approach rather than a variety of alternatives. And lets start with the South Korean approach, right? Not closing all businesses, not closing all restaurants, focusing instead on aggressively tracking the sick and testing as many people as possible. And it seems to be working, right? So why cant we do that here? Why isnt that a viable alternative to shutting things down?

Well, we could do that here, if we had a time machine and we could travel back in time to about January 20, because January 15 is where we know one of the first cases arrived in the United States and started spreading. That was the case in Washington. The idea that we could try to start cracking down now, when we have over 40,000 cases and 500 deaths, its just utterly impossible. Its not close to anything that South Korea faced. I mean, South Korea, they were doing this kind of crackdown when they first saw cases arriving, before there was a single death. So were just behind the eight ball on that kind of thinking. And mostly they had small scattered cases, and then they had this gigantic explosion inside one church. I think it was more than 500 cases inside that church. All right, they managed to do contact tracing on 210,000 members of that church. Los Angeles just gave up contact tracing today.

Wow.

Just knowing that they dont have the tests to do it.

Meaning, tracing those who were in contact with somebody who has tested positive.

Tracing everybody who was in contact with somebody who was tested positive. Not only everybody theyve been in contact with since they knew they were infected, but everybody even 48 hours before that.

So not only is it too late to follow the South Korean model, youre saying, as an alternative in the U.S., we just dont have the capacity or the resources to follow it.

Correct.

OK, so we can dispense with that. Another possible alternative to just shutting everything down is isolating the most vulnerable in American society to the coronavirus. So the elderly, those with pre-existing conditions, underlying medical problems, rather than asking everyone to isolate in some form or another. And in that scenario, most Americans would be treated as we treat most Americans during the regular flu season, right? Take some precautions, be careful but dont fundamentally alter your life. And there are doctors who seem to be advocating for this isolate the most vulnerable scenario. And one of our colleagues, columnist Tom Friedman, gave voice to their views over the weekend. And it seems President Trump is interested in this kind of a concept. What do the experts that you have talked to say about the viability of that?

This was an idea that was floated for a while in the Netherlands, and was floated for a while in the U.K., and dropped because they realized that it was ridiculous. Why is it ridiculous? One, how do you only isolate the elderly?

Hm.

Elderly people in this country very often live with their families. Elderly people need services, which people deliver to them in their houses. Or they go to community centers, or to their relatives houses for services they absolutely need, from everything from food to company. How do you isolate the vulnerable? How do you isolate everybody whos obese in this country?

Why do you mention obese?

Because many have diabetes. And diabetes is one of the conditions that renders you more susceptible to dying of this disease. Everybody whos got high blood pressure, not all high blood pressure but uncontrolled high blood pressure, which a lot of people do in this country, is more susceptible to this disease. Anybody whos taken any sort of immunosuppressive drugs or is fairly recently beyond cancer treatment may be more susceptible to this disease.

Hm.

Theres some data suggesting now that people who vape may be more susceptible to developing pneumonia from this disease. Vaping is not something thats common among the elderly in this country.

So youre saying, there are just too many vulnerable populations for this to be practical?

Yes. So the idea that you can just isolate all the most vulnerable people in the U.S. is simply wishful thinking.

So given that, Donald, I want to talk through another possible alternative, one that President Trump seems to be talking up a lot in the past couple of days.

Its a common malaria drug. Its been available, so therefore the safety level we understand very well. Its been relatively safe.

Which is the idea that we are close to a treatment to the coronavirus, something that would reliably combat it, and mean that we dont need to shut down societies.

Were also studying this and other promising therapies, which is a therapy produced by Gilead. And that would be rems its called remdesivir, remdesivir and it shows great promise.

So tell me about these drugs that President Trump has been referring to and whether he is right to suggest that they might be a solution here.

OK. The drugs that President Trump has mentioned over the past week are chloroquine and hydroxychloroquine, which are two versions of a longstanding malaria drug. Goes back 70 years. And the other drug is called remdesivir, and its a drug made by Gilead, and it doesnt actually have any use. I think they may have hoped it would work against H.I.V., and it didnt. It definitely did not work against Ebola when they tried it. Now theyre hoping it works against coronavirus. Theres some evidence to suggest it does. I mean, theres evidence in animal testing to suggest that both of these drugs might possibly work.

OK.

Those drugs have been used in China. But this was by doctors who were desperate, who were basically throwing everything they had at patients.

Hm.

And in some cases, where doctors had a certain number of patients that said, gee, these patients seemed to do better when I gave them that drug. Now, that doesnt mean this was some sort of Lazarus-like rise from your hospital bed and walk away smiling miracle drug. This was a drug that seemed to let these patients have better outcomes. But they werent able to do, for several reasons, real clinical trials, where you have two groups of patients who are basically exactly equal to each other and half of them get the drug and half dont. Thats what you need in order to be sure that a drug really works. Once you license a drug, then doctors start giving it all over the place. Actually, chloroquine is already licensed, so doctors are giving it in the hopes that it will work, and patients are demanding it in the belief that it will work, the belief partially spread by the president. And we dont really know how well it works. And these drugs are not completely safe. They shouldnt be taken, especially by children, without medical supervision. And the fear is that false hopes will be raised. And that also people get so excited about it that some may start taking the drugs to protect themselves out of fear, if theyve managed to get a hold of a bottle, and they may end up poisoning their kids. These are bad outcomes. There is a case where the cure is worse than the disease.

So beyond the fact that theres not yet enough medical evidence that this is a legitimate set of treatments, theres potentially real medical risk in people starting to take them, because they might actually make people sick.

Yes.

OK, so with all those options basically deemed impractical, that would seem to bring us back to social isolation. But is that working? Because my sense is, so far in the United States, it is not working.

No, its not working. And thats because were not doing it right.

And, you know, to write the articles Ive been writing recently, I talked to a dozen top experts, not just at the World Health Organization, but people who run medical schools, people who have fought pandemics, people who fought Ebola, people fought SARS, people who fought MERS. And they say that if were going to get a grip on our epidemic, we have to imitate China, because weve got China-like spread. Were not going to be able to catch it up with a South Korea-like program, and were going to have to do a whole lot better than Italy and Iran did. And were not on that track right now.

Well be right back.

So if the U.S. is failing at social isolation, what would the ideal version of social isolation look like right now? What would it entail?

So in an ideal world, if you could wave a magic wand and make everybody in the United States freeze in place, sitting six feet apart from each other for two weeks

Mm-hm.

we could stop the epidemic in two weeks. If we had enough

Really?

Yeah, because within two weeks, the virus would die out on every surface that it was. People wouldnt be interacting, so they wouldnt transmit it. And everybody who has symptoms, the symptoms turn up in two weeks at the most. So youd know who was sick. And even for the few asymptomatics, youd be able to find them by doing tests. And so thatd be it. Epidemic over. I mean, youd have a lot of people in the hospitals, but that would be the end of it.

Knowing that we dont have a magic wand but wish we did, what do we do? Whats the playbook for how to keep people away from each other in the United States, given where the virus is?

As much as possible, we have to stop everything in places where we know the virus is. That is what China did. They knew the virus was incredibly hot in Wuhan and the surrounding province, and so they put that entire province on lockdown. Unfortunately, that means not just stopping all air travel, it means basically stopping all travel.

Hm.

I mean, people cant be together on buses. People cant be together on planes. People cant be together in cars, unless its just them and theyre going to socially isolate together when they get to the end of their journey, and stay in place for, unfortunately, an indefinite amount of time. The loosey goosier the freeze is, the longer it lasts. And the longer its going to take us to get our economy started again. Because the looser it is, the more transmission there is. The more transmission there is, the more people end up overcrowding hospitals. The more people overcrowd hospitals, the more people die.

OK, so thats transportation. And youre suggesting that, in many ways, we have to further restrict that. What about businesses? What about restaurants all over the country? Do they need to be shut down?

Yes, all of these things. Transportation, restaurants all over the country, schools all over the country, workplaces all over the country, bars and restaurants all over the country. And different places are turning into hotspots spots even as we speak, because people are now traveling all over the country and still spreading the virus, starting new clusters. The only way to get on top of this disease is to stop the clusters.

In this scenario that youre describing, what can be open? Whats an acceptable reason for anyone to be out and about?

Doctors, nurses, people who work in the health care field. Police, fire, the people who keep the water mains open and the electrical grid running and Wi-Fi reaching houses. And food delivery and medicine delivery. Thats the ideal. Those are the only people who are allowed out and that keep the country functioning. We need people to freeze in place, and we need to make sure they have enough calories and water and medicine to stay alive.

Hm.

You know, not that they are worried about how their business is running and how their investments are going or whether or not theyre collecting their rents. And we have to do things like tell landlords that they cant collect their rents, tell banks that they cant collect their mortgages. The idea is to keep the country alive until the virus slows down. It may be impossible, but if you want to try to use any sort of social distancing tactic, it has to be much more intense than it is now, because were not slowing the virus. Its still spreading wildly.

And this slowdown, how would it be enforced in a place like the United States? Lets say that suddenly every state, every mayor locks down a community along the lines of what experts say needs to be done now to freeze this in place. How does it actually get enforced? Who is in charge of punishing those who violate it, roaming the streets and making sure it actually happens?

Well, I mean, legally you can do it. The governor and the health commissioner have the power to use the police to enforce these laws. In Italy, as in China, they went to roadblocks everywhere. You couldnt drive down a street without a permit that had been issued by the government that said, Im an emergency worker. I am allowed to drive down the street. Thats what will have to happen if people dont do it voluntarily, and I fully expect that Americans are not going to do this voluntarily. But then were going to suffer the consequences.

So what happens if we dont do all the things that experts are saying we must do, the social isolation, the lockdowns? I mean, it doesnt seem were headed there. So what happens if we dont implement any of these measures?

If we dont implement these measures, we will have a Wuhan in New York, and a Wuhan in Seattle, and a Wuhan in South Florida, and a Wuhan in Wheeling West, Virginia, and a Wuhan in Helena, Montana, and so on.

Hm.

Because hospitals will get overwhelmed everywhere. And in Wuhan, in the early weeks of the epidemic, the death rate was 4 percent to 6 percent. Its a little unclear, because there were people who couldnt make it to the hospitals and just died at home. But if you go on the South China Morning Post site and you look for the videos that were shot then, youll see hospitals with people crowded in the corridors and literally dead bodies lying in the halls, that nobodys had time to take away. Youll see nurses and doctors screaming, having breakdowns, screaming in frustration, I cant take it anymore, I cant take it anymore. You will see lines of coffins outside the crematories, just sitting there waiting for their turn to go into the furnace, because theres too many coffins for the flames to burn fast enough. I mean, we have seen that in Wuhan and weve seen it in Italy, where they were having to stack coffins on the pews of the churches that had been closed down, because there was no place to put the coffins and they couldnt dig graves fast enough. So thats what were headed for.

I mean, its horrific.

Yeah, yeah, yeah. And weve Ive been looking at this stuff since late January, early February, and frightened by it. The visions are nightmarish, and I dont see anybody taking it seriously. But thats what were headed for.

Its kind of hard to process this, because what youre suggesting is that a short term, essentially, shutdown down of much of our life in the U.S. would potentially bring this whole pandemic to an end. And yet there are a lot of practical reasons why that would be very, very hard to imagine. But for those who are very skeptical of it, and who think, as the president said, that the cure may be worse than the illness, it would seem like a short-term version of this would be kind of ideal, right? Because it would happen

Who said short-term? I said if there were a magic wand, you could do a short-term shutdown. I think for the shutdown to be effective, given how lax Americans are about staying in the shutdown, we have got to have a shutdown that lasts for months and months.

So theres no short-term version of this, given the way the U.S. operates.

Theres no magic wand. Theres no 15-day cure.

Thats pretty depressing, because it means that theres almost nothing we can do right now. That the genie is out of the bottle, the horses have left the barn, the pandemic is too deeply in our system.

In New York, I think thats true. We dont know exactly how many people have been infected, but we know that its been incredibly hot with virus out there for awhile now. And yet people are really struggling, because, you know, they havent had their Rock Hudson, heres somebody I know whos got the disease, so now I believe in it, moments. People are still theyre beginning to hear about colleagues who were sick, colleagues who were infected and stuff, but that only began four or five days ago. People beginning to need to be hospitalized in large numbers is usually 10 days, and the deaths dont usually take place until three to six weeks. So we have a lot more pain in the future.

But is it possible for other cities in the U.S. smaller cities, maybe even mid-sized cities, not New York, not Seattle, maybe not Los Angeles to do these things and spare themselves?

Link:
Trump Considers Reopening Economy, Over Health Experts Objections - The New York Times

‘Everyone should use a topical retinol’ Dr Rosemary Coleman on the essential skincare routine – image.ie

Posted: at 7:46 pm


In 2018, the global skincare market was worth over 121 billion. As beauty halls, pharmacies and savvy social media-driven brands become ever more crowded and complex,Dr Rosemary Coleman, consultant dermatologist at Blackrock Clinictells how many steps we really need in our routines.

THE ROUTINE WE ALL SHOULD HAVE Wash your skin properly at the end of the day to remove dirt, pollution and make-up. Use a cleanser and a muslin cloth, as this gets into the nooks and crannies and gives you a thorough cleanse without being too harsh. Your choice of cleanser will depend on your skin type and preference. I swear by glycolic acid cleansers, as this tiny fruit acid molecule penetrates deep into the pores while exfoliating and enhancing radiance. For oily or acne-prone skin, choose a product designed for this problem. Sensitive skin often tolerates creamy or milk cleansers best, but dont be tempted to wipe them off with a cotton pad, as this leaves a film of cleanser on your skin wash with water and a muslin cloth. While its nicer to wash your face with warm water, always give a final cold rinse this is an excellent toner!

THE INGREDIENTS WE SHOULD ALL USE The top active ingredients in skincare products are retinols, glycolic acid, vitamin C, hyaluronic acid, peptides and resveratrol. I like to have a variety of these and rotate them from day to day, as you cant realistically apply them all every day. Everyone should use a topical retinol, preferably increasing in strength from over-the-counter products to prescription-grade retinol, if it is tolerated. Benefits include preventing skin cancer, pigmentation, acne, fine lines and ageing. Unfortunately, about 30 per cent of people just cant tolerate this ingredient. Dont overuse retinol or the skin gets stripped, fine and crepey looking. Once or twice a week is plenty.

WHAT WE SHOULD SPEND BIG ON Its really about quality, not cost. What we shouldnt skimp on is SPF. I often see people using SPF 50 on their face, but ignoring their neck and chest. Be generous with your SPF every morning, treating from the hairline to the cleavage, and youll get into the habit of always doing so. Would you ever wash your top teeth and not the bottom? Save money and time with a combination moisturiser with SPF 50 (it will often have collagen-stimulating peptides). Invest in an excellent antioxidant serum such as SkinCeuticals CE Ferulic, 135, or Phloretin CF, 170.

NOT NECESSARY IN A ROUTINE Many people dont need an eye cream, especially younger women with firm skin they can lightly apply their facial moisturiser to this area. For eye bags or very crinkly skin, lighter eye creams or serum, applied in the morning, will prevent the area from becoming puffy. I think a daily exfoliant should be avoided at all costs and once weekly exfoliation will suffice for most skin types.

This article originally appeared in theVolume 1 (January/February) 2020 issue of IMAGE Magazine.

Read more:8 Irish women in the beauty business on what their biggest failure taught them

Read more:5 things to know about the new Dyson Corrale straightener

Read more:Shopping fix: a silicone-free primer that locks your foundation in place

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'Everyone should use a topical retinol' Dr Rosemary Coleman on the essential skincare routine - image.ie

The best reasons why wine is healthy look – The KXAN 36 News

Posted: at 7:46 pm


The good drops at the end of a long day is not only for the soul a treat, but acts in masses from drinking, even a positive effect on the health. Red wine has some health promoting properties, if you overdo it with him.

How much is good?

A positive effect is only hope, if not too much is drunk. In the healthy range, you will move, if you as a middle-aged woman not more than 20 grams of alcohol that is to say 0.15 of a litre of wine a day and as a man, not more than 30 grams, i.e., 0.25 liters of wine.

white wine, Ros or red wine?

According to diet medical studies alcohol increases the good HDL cholesterol in the blood and prevents the formation of blood clots. It doesnt matter what type of wine you prefer.

red wine can be used more

red wine contains a much higher content of bioactive substances and vitamins A, B1 , B2, C, and D. antioxidants that slow down cell aging, especially in the skin of the grape which in the production of red wine. White wine is made without skin. In the production of ros wine, the grapes are tied to the same long to the skin, such as in the case of red wine production. During storage of the wine in a decrease in the vitamins, which is however slowed down by the acidity in the wine.

A glass of wine for the figure

Before sleeping, a glass of wine and go to drink, can actually help you lose weight. These studies were conducted at Washington State University and Harvard University say. The evening enjoyment of a glass of wine, in particular, can contribute to the night-time Demand arises for food. Late-night meals do not increase the risk of an increase in weight, as the bowel over night works equally well as during the day. Wine also contains the digestive substance Resveratrol, a substance that has a positive effect on the composition of blood lipids and prevents fat cells grow.

look Younger by wine

wine to drink, and to smooth wrinkles? Sounds like a true dream! The grapes contained Resveratrol is also a powerful antioxidant. With the help of the skin aging to combat and reduce wrinkles. You drink red wine so a daily glass, you can have your wrinkle cream in the Cabinet.

wine against dental caries

According to the Journal of Agricultural and Food Chemistry published a study of the regular handle can prevent to a glass of red wine, that dangerous bacteria from spreading in the mouth. Because red wine kills the bacteria. Bacteria can cause dental problems, including tooth decay.

Good for the heart and circulatory system

The daily glass of wine improves circulation and reduces the risk for cardiovascular disease by as much as 25 percent compared to a Abstinenzlers. Especially reducing the risk of a heart attack. Moderate wine consumption has a positive effect on the composition of the fats in the blood and helps the removal of harmful LDL-cholesterol, and expanded with the addition of the arteries. In addition, the risk is reduced to thrombosis, because the alcohol in the wine enhances the blood flow and the clotting of the blood.

How many calories in wine

Drink you like wine? Red wine protects the heart and preserves seizures before. The daily glass of alcohol is really healthy and how many calories are in a bottle?

This happens after a month without alcohol

After the holiday feasts, thousands take on the challenge to spend the first month in the new year sober. However, it brings anything at all to do without for such a short time on alcohol?

drinking culture has consequences for the health

Nowhere in the world is drunk so much alcohol as in Europe. This is the alarming result of experts concerned with diseases of the digestive organs. Few people know that with the consumption of alcohol, the risk for cancers of the digestive tract increases.

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The best reasons why wine is healthy look - The KXAN 36 News

Anti-aging Services Market Recent Trends and Developments, Challenges and Opportunities, key drivers and Restraints over the Forecast Period 2020-2026…

Posted: at 7:45 pm


The Anti-aging Services market research focuses on the market structure and various factors (positive and negative) affecting the growth of the market. The study encloses a precise evaluation of the Anti-aging Services market, including growth rate, current scenario, and volume inflation prospects, on the basis of DROT and Porters Five Forces analyses. In addition, the Anti-aging Services market study provides reliable and authentic projections regarding the technical jargon.

Anti-aging Services Market Research, in its recent market report, suggests that the Anti-aging Services market report is set to exceed US$ xx Mn/Bn by 2029. The report finds that the Anti-aging Services market registered ~US$ xx Mn/Bn in 2018 and is spectated to grow at a healthy CAGR over the foreseeable period. This Anti-aging Services market study considers 2018 as the base year, 2019 as the estimated year, and 2019 2029 as the forecast timeframe.

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The Anti-aging Services market study answers critical questions including:

The content of the Anti-aging Services market report includes the following insights:

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The key players covered in this studyAllergan, Inc.Elizabeth ArdenProcter & GambleLOreal SACynosure SAAge Sciences, Inc.Estee Lauder, Inc.Solta Medical, Inc.Beiersdorf AGLumenis, Ltd

Market segment by Type, the product can be split intoMicrodermabrasionLiposuctionBreast AugmentationChemical PeelSclerotherapyBotoxDermal FillersOthers

Market segment by Application, split intoFemaleMale

Market segment by Regions/Countries, this report coversNorth AmericaEuropeChinaJapanSoutheast AsiaIndiaCentral & South America

The study objectives of this report are:To analyze global Anti-aging Services status, future forecast, growth opportunity, key market and key players.To present the Anti-aging Services development in North America, Europe, China, Japan, Southeast Asia, India and Central & South America.To strategically profile the key players and comprehensively analyze their development plan and strategies.To define, describe and forecast the market by product type, market and key regions.

In this study, the years considered to estimate the market size of Anti-aging Services are as follows:History Year: 2014-2018Base Year: 2018Estimated Year: 2019Forecast Year 2019 to 2025For the data information by region, company, type and application, 2018 is considered as the base year. Whenever data information was unavailable for the base year, the prior year has been considered.

All the players running in the global Anti-aging Services market are elaborated thoroughly in the Anti-aging Services market report on the basis of R&D developments, distribution channels, industrial penetration, manufacturing processes, and revenue. In addition, the report examines, legal policies, and comparative analysis between the leading and emerging Anti-aging Services market players.

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Anti-aging Services Market Recent Trends and Developments, Challenges and Opportunities, key drivers and Restraints over the Forecast Period 2020-2026...

7 Bad Habits That Are Even Worse in the Age of Coronavirus – Best Life

Posted: at 7:45 pm


Everyone's got a few bad habits they'd rather not share with the worldwhether it's not flossing as frequently as you should, or easing your nerves by biting your fingernails. However, in the age of coronavirus, many behaviors that may have once seemed relatively innocuous could now pose an even more serious risk to your health. So, if you want to protect your well-beingand ensure the safety of those around youthese are the bad habits you need to kick during the coronavirus outbreak, according to medical experts.

There's never been a better time to invest in a bottle of no-bite nail polish.

"The space under the tips of your nails is a cozy place for all sorts of germs," explains dental surgeon Mike Golpa, chief executive officer of G4 by Golpa. "Putting unwashed hands straight into your mouth is a highway for bacteria."

Sure, you can't run out to Sephora or the spa when your skin is looking worse for wear these days, but that doesn't mean you should take matters into your own hands.

Anti-aging and functional medicine physician, Yeral Patel, MD, cautions against picking at your skin during the pandemic, noting that doing so could put your health in jeopardy. "Touching surfaces with the virus and then touching your face allows for easy access into the body via the mouth, eyes, or nose," she says.

The hairdresser tasked with taming those broken strands and split ends isn't the only person who wishes you'd stop idly twirling your hair around your fingers.

"Hair, if it has touched a dirty surfaceespecially long haircan then transmit the virus to the mouth, nose, or eyes via hand transmission," explains Patel.

Since the virus can live on some surfaces for up to a few days, it's important to increase the regularity with which you wash anything that comes into direct contact with your bodyand that's especially true when it comes to your bedsheets.

"People who do laundry every 1-2 weeks for sheets and towels should try to wash at least 2-3 times a week," Patel says.

Your toothbrush may be getting those pearly whites clean, but if you're not careful, it could be making you sick, too.

"Toothbrushes may have saliva or blood on them and have been shown to transmit viruses," says Henry Hackney, DMD, director of content at Authority Dental, who notes that the virus can live on certain surfaces for up to three days. To protect yourself, he recommends storing your toothbrush upright instead of flat against a sink or countertop, and keeping it at least a few inches from those belonging to your family members or roommates.

As tempting as it may be to get that piece of spinach out of your teeth immediately, your health may benefit from your decision to wait.

"You may have a virus and other germs on your hands," says Hackney, who recommends waiting to attend to those dental issues at home after washing your handsand preferably with floss or a toothbrush, not your fingers.

Save those romantic meals for when the pandemic has subsided, as the virus can be easily transmitted from dishes and eating utensils.

"Don't share food, drinks, eating utensils, drinking containers, dishes, glasses, cups, cutlery, [or] straws," advises Hackney.

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7 Bad Habits That Are Even Worse in the Age of Coronavirus - Best Life

Intensive Anti-Aging Treatment Market Demand Analysis and Projected huge Growth by 2025 – Daily Science

Posted: at 7:45 pm


A detailed research study on the Intensive Anti-Aging Treatment Market was recently published by UpMarketResearch. The report puts together a concise analysis of the growth factors influencing the current business scenario across various regions. Significant information pertaining to the industry analysis size, share, application, and statistics are summed in the report in order to present an ensemble prediction. Additionally, this report encompasses an accurate competitive analysis of major market players and their strategies during the projection timeline.

The latest report on the Intensive Anti-Aging Treatment Market consists of an analysis of this industry and its segments. As per the report, the market is estimated to gain significant returns and register substantial y-o-y growth during the forecast period.

Request a Sample Report of Intensive Anti-Aging Treatment Market at: https://www.upmarketresearch.com/home/requested_sample/37116

According to the report, the study offers details regarding the valuable estimations of the market such as market size, sales capacity, and profit projections. The report documents factors such as drivers, restraints, and opportunities that impacts the remuneration of this market.

An Outline of the Major Key Points of the Intensive Anti-Aging Treatment Market Report:

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The Geographical Landscape of the Market Include:

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Some of the Major Highlights of TOC Covers:Chapter 1: Executive Summary

Chapter 2: Methodology & Scope

Chapter 3: Market Insights

Chapter 4: Company Profiles

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About UpMarketResearch:Up Market Research (https://www.upmarketresearch.com) is a leading distributor of market research report with more than 800+ global clients. As a market research company, we take pride in equipping our clients with insights and data that holds the power to truly make a difference to their business. Our mission is singular and well-defined we want to help our clients envisage their business environment so that they are able to make informed, strategic and therefore successful decisions for themselves.

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Focus on Aesthetics and Durability to Drive Demand Within Global Active, Smart, and Intelligent Packaging Market for Cosmetics and Personal Care:…

Posted: at 7:45 pm


- Packaging solutions for the cosmetics industry need to encapsulate several factors such as cost, aesthetics, safety, and durability

- A large population of people relies on the use of personal care products for their daily grooming. Manufacturers are, therefore, required to follow high standards of packaging that fit the needs of the consumers

ALBANY, New York, March 30, 2020 /PRNewswire/ -- The past decade has witnessed an upsurge in the consumption of cosmetic products, and has created growth spaces within the global active, smart, and intelligent packaging market for cosmetics and personal care. Several companies have entered the global cosmetics industry, and are making extensive efforts to establish their foothold in this industry. The success of these new vendors relies on a range of factors pertaining to product packaging, sales channels, customer demands, and retailing efficiency. Cosmetic products continue to attract the attention of the young population. Marketers and packaging entities play with the psyche of the customers by using attractive, appealing, and compelling packaging modules. In the current times, retail outlets are glutted with several brands of cosmetics that are readily bought by the younger population.

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The total worth of the global active, smart, and intelligent packaging market for cosmetics and personal care products was valued at US$ 145.4 million in 2018. It is estimated that this market would expand at a formidable CAGR of 7.8% over the period between 2019 and 2027. The unprecedented need for improved cosmetic products has played a critical role in driving sales across this market.

Product Differentiation as a Crucial Element of Market Growth

Get comprehensive insights about various trends and opportunities prevailing in the Active Smart and Intelligent Packaging Market for Cosmetics and Personal Care (Application - Flexible Packaging, Rigid Packaging; Function - Protection & Security, Indication, Track & Trace, Authenticity; Product - Active Packaging, Smart & Intelligent Packaging; End Use - Skin Care, Hair Care, Make up, Nail Care, Perfumes, Others) - Industry Analysis, Size, Share, Growth, Trends and Forecast 2019 2027 at:

https://www.transparencymarketresearch.com/active-smart-intelligent-packaging-market.html

Changing Packaging Standards across the Cosmetics Industry

The cosmetics industry has transformed into a sophisticated domain that continually embraces new technologies and grabs on to new opportunities. Several manufacturers have used data tools, analytics, and surveys to understand the propensities of the consumers. These manufacturers found that a large population of people is compelled into buying a cosmetic product with distinct packaging styles. Therefore, new-age manufacturers are using attractive designs and colours to market their products across key regions. Some of the leading drivers of demand within the global active, smart, and intelligent packaging market are:

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Sluggish Pace of Digital and Technological Transformation to Hamper Market Growth

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Global Active, Smart, and Intelligent Packaging Market: Competitive Tracking

Packaging solutions for cosmetic products need to combine aesthetics, durability, and strength. Therefore, leading vendors focus on positioning their solutions along the aforementioned lines. Some of the key players are LCR Hallcrest LLC, 3M Company, Thin Film Electronics ASA., Bemis Company, Inc., Amcor Limited, CCL Industries Inc., and Coveris Holdings S.A.

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The global active, smart, and intelligent packaging market is segmented by:

Application

Function

Product

End Use

Explore Transparency Market Research's award-winning coverage of the Global Packaging Industry:

Sustainable Packaging Market Initiatives taken by sustainable packaging manufacturers to use environmental friendly packaging materials and technology in packaging products, has been supported by various organizations as well as governments. Sustainable packaging manufacturers are looking towards developing biodegradable plastics that will reduce carbon footprint. With a growing demand for a sustainability driven world, packaging experts and consumer products companies are focusing on "green packaging".

Healthcare Packaging MarketHealthcare packaging is one such lucrative end-use segment of the packaging industry, which has been on an incremental growth path, given the influence of doorstep delivery on consumers. As the scale of innovation shifts towards a higher range in the healthcare industry, with the advent of customized-drug development, healthcare packaging manufacturers step up their efforts to devise solutions, competent enough to handle drugs in even small batches.

Pre-press for Packaging Market Growing consumer affinity toward innovative and attractive packaging, coupled with advances in flexographic and digital printing, are some of the leading factors that are expected to drive the growth of the pre-press for packaging market close to the US$ 5 billion figure by the end of the forecast period (2019-2027).

Vacuum Packaging MarketThe changing lifestyle and growing preference for packaged food has grown the demand for vacuum packaging. Vacuum packaging helps in providing better shelf life, better flexibility, and portability for the food. Nowadays, more than 20% of the manufacturers have started using vacuum packaging. In addition, the players in the market introduce innovative solutions to meet the functional requirements of various end-user, especially in the food and beverages segment.

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Focus on Aesthetics and Durability to Drive Demand Within Global Active, Smart, and Intelligent Packaging Market for Cosmetics and Personal Care:...

Celebrities that take HGH: Why do they need it? – – VENTS Magazine

Posted: at 7:45 pm


Human Growth Hormone (HGH) therapy has been around for decades but has been reserved for specific patients. Those with HIV or children with a hormone deficiency were some of the patients who benefitted. However, in recent years, a new focus has targeted therapy to help adults with hormone deficiencies.

HGH is aproteinproduced by the pituitary gland. The hypothalamus and hormones in the intestinal tract and pancreas help to balance it. It thrusts into production during sleep, exercise or trauma with more produced at night than in the daytime, given rising to the term beauty rest as the hormone is also linked to anti-aging.

Production of the hormone decreases as we age and that can lead to problems typically associated with getting older like:

The purpose of the growth hormone in children is to help bones and muscles grow. It also helps with organ function. Hormone therapy in adults is linked to:

Manycelebritiesare reportedly using hormones, but many are doing it illegally. They do it for anti-aging or for muscle mass. This is something all doctors warn against because the growth hormone has some possible side effects including water retention, high blood sugar, and joint and muscle pain. Plus, for those who have normal hormone levels, illegal use of it and then stopping will cause your body to produce less. That leaves you worse off than before.

Most celebrities who take legal hormone therapy dont like to talk about it for a variety of reasons. Its a controversial subject and many deem it private. However, a handful of aging stars have come out to talk about their decision to go on legal hormone therapy.

Benefits of therapy were noted in a New EnglandJournal of Medicine study. Men on six months of therapy increased their muscle mass 8.8 percent and reduced body fat by more than 14 percent. While it is linked to anti-aging, there are no conclusive studies to prove that.

Those considering hormone therapy must get a prescription in order to go to Hormone Clinic. That includes going to a doctor, getting a blood test and probably some specialized testing on the pituitary gland and hypothalamus. Or, you can just call for free consultation toHGH Therapy Clinicand get all the instructions. This clinic, as long as other top-rated clinics, does not provide therapy for bodybuilders and only provides it to those with a hormone deficiency.

This therapy is administered by injection and should be part of a routine health management plan under a doctors care to avoid side effects. For more information about hormone therapy, fill in the contact form and the knowledgeable advisor will call you back.

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Celebrities that take HGH: Why do they need it? - - VENTS Magazine

Targeting Unhealthy Lifestyles May Increase Longevity in Those With Severe Mental Illness – PsychCentral.com

Posted: at 7:44 pm


Addressing unhealthy lifestyle factors among people with severe mental illness could potentially provide the greatest benefit in increasing life expectancy, according to a new U.K. study conducted by researchers at Kings College London.

Severe mental illnesses include schizophrenia, schizoaffective disorder, bipolar disorder and major depression.

In particular, the study found that interventions designed to help schizophrenia patients quit smoking and approaches to help lessen sedentary behavior among patients with bipolar disorder appear to be the most promising ways to increase life expectancy, showing an increase of 2 years 5 months and an increase of one year 3 months, respectively.

Currently, people with severe mental illness tend to live on average 12 to 15 years less than those in the general population. For example, 80% of deaths in patients with severe mental illness are caused by common diseases such as heart disease, respiratory illnesses, diabetes, cancer and digestive disorders.

All of these diseases can be at least partly attributed to unhealthy lifestyle factors, social isolation and deprivation, and inadequate use of healthcare services.

To help inform public health policy, the research team aimed to estimate how much tackling these changeable factors in the lives of people with severe mental illness could translate into a gain in life expectancy.

Using data from systematic reviews, the research team investigated the links between a range of different risk factors and the total number of deaths among participants with severe mental illness.

The factors were categorized into three groups: behavioral risk factors, such as smoking and physical inactivity; healthcare risk factors, such as uptake of treatment and access to healthcare resources; and social risk factors, such as stigma and exclusion.

By considering the effectiveness of interventions aimed at changing these factors, the research team then calculated the gains in life expectancy that could occur. Examples of interventions to address the risk factors were smoking cessation initiatives, improving access to antipsychotic medication and educational approaches to help reduce mental health stigma.

The analysis findings suggest that approaches that tackle all of these factors could produce a potential gain in life expectancy of four years for those with bipolar disorder and seven years for those with schizophrenia. Gains in life expectancies were also estimated later in life and at 65 years the projected gain was three years for bipolar disorder and four years for schizophrenia.

Our study shows that by addressing the health behaviors, health care engagement and social issues of people with severe mental illness we could potentially increase their life expectancy by about 4 to 7 years, said lead author Dr. Alex Dregan from the Institute of Psychiatry, Psychology & Psychiatry at Kings College London.

The analysis indicates that, when considering different approaches to help those with severe mental illness, the whole is greater than the sum of the parts and there is more benefit if a multifaceted approach is taken which addresses behaviour, healthcare and social issues simultaneously.

Greater investments in developing more effective interventions aimed at reducing unhealthy behaviors and treating the underlying symptoms would contribute to reducing the gap in premature mortality between those with severe mental illness and the general population.

The study is published in the journal PLOS ONE.

Source: Kings College London

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Targeting Unhealthy Lifestyles May Increase Longevity in Those With Severe Mental Illness - PsychCentral.com

Research helps to explain POPs and sow longevity – The Pig Site

Posted: at 7:44 pm


A little over a year and half ago, a study to better understand potential issues around POP and sow mortality began with faculty investigators and staff at the Iowa Pork Industry Center. It started as a survey project, collaborating with about 13 larger sow production systems and about 20 independent producers throughout the country, and has continued to grow.

As we worked on the project, it gave us some different ideas and strategies that have helped us start developing additional research protocols and programmes, said Dr Ross. Since then we've continued to do research trying to better understand individual sows and characteristics around individual sows that have a high risk for POPs.

The research team then developed a strategy to evaluate sows during late gestation and identify sows that are at a higher risk for POP than other sows in their group. The team collects biological samples from sows and evaluates those samples to help get a better picture of what's going on inside the sow that precedes the occurrence of a prolapse in the farrowing room.

We have had some good results, but it's a very complex issue. There are a lot of variables that we can't quite account for, and we dont understand what the contribution of every individual variable is, Dr Ross said. But one of the things we have been able to see fairly consistently is that there are endogenous changes within the sow and the vaginal microbiome. There are differences in the serum biomarkers and some of the biomarkers that we see are different in sows that have a high and low risk for POP. Some of these are associated with inflammation and steroid biosynthesis.

The study continues to validate some of the biomarkers and also assists researcher with the development of mitigation strategies that they can test with producers. The team also has biomarkers to check if the sows are responding to the mitigation strategies.

At the end of the day, the reason we started all this work is because there's been a consistent increase in POPs across the industry for the last 10 years, Ross said. Our long-term goal is to work hard to understand some of the biological underpinnings that contribute to a sow's risk of POP.

For producers, the value of the long-term POP research is that it helps the producer understand the biological aspects that contribute to why a sow might prolapse. It also offers mitigation strategies and protocols to use when their sows do show a POP.

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Research helps to explain POPs and sow longevity - The Pig Site

These companies are racing to roll out COVID-19 treatments – KMOV.com

Posted: at 7:44 pm


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These companies are racing to roll out COVID-19 treatments - KMOV.com

The Difference of Asphalt, Concrete In Drive Work and Repair – Fife Free Press

Posted: at 7:44 pm


When building or repairing driveways, concrete is often preferred for its longevity, while asphalt is the go-to material when it comes to cost-effectiveness. But there are more technical factors to consider.

Looking to install a new drive or simply renovate an existing one? Whether its an asphalt or concrete drive, knowing the differences and the merits of each one will help you in your efforts.

Asphalt is a mixture of rock, sand, asphalt cement, and petroleum products. In terms of cost, youll spend about $2 to $5 per square foot. Due to the presence of petroleum in its composition, asphalt is flexible enough to withstand pressure that causes cracking.

After asphalt is poured, it is relatively quick to dry about 2 to 3 days. As result, you can start using your asphalt drive much sooner after installation compared to concrete.

However, a big downside is that asphalt has a relatively short lifespan of about 10 to 20 years. Of course, this will depend on the workmanship upon installation, quality of maintenance, climate, and other usage factors.

In summer, asphalt tends to get hot as it absorbs heat. This might be inconvenient for some, especially if it prevents you from spending more time outdoors during this time of the year.

Asphalt driveways also need to be regularly maintained, ideally twice a year, to make them last longer and avoid costly repairs.

Concrete, on the other hand, is widely considered as the more durable and long-lasting material. Its made up of different kinds of stone and sand, which are held together by water and cement.

Slabs made of concrete are tough enough to handle very heavy loads and they require only occasional maintenance work. In terms of lifespan, you can make concrete last up to 50 years, given the right conditions and quality of workmanship.

There are a couple of trade-offs for all these good qualities, starting with price.

Concrete is more expensive and will cost you approximately $4 to $10 per square foot. It also takes about seven days to properly dry and cure.

Installing a concrete drive is no small feat and may prove difficult for less savvy and not so technically capable. This is because the process of pouring and finishing concrete must be done expeditiously since the hardening of the material happens quickly. Hiring professionals can make the job much easier.

Unlike asphalt, concrete is much more prone to cracking. Concrete repair, whether youre in Ogden, Sacramento, or elsewhere, can be quite expensive so make sure to do annual maintenance work. Scrubbing and applying sealers will contribute to concretes longevity.

While installing either asphalt or concrete on your drive has less stringent requirements compared to regulations governing public roads, you need to have a basic understanding of their technicalities to find the most ideal approach.

What are the pros and cons that you can bear with and which fits your budget best? The answers to these questions are derived from knowing the unique characteristics of both asphalt and concrete.

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The Difference of Asphalt, Concrete In Drive Work and Repair - Fife Free Press

Pro featherweights name their 145-pound GOAT – BJPENN.COM

Posted: at 7:44 pm


One of the biggest questions in all of MMA is who is the GOAT? Is it someone who had the biggest impact on the sport or the person who won the most? Its an interesting debate for fighters and fans alike to have at any time.

So, with little to no MMA on for the foreseeable future, BJPENN.com reached out to several current and former featherweights to ask who their divisional GOAT is. The majority believe it is Jose Aldo but it is a three-person race between the Brazilian, Max Holloway and Conor McGregor.

Ryan Hall, UFC featherweight: In my eyes, the featherweight GOAT to date is Jose Aldo based on his longevity and body of work. Max Holloway has a legitimate claim, as well, but I would lean towards Jose. Conor McGregor and Alexander Volkanovski both have/had fantastic runs through 145 division, but lack longevity.

I would draw a line between greatest and best as one vs. one matchups arent indicative of dominance overall. In many cases, the skill of a fighter and their resume are not in sync. Fighters from later generations have the benefit/advantage of learning athletes who came up ahead of them. Not fair to make a direct comparison based on skill.

Artem Lobov, former UFC featherweight: To me, to be the best you have to beat the best and Conor did that. He beat Aldo, and people forget when he fought Aldo, Aldo was undefeated for 10 years. He was the top pound-for-pound guy and showed no signs of slowing down. Look what Conor did to him. Also, look at his climb up, he beat Dustin Poirier but people say oh Poirier is a different fighter since then. No, he has always been a killer, when Conor fought Dustin, Dustin was number five in the world. He was one of the best featherweights, huge winning streak and was putting guys away. Conor destroyed him in under two minutes. How impressive is that? He came out of nowhere, he didnt have any money and no one knew who he was. No one has done what he has done so he is the GOAT at featherweight.

Sodiq Yusuff, UFC featherweight: Its a pretty close race in my mind between Aldo and Max but Im leaning towards Aldo because of his dominance for such a long time. But Max beat him twice with a similar resume of wins. It is a close race between them.

Jared Gordon, UFC featherweight: Jose Aldo. Only because he defended and was undefeated for so long.

Dan Ige, UFC featherweight: Aside from myself I believe Aldo is the greatest. He reigned on top forever in the WEC and UFC and was dominating everyone for a long time. Max and Frankie are up there too.

Mirsad Bektic, UFC featherweight: Jose Aldo. He was the first UFC featherweight champion and has the longest winning streak in the division.

Billy Quarantillo, UFC featherweight: It has to be Jose Aldo still. What he did in the WEC and UFC is still the most impressive featherweight resume.

Steven Peterson, UFC featherweight: Jose Aldo was the most feared featherweight at his prime. He dismantled everyone at that time and made it look easy. It took years for someone to figure him out and I think he was past his prime when he fought and got KOd by Conor McGregor. Had he been in his prime I think that fight wouldve gone differently. After that, he was never the same. While he was the champ he seemed unbeatable. Thats why I consider him the featherweight GOAT.

Jeremy Kennedy, PFL featherweight: Its a tough one between Aldo and Max. Max had the longer winning streak within the UFC but has some early losses and his loss at lightweight doesnt help either. Ultimately, Im going to go with Aldo as he had such a long runt through WEC and then was the only UFC featherweight champ for years. He cleared out the division before Conor came. During his reign, he looked unbeatable and had never lost outside of that early one on his career.

Kyle Nelson, UFC featherweight: As of right now I think Jose Aldo is still the featherweight GOAT. He held the title in the WEC and UFC. Since he lost the belt it has changed hands a few times so I dont think anyone else has earned the GOAT status yet.

Georgi Karakhanyan, Bellator featherweight: Who the featherweight GOAT is such a good question. I think it is Patricio Pitbull. He is a great fighter and has been killing it in Bellator. I was thinking about Aldo but Patricio is a champ-champ and hes a very strategic fighter and is on a long winning streak.

Consensus featherweight GOAT: Jose Aldo

Do you agree with the pros that Jose Aldo is the featherweight GOAT? Let us know in the comment section.

ICYMI: Pros have already picked the flyweight and bantamweight GOATs.

Stay locked to BJPENN.com over the coming days to see who pros picked as the GOAT for every division.

This article first appeared onBJPENN.com on 3/30/2020.

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Pro featherweights name their 145-pound GOAT - BJPENN.COM

The Rock Reveals His Wrestling Mount Rushmore Ahead of WWE WrestleMania 36 – Bleacher Report

Posted: at 7:44 pm


Jean Baptiste Lacroix/Getty Images

If you're building a wrestling Mount Rushmore, there's a solid argument to be made for including The Rock. He's one of the two or three greatest promos in history, wrestled with a charisma that had fans hanging on his every strike and only had a career shortened because heleft to become the highest-paid actor in Hollywood.

When it comes to Rock's own personal Mount Rushmore, though, he can only come up with three, along with a host of others for the fourth spot.

"My wrestling Mount Rushmore would be 'The Immortal' Hulk Hogan, 'The Nature Boy' Ric Flair, 'The Texas Rattlesnake' Steve Austin," Rock said during an Instagram Live Q&A, per Kellie Haulotteof Wrestling Inc. "That fourth person, I always kind of keep blank because I vacillate back and forth between 'Nature Boy' Buddy Rogers, Bruno Sammartino, Randy 'Macho Man' Savage, Dusty Rhodes."

That list of three is about as close to ironclad locks as one can get. Hogan's racist commentshave turned off many fans, but he's undeniably the biggest star in wrestling historyperhaps more responsible than any person, save Vince McMahon, for the popularity of wrestling in the United States. Flair is the consummate pro wrestler and to many the GOAT for his combination of mic skills, in-ring classics and longevity.

Austin and Rock defined the Attitude Era, pushing WWE to heights it has not seen in the two decades since.

He added:

"You always want to pick people who have had the most impact on the wrestling business, who have moved the bottom line, but also, most importantly, they just have this intangible, this X-factor, where they can connect with the crowd and connect with an audience. And the bottom line is with those three individuals that I mentionedHogan, Austin and Flairthey really moved the company's bottom line. They moved the NWA's bottom line, the WWF and the WWE's bottom line. In terms of drawing power, these were the biggest draws in the history of professional wrestling, and that's all that matters."

Rock said he considers himself "on the back of Mount Rushmore," which is a bit of humility downplaying his impact.

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The Rock Reveals His Wrestling Mount Rushmore Ahead of WWE WrestleMania 36 - Bleacher Report

Resveratrol Market Insights Trends and Forecast Prediction by 2026 | Industry Leading Key Players: DSM, Sabinsa, InterHealth, Maypro., Evolva, Laurus…

Posted: March 29, 2020 at 6:54 pm


Data Bridge Market Research has published a new report titled Resveratrol Marketreports provides 5 year pre-historic and forecast for the sector and include data on socio-economic data of global. Key stakeholders can consider statistics, tables & figures mentioned in this report for strategic planning which lead to success of the organization. Some are the key players taken under coverage for this study are DSM, Sabinsa, InterHealth, Maypro., Evolva, Laurus Labs, Resvitale, LLC, Endurance Products Company, Chemamde, ,Jiangxing Hesheng Biologics Co., Ltd., Shanghai Natural Bio-engineering Co., Ltd, drugdu.com, Xieli Pharmaceutical, HANGZHOU GREAT FOREST BIOMEDICAL LTD ., among other domestic and global players.

The overviews, SWOT analysis and strategies of each vendor in the Resveratrol market provide understanding about the market forces and how those can be exploited to create future opportunities.

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Market Analysis and Insights: Global Resveratrol Market

Resveratrol market is expected to reach a market value of USD 149.43 million by 2027, while growing at a growth rate of 9.5% in the forecast period 2020 to 2027. Increasing demand of dietary supplements is the factor for the resveratrol market in the forecast period of 2020- 2027.

Resveratrol is a type of polyphenolic compound which is developed from various fruits such as grapes, blueberry and others while used as antioxidant agent and key compound in red wine. Resveratrol has many health benefits and helps in the treatment of cancer, cardiovascular diseases, metabolic disorders and others.

Increasing awareness regarding the benefits of healthy food products, rapid urbanization, rising demand of health supplements, busy and hectic lifestyle are some of the factors that will enhance the growth of the resveratrol market in the forecast period of 2020-2027. On the other hand, increasing applications from different economies and research activities will further create new opportunities for the growth of resveratrol market in the above mentioned forecast period.

Stringent regulatory factor will act as a restraint factor for the growth of resveratrol market in the above mentioned forecast period.

Competitive Analysis:

The key players are highly focusing innovation in production technologies to improve efficiency and shelf life. The best long-term growth opportunities for this sector can be captured by ensuring ongoing process improvements and financial flexibility to invest in the optimal strategies. Company profile section of players such asDSM, Sabinsa, InterHealth, Maypro., Evolva, Laurus Labs, Resvitale, LLC, Endurance Products Company, Chemamde, ,Jiangxing Hesheng Biologics Co., Ltd., Shanghai Natural Bio-engineering Co., Ltd, drugdu.com, Xieli Pharmaceutical, HANGZHOU GREAT FOREST BIOMEDICAL LTD ., among other domestic and global players.

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Global Resveratrol Market Scope and Market Size

Resveratrol market is segmented on the basis of product type, form and end-use. The growth among segments helps you analyse niche pockets of growth and strategies to approach the market and determine your core application areas and the difference in your target markets.

The report presents relevant data about the different dangers and difficulties looked by various stakeholders. With the proper utilization of established and advanced tools such as SWOT analysis and Porters Five Forces Analysis, this market report has been structured. The Resveratrol market report considers indispensable viewpoints about the key players in the market, for example, solid and feeble points of the contenders and examination of their techniques as for product and market.

To comprehend Resveratrol market dynamics in the world mainly, the worldwide Resveratrol market is analyzed across major global regions.

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In this study, the years considered to estimate the market size of Resveratrolare as follows:

History Year: 2013-2018

Base Year: 2018

Estimated Year: 2018

Forecast Year to 2027

Key Stakeholders/Global Reports:

Resveratrol Manufacturers

Resveratrol Distributors/Traders/Wholesalers

Resveratrol Subcomponent Manufacturers

Industry Association

Downstream Vendors

Thanks for reading this article, you can also get individual chapter wise section or region wise report version like North America, Europe or Asia.

About Data Bridge Market Research:

Data Bridge Market Research set forth itself as an unconventional and neoteric Market research and consulting firm with unparalleled level of resilience and integrated approaches. We are determined to unearth the best market opportunities and foster efficient information for your business to thrive in the market. Data Bridge endeavors to provide appropriate solutions to the complex business challenges and initiates an effortless decision-making process.

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Tel: +1-888-387-2818

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Resveratrol Market Insights Trends and Forecast Prediction by 2026 | Industry Leading Key Players: DSM, Sabinsa, InterHealth, Maypro., Evolva, Laurus...

Anti-Aging Medicine Market: Business Opportunities, Current Trends and Industry Analysis by 2023 – Daily Science

Posted: at 6:52 pm


The global Anti-Aging Medicine market is forecasted to reach a market value of ~US$ XX Mn/Bn by the end of 2029 registering a CAGR growth of around XX% during the forecast period (2019-2029). The recent market report provides a detailed analysis of the current structure of the Anti-Aging Medicine market along with the estimated trajectory of the market over the course of the stipulated timeframe.

The report provides an in-depth assessment of the numerous factors that are anticipated to impact the market dynamics with utmost precision and accuracy. The SWOT and Porters Five Forces Analysis provides a clear picture about the current operations of the various market players operating in the global Anti-Aging Medicine market.

Request Sample Report @ https://www.persistencemarketresearch.co/samples/26233

The Anti-Aging Medicine market report portrays the market share and the application of each of the sub-segments across various verticals.

The report ponders over the market scenario in various geographies and highlights the major opportunities, trends, and challenges faced by market players in each region. An in-depth country wise analysis of each major region provides readers a deep understanding of the regional aspects of the market including, the market share, pricing analysis, revenue growth, and more.

key players in the region.

Some of the players operating in the global anti-aging medicine market are Pfizer, Evolution GmbH, Himalaya Global Holdings Ltd., Cipla Limited, Mylan Laboratories, Novartis, Merck Group, Vitabiotics, William Ransom & Son Holdings Plc, Uni-Vite Healthcare and Health Made Easy Limited amongst others.

The report covers exhaustive analysis on:

Regional Analysis:

Report Highlights:

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The market report on the Anti-Aging Medicine market addresses some important questions such as:

Crucial data enclosed in the report:

For any queries get in touch with Industry Expert @ https://www.persistencemarketresearch.co/ask-an-expert/26233

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Anti-Aging Medicine Market: Business Opportunities, Current Trends and Industry Analysis by 2023 - Daily Science

Anti-aging Market : Analysis and In-depth study on market Size Trends, Emerging Growth Factors and Forecasts to 2023 – Jewish Life News

Posted: at 6:52 pm


Anti-aging Market 2018: Global Industry Insights by Global Players, Regional Segmentation, Growth, Applications, Major Drivers, Value and Foreseen till 2024

The report provides both quantitative and qualitative information of global Anti-aging market for period of 2018 to 2025. As per the analysis provided in the report, the global market of Anti-aging is estimated to growth at a CAGR of _% during the forecast period 2018 to 2025 and is expected to rise to USD _ million/billion by the end of year 2025. In the year 2016, the global Anti-aging market was valued at USD _ million/billion.

This research report based on Anti-aging market and available with Market Study Report includes latest and upcoming industry trends in addition to the global spectrum of the Anti-aging market that includes numerous regions. Likewise, the report also expands on intricate details pertaining to contributions by key players, demand and supply analysis as well as market share growth of the Anti-aging industry.

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Anti-aging Market Overview:

The Research projects that the Anti-aging market size will grow from in 2018 to by 2024, at an estimated CAGR of XX%. The base year considered for the study is 2018, and the market size is projected from 2018 to 2024.

Leading manufacturers of Anti-aging Market:

competitive landscape and key product segments

And Many More.

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Anti-aging Market : Analysis and In-depth study on market Size Trends, Emerging Growth Factors and Forecasts to 2023 - Jewish Life News

Botox Treatment: How It Feels To Look Young Again – Love Belfast

Posted: at 6:52 pm


Long gone are the days where individuals commonly associate Botox injections with celebrity status. There are growing demographics of men and women who are looking to reverse the signs of aging and turn back the clock. The growing popularity of trained Botox administration has increased the accessibility of this form of treatment. With the ability to look younger at your fingertips, you will find yourself wondering if Botox actually works.

Botox is generally used to reduce the appearance of wrinkles and aging in the facial area. Physicians will use Botox to reduce the presence of frown lines or the eleven sign between the eyebrows. Botox may be used to reduce the effects of smoking on aging too. There are many ways that Botox is used for medical treatments aside from purely aesthetic purposes however, they are more commonly known for their aesthetic uses. If you are curious if Botox injections are used for your needs you can schedule a consultation with an appropriate professional. There are some off-label uses of Botox, but these are generally not recommended or dont have sufficient evidence to approve them.

This treatment involves a chemical derived from a bacterium known as Botulinum toxin which produces the neurotoxic agent known as Botox. It prevents the ability of muscles to contract and forces them to relax. This is what causes the inhibition of wrinkles and signs of aging. So the short answer would be yes, Botox treatments can and do work, as long as theyre monitored by a physician. They do make people look younger, and by association, they feel younger. Im sure weve all seen the pictures of people who have taken treatment to an excess and they cant complete many facial expressions. This can be for a variety of reasons, particularly over-treatment. There are some scenarios where Botox is not effective for certain individuals, and they may require more units in order to stimulate the paralyzing effect.

To let you know, this kind of treatment does involve injections into the portions of the face where you are looking to reduce wrinkling. However, they tend to use higher gauge needles (smaller needles) to complete the procedure. Besides that, it usually takes less than a half-hour, so even if there is mild discomfort, it does not take long to complete the procedure at all. The length of the procedure will be dependent on how extensive you want the treatments to be.

Botox maintain their anti-aging properties for a period ranging several months. Depending on the extent of the treatment they will typically last between a few months to half a year. Because these results are temporary, people who are looking to combat their aging tend to get these treatments periodically. It may be used as a preventative measure against aging.

The cost depends on the extent of treatment that youll be getting done. Many aesthetic physicians will charge their prices based on the number of Botox units that they will be using. But the amount of aging or wrinkles youre looking to reduce will change this number. Other aesthetic physicians will base the cost of their treatments on their experience, and amount of time customizing treatment to a particular individuals needs. Botox injections can easily cost anywhere from and upwards of $400.

Who can provide Botox injections depends on the laws of the state that you currently live in. In some states, nurses or nurse practitioners can perform the procedure, while others require a physician. Nurses will need to work in a facility with a medical professional who can prescribe the Botox, as its a prescription-only medication. Who provides the treatment for you depends on your personal decision and local laws. Whoever you choose to use for Botox injections you should always look for reviews, or ask other people who have got Botox injections what their experience was.

Prior to getting any treatment, you should also verify the credentials of the administrator prior to making an appointment. Online reviews can also provide some insight into other patients experiences with a particular individual. You also want to gauge how comfortable you feel with an aesthetic professional during your consultation. There are some risks associated with the procedure, but theyll likely be explained to you during your consultation. If you are looking to prevent or reduce the signs of aging, Botox is definitely a method that can and does make many people look younger.

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Botox Treatment: How It Feels To Look Young Again - Love Belfast

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