Students at most Michigan public universities began classes this week, and even though schools have spent months preparing for a safe return amid the pandemic, what's happening off campus is causing heightened concern. The parties were inevitable, some say. They started happening at schools where students returned to campuses earlier than most, such as the University of South Carolina, which began Aug. 20 and now has more than 1,000 cases of COVID-19. All but nine positive cases are students. In Michigan, Central Michigan University now has 260 cases traced to the Aug. 17 return of students, including people living in and around the community, according to the Central Michigan District Health Department that serves six mid-Michigan counties. At Adrian College, the number of cases reached 152, which includes 138 cases that are active, the Lenawee County Health Department reported Thursday. At Wayne State University, President M. Roy Wilson sent a letter to students, asking them to behave. Dr. Teena Chopra, an infectious disease professor at Wayne State, said getting the younger generation to embrace safe behaviors is tough. "We can control what students do on campus," she said. "But when they are off campus, we cannot control that. These social gatherings are very good examples of how we are spreading the virus, and how the transmission can happen. Right now, students tend to gather outside, which is less risky. But once the weather changes and it's too cold to be outside all the time, Chopra doesn't expect schools to be able to continue in-person instruction. "We are going to be in a different situation," she said. "I don’t think the schools and colleges in the midst of winter will be able to remain open very long. It is impossible for younger kids to comply with 100% masking, and not be within 6 feet of one another."

For women who are pregnant, the pandemic can be particularly fraught with anxiety as they worry about the effects of COVID-19 on themselves and their babies, all while coping with potential job loss, child care issues and economic uncertainty. An evolving body of research — including a recent study by investigators at the Wayne State University Medical School and the National Institutes of Health Perinatology Research Branch in Detroit — has shown it's unlikely for the virus to pass from a pregnant woman to her fetus. A data analysis of U.S. cases, published by the federal Centers for Disease Control and Prevention in July, concluded that pregnant women are at no greater risk of dying from the virus than non-pregnant women, though they are more likely to end up in intensive care and require a ventilator. With 24 million cases of COVID-19 worldwide, including about 6 million in the United States and more than 100,000 in Michigan, there has been no consistent evidence of pregnant mothers passing the infection to their newborns, what's called vertical transmission. While other viral infections such as Zika, cytomegalovirus and rubella can be passed from mother to fetus, researchers led by Dr. Roberto Romero, chief of the Perinatology Research Branch at the National Institute of Child Health and Human Development at Wayne State, investigated why the same isn't true of SARS-CoV-2, the virus that causes COVID-19. "The rate of vertical transmission is extremely low," Romero said. "The best estimates that we have are less than 2%, or less than 1%. There have been some reports of neonates testing positive after birth, but there is always the question: Was that virus acquired in utero, or was it acquired from a mother who is sick?" 

Tabitha Moses, MD/PhD candidate at Wayne State University, wrote an article for The Conversation about the challenges that online instruction can pose for students if they are required to keep their cameras on during class. “As the 2020-21 school year gets underway – both at the K-12 and college level – many students find themselves attending online classes via Zoom or similar teleconferencing platforms. Although sticking with remote instruction may be the correct decision from the standpoint of public health, it is not without problems. As a researcher who studies behavior and the brain, I have found the evidence suggests that online instruction can pose a range of challenges for students if they are required to keep their cameras on during class. Here are five reasons why I believe students should be allowed to keep their cameras off instead: Increased anxiety and stress; ‘Zoom fatigue;’ Competing obligations; Right to privacy; and, Financial means and other kinds of access

With two pen strokes last week, Gov. Gretchen Whitmer declared racism in health a priority within the state’s government offices. But health leaders say it will be the follow-up — funding, policy change and enforcement — that determines whether the move is symbolic or transformative. “I'm glad they're getting people to the table … The thing is we've been discussing this and discussing this and discussing this,” Dr. Lynn Smitherman, a Detroit pediatrician, associate chair of medical education at Wayne State University, and a diversity and inclusion champion for the American Academy of Pediatrics. “You still have to do something. Discussion without action is just another academic exercise,” she said. At a panel discussion last week organized by Wayne State University and others, Dr. Michelle Williams said Black Americans also face institutional racism when they are sick — with access at times only to lower-quality care and even clinicians that turn them away or don’t listen to their concerns. Lyke Thompson, director of the Center for Urban Studies at Wayne State University, has studied lead poisoning extensively and said Black children in Detroit often live in older homes that have high levels of lead paint, which can impair learning and hinder lifetime earning potential. Thompson said he has called for strengthening laws that hold accountable the landlords who don’t address those issues, but a lack of political will has stopped short of making that happen. An official declaration that racism plays a role in policies — and a commitment to address it — may finally make a difference, he said. “This takes serious, clear, ongoing focus,” he said.

In parts of Wayne County, including Detroit and eight surrounding suburbs, older adults are dying at twice the rate of those who live elsewhere in Michigan, according to a report, “Dying Before their Time,” a 19-year analysis between the Detroit Area Agency on Aging and Wayne State University Medical School. The agency attributed much of the cause to be a "result of deep-rooted negative social and economic policies and significant inequities in resource distribution." Chronic illnesses, living conditions, accessibility to health care and lack of health insurance, food and transportation are specifically cited as reasons for the shortened lifespans, the study found. Study co-author Dr. Herbert Smitherman Jr. of Wayne State University School of Medicine and Detroit Medical Center said it was shocking to discover how many people aren’t making it to 60 years old. “I’m a physician but also a scientist, so when they approached me, my first recommendation was that an analysis needed to be done since there was never data collected by the state,” Smitherman said. “To see we lost not 1 or 2%, but 23% of the entire population, it seemed unrealistic. The Detroit region had 1.3 million people and lost more than 150,000 people, that’s just what the (nation) lost with coronavirus. “That’s when we realized something was happening to seniors that wasn’t happening with any other population, and it got my full attention. Next, we realized if they’re dying before age 60, what’s happening before?" Smitherman worries the trend will continue without a coordinated push to reverse it. "What we’ve seen over 19 years is that it’s the same," Smitherman said. "Unless we have some sustained effort where they allocate funding and collaboratively work to improve health and reverse centuries of racial poverty, this trend will persist over many decades to come. "If we do nothing, nothing’s going to change."

Rebecca Klisz-Hulbert, assistant professor, Department of Psychiatry and Behavioral Neurosciences, wrote an article for The Conversation. “Black youth in the U.S. experience more illness, poverty, and discrimination than their white counterparts. These issues put them at higher risk for depression and other mental health problems. Yet Black youth are less likely to seek treatment. About 9% of them reported an episode of major depression in the past year, but less than half of those – about 40% – received treatment. By comparison, about 46% of white youth who reported an episode were treated for depressive symptoms. Instead, some turn to suicide, now the second leading cause of death among Black children ages 10 to 19. That rate is rising faster for them than any other racial or ethnic group.”

The Centers for Disease Control and Prevention recommends that anyone who has spent more than 15 minutes within six feet of somebody who has COVID-19 should quarantine for 14 days. On the field, football players are continually within six feet of each other, especially at the line of scrimmage. Even if distancing six feet during football games and practices were possible, it might not be enough. Studies on superspreading events suggest that heavy breathing may spread droplets as far as 12 feet, or four yards, according to Gretchen Snoeyenbos Newman, an assistant professor of Infectious Disease at Wayne State University. “For football players on the field while they’re playing, the linemen are really your most at-risk people [to become infected]. Athletes are professional droplet producers.” Also, some conclude that professional athletes in peak physical fitness would be minimally affected by contracting the virus. Snoeyenbos Newman says that isn’t the case. There is increasing evidence that COVID-19 can damage the lungs, heart, and even the brain. Snoeyenbos Newman says that while the average person who contracts and recovers from COVID-19 may not notice if they lose 2 percent of their lung capacity, elite athletes will absolutely notice, and long-lasting lung or heart problems could be career-ending. “Getting really, really sick but not dying can also have very negative life-long consequences,” Snoeyenbos Newman says. “You don’t have to die in order for it to be really bad.”

Why are newborns born to mothers with COVID-19 rarely infected? Researchers at the Wayne State University School of Medicine and the Perinatology Research Branch of National Institute of Child Health and Human Development/National Institutes of Health in Detroit have found that placental cells minimally express the instructions, or mRNA, to generate the cell entry receptor and protease required by the virus that causes COVID-19 to invade human cells. The pandemic caused by SARS-CoV-2 has infected more than 10 million people worldwide, including pregnant women, yet to date there is no consistent evidence that pregnant mothers pass the virus to their newborns. “The findings of this study help to understand why mother-to-fetus transmission is so rare (less than 2% of cases),” said Roberto Romero, M.D., D.Med.Sci, chief of the PRB. “The most likely explanation is that the cellular instructions for the production of the main receptor for SARS-CoV-2 are not expressed in the human placenta. In contrast, the receptors for other viruses known to cause fetal infection such as Zika and cytomegalovirus were found in placental cells.” Roger Pique-Regi, Ph.D., assistant professor of the WSU Center for Molecular Medicine and Genetics, and of Obstetrics and Gynecology, first author of the study, explained that the single-cell genomics technology the researchers employed allows them to study the transcriptome of individual cells isolated in tiny oil droplets using microfluidics.  

Dr. Mark Schweitzer, dean of the School of Medicine and vice president of health affairs at Wayne State University, co-wrote an op-ed about the need to address personal health issues that may have been neglected during the pandemic. “As we’ve watched our state battle to reduce the toll of COVID-19 on Michigan residents, we’ve understood — and supported — the sense of caution that has kept people home rather than visiting their doctors or going to the hospital if they think they need medical help. But as health care specialists trained as medical doctors, we also know the risks of getting medical attention too late. Strokes, heart attacks, diabetes and cancer don’t take a break just because we’re in the middle of a pandemic. The danger of hospitals being overwhelmed by the need to treat COVID-19 patients required us to limit access this spring so patients could receive the treatment they needed and caregivers could get the personal protection equipment critical to protecting their health. But the situation today is much different. The doctors affiliated with our three universities that make up Michigan’s University Research Corridor — Michigan State University, the University of Michigan and Wayne State University — along with our clinics and Michigan Medicine, UM’s medical center, are taking the steps to help their patients through telemedicine, where appropriate.”

Tabitha Moses, MD/PhD candidate at Wayne State University, wrote a Conversation piece about the growing trend of using military metaphors in references to the coronavirus. “Sometimes war involves battling other countries; other times, it’s the metaphorical kind, like our current “war” against the coronavirus. We see this war reflected in the language that gets used by politicians, policymakers, journalists and healthcare workers. As the “invisible enemy” rolled in, entire economies halted as populations “sheltered in place.” We were told to “hunker down” for the long battle ahead and to “support our troops,” the health care workers, fighting on the “front lines.” These military-inspired metaphors serve a purpose. Unlike the dense linguistic landscape of science and medicine, their messages are clear: Danger. Buckle Down. Cooperate. In fact, studies have shown that sometimes military metaphors can help unite people against a common enemy. They can convey a sense of urgency so that people drop what they’re doing and start paying attention. However, as someone who has studied the way language influences behavior, I know that this kind of rhetoric can have long-term effects that are less positive, particularly within health and medicine. In fact, research has shown that these metaphors can cause people to make decisions that go against sound medical advice.”

Lauren Hamel, Ph.D., assistant professor and member of the Population Studies and Disparities Research Program at Karmanos Cancer Institute and the Wayne State University School of Medicine, was awarded a Research Scholar Grant by the American Cancer Society. She will use the grant to test the effectiveness of a patient-focused intervention to improve patient-provider treatment cost discussions and other patient outcomes related to the financial consequences of cancer treatment. Hamel and her team responded to the growing problem of financial toxicity, or the severe material and psychological burden of the cost of cancer treatment. Financial toxicity affects an estimated 30% to 50% of patients with cancer, especially patients who are racial/ethnic minorities, have lower incomes or are under 65. However, well-timed and effective patient-oncologist treatment cost discussions could help.

Julie Wargo Aikins, associate professor of psychiatry and behavioral neurosciences, Merrill Palmer Skillman Institute, wrote this piece earlier for The Conversation. “Children's social worlds have been upended by the suspension of school and extracurricular activities due to the pandemic. Many older children and adolescents have been able to maintain their friendships over social media. But, for younger children, this approach is less likely to be available to them and less likely to meet their social needs. In some places, a silver lining of Covid-19 may well be the resurgence of childhood friendships in American neighborhoods.”

Arash Javanbakht, associate professor of psychiatry, wrote an article for The Conversation about celebrating the Fourth of July with respect to individuals with PTSD. “For some combat veterans, the Fourth of July is not a time to celebrate the independence of the country they love. Instead, the holiday is a terrifying ordeal. That’s because the noise of fireworks – loud, sudden, and reminiscent of war – rocks their nervous system. Daily fireworks in many U.S. cities in recent weeks have no doubt been interfering with the sleep and peace of mind of thousands of veterans. This reaction is not unique to veterans with post-traumatic stress disorder, or PTSD. Also affected are millions of others, including civilians, refugees, and first responders. As a psychiatrist who specializes in trauma and PTSD, I urge you not to overdo an act which causes so much suffering for so many of your fellow Americans.”

Tamara Hew-Butler, associate professor of exercise and sports science, and Phillip D. Levy, assistant vice president for translational science and clinical research innovation, wrote an article for The Conversation about reopening school and club sports amidst the pandemic. “Along with the revival of professional sports comes the yearning for a return to amateur sports – high school, college and club. Governing officials are now offering guidance as to when and how to resume play. However, lost in the current conversation is how schools and club sports with limited resources can safely reopen. As an exercise scientist who studies athlete health and an emergency medicine physician who leads Michigan’s COVID-19 mobile testing unit, we wish to empower athletes, coaches and parents by sharing information related to the risks of returning to play without COVID-19 testing. This includes blood tests to see if athletes have already had COVID-19 plus nasal swabs to test for the active SARS-CoV-2 virus. Regular COVID-19 testing on all athletes may seem like overkill, but the current tally of 150 collegiate athletes, mostly football players, who have tested positive for COVID-19 grows longer by the day.”

Dr. Jennifer Gomez, an assistant professor in the Department of Psychology and an expert in the impact of violence on black and other minority youth and young adults, had this to say about the Black Lives Matter protests. "The tragedies that we're witnessing are neither new nor isolated. And, of note, they haven't stopped, even though videos have made it possible for the world to be watching and condemning the government-sanctioned violence against black people in the U.S. The difference is this moral elevation, this action-oriented hope, that has resulted in so many of us coming together to fight for justice. And, at long last, for some of us to finally listen and bear witness to the anti-black hate and violence that so many of us for so many years have been sharing without being believed." Gomez explained that as a black feminist trauma psychologist, she sees moral elevation often. "What should be completely depressing engenders action-oriented hope," she said. "When truth of depravity is finally acknowledged, we discover avenues for enacting change on large and small scales. Witnessing those actions in ourselves and others gives us this moral elevation that makes life worthier of living."

A new study by Chinese researchers found that COVID-19 pediatric patients had higher incidents of initial symptoms like fever, vomiting, and diarrhea than adult patients and often recovered an average of 3 to 4 days after treatment. Research on COVID-19 pediatric cases is still limited, but this new study offers a fresh perspective on the early diagnosis and epidemic control of COVID-19 in children and could enhance early intervention and diagnosis. The new study highlights the fact that so much about the pathogen underlying the disease remains unknown and there’s so much more to learn, added Dr. Teena Chopra, a professor of infectious diseases at Wayne State University’s School of Medicine. “[What] is interesting is that the children [in the study] did not present with severe disease unlike adults,” she said. “And most of them had mild or moderate symptoms.” Chopra added that the study has lots of implications for authorities pondering decisions such as school reopenings in the fall. Although the sample size is a “small number, it gives us insight into the world of children and helps us understand the impact on a younger age group,” said Chopra who serves on Wayne State’s reopening task force as well as one of a Detroit area school. School officials “should take studies like this into account before opening schools and making decisions about whether it can affect children or not,” she said.

David Rosenberg, professor of psychiatry and neuroscience, wrote an article for The Conversation. “One of the hallmarks of obsessive-compulsive disorder is contamination fears and excessive hand-washing. Years ago, a patient with severe OCD came to my office wearing gloves and a mask and refused to sit on any of the “contaminated” chairs. Now, these same behaviors are accepted and even encouraged to keep everyone healthy. This new normal in the face of a deadly pandemic has permeated our culture and will continue to influence it. Many stores now prominently post rules mandating face masks and hand sanitizer use and limit the number of customers allowed inside at one time. Walkers and joggers politely cross the street to avoid proximity to each other. Only a few months ago, this type of behavior would have been considered excessive, irrational, even pathological, and certainly not healthy. So, where do doctors draw the line between vigilance to avoid being infected with the coronavirus and obsessive-compulsive disorder that can be harmful? This is an important question that I, a psychiatrist, and my co-author, a wellness and parenting coach, often hear.”

Julie Wargo Aikins, associate professor of psychiatry and behavioral neurosciences, Merrill Palmer Skillman Institute, wrote an article for The Conversation. “As the weather has warmed in my Midwestern town, my neighborhood is full of children on bicycles pretending to be riding through the Wild West. I can’t walk down the sidewalk without stepping on chalk drawings or hopscotch boards. There are children jumping rope and playing ball. In the eight years I’ve lived here, I’ve never witnessed this before. As a clinical psychologist who studies children’s friendships, I am fascinated by this development. Children’s social worlds have been upended by the suspension of school and extracurricular activities due to the pandemic. Many older children and adolescents have been able to maintain their friendships over social media. But, for younger children, this approach is less likely to be available to them and less likely to meet their social needs. In some places, a silver lining of COVID-19 may well be the resurgence of childhood friendships in American neighborhoods.”

The desperately ill patients who deluged the emergency room at Detroit Medical Center in March and April exhibited the telltale symptoms of the coronavirus: high fevers and infection-riddled lungs that left them gasping for air. With few treatment options, doctors turned to a familiar intervention: broad-spectrum antibiotics, the shot-in-the-dark medications often used against bacterial infections that cannot be immediately identified. They knew antibiotics are not effective against viruses, but they were desperate, and they feared the patients could be vulnerable to life-threatening secondary bacterial infections as well. “During the peak surge, our antibiotic use was off the charts,” said Dr. Teena Chopra, the hospital’s director of epidemiology and antibiotic stewardship, who estimated that more than 80 percent of arriving patients were given antimicrobial drugs. “At one point, we were afraid we would run out.” Chopra and other doctors across the country who liberally dispensed antibiotics in the early weeks of the pandemic said they soon realized their mistake. “Many physicians were inappropriately giving antibiotics because, honestly, they had limited choices,” she said. Chopra estimated that up to a third of coronavirus patients who died at the hospital were killed by opportunistic pathogens like C. difficile, a pernicious infection that causes uncontrolled diarrhea and is increasingly resistant to antibiotics. That figure, she said, was quite likely heightened by the poor underlying health of patients who also had diabetes or hypertension or were obese. “Even before Covid hit, our population in Detroit was very vulnerable to drug-resistant infections,” said Chopra, a professor of infectious diseases at Wayne State University.

Arash Javanbakht, associate professor of psychiatry, updated a Jan. 11, 2020 article he wrote for The Conversation about how the human brain can be  manipulated to tribalism during the politics of fear and racism. “Tribalism has become a signature of America within and without since the election of President Trump. The nation has parted ways with international allies, left the rest of the world in their effort to fight the climate change, and most recently the pandemic, by leaving the World Health Organization. Even the pandemic was not a serious issue of importance to our leaders. We did not care much about what was happening in the rest of the world, as opposed to the time of previous pandemics when we were on the ground in those countries helping block the progress so long as it was China’s or the European Union’s problem. This marks drastic change from previous U.S. altruistic attitude, including during the World War II.” Javanbakht continued: “The irony of evolution is that while those attached to tribal ideologies of racism and nationalism perceive themselves as superior to others, in reality they are acting on a more primitive, less evolved and more animal level.”