Face-covering use up, more people are taking COVID-19 threats seriously, study finds

A new National Science Foundation-funded survey of six states has found that during the past two months, more people are wearing masks, vaccine uncertainty is on the rise, and many people are overestimating their risk of becoming seriously ill and dying from COVID-19.

The results are in a new report published this month by the Risk and Social Policy Group, a team of more than 15 scholars across the country that includes University of Central Florida associate professor Lindsay Neuberger.

“One of our primary goals is to get essential COVID-19 data into the hands of policymakers to try to help guide not only policy but also the effective communication of those policies to increase public health,” says Neuberger, who is with UCF’s Nicholson School of Communication and Media.

“These data provide valuable insights into public perceptions and behavior and demonstrate where messaging should be focused, such as priority populations, and potential pathways for effective communication,” she says.

The survey, conducted in August, is the second of a three-part, six-month study that is examining perceptions and behaviors in response to the risk of COVID-19. The first survey was completed in late May and early June.

Respondents from the first survey were surveyed again for the next round to track any changes.

More than 2,000 people responded to the second survey. The respondents were from Colorado, Idaho, Louisiana, Massachusetts, Michigan and Washington.

The researchers selected the states to capture variation in U.S. demographic and social factors.

Mask-Wearing Practices

The researchers found that since late May and early June, indoor mask wearing in public places has increased among the respondents from 66% in the first survey to 79% in the second survey.

Although the reasons for this can’t be determined from the survey, Neuberger says the increase may be the result of more evidence that supports mask wearing and an increase in mask policies at state, local and business levels.

Survey respondents least likely to wear a mask in indoor, public spaces were conservative men with high school and less than a four-year degree education levels.

Neuberger says one way to reach people not wearing masks may be to focus on efficacy in risk communication messaging.

“Our data suggest one of the strongest predictors of mask wearing is actually efficacy — so the beliefs that one is both able to wear a mask and the belief that a mask can be effective in avoiding a risk,” she says. “I have not seen many efficacy-boosting messages, and I think that could be a strong approach for future messaging.”

Chances of Getting COVID-19

The respondents, on average, perceived they had a 30% chance they would contract the virus in the next three months, a 2% increase from survey one.

They perceived they had 36% chance of getting seriously ill from COVID-19 and a 23% chance of dying from it, up 2 and 1%, respectively, from survey one.

The researchers say that although individual risk is difficult to calculate because of differences in people’s choices to social distance, wear protection and their pre-existing conditions, this is an overestimation of COVID-19 risks.

Current data from Johns Hopkins University estimates there is a 97% survival rate for COVID-19. However, the U.S. Centers for Disease Control and Prevention states that people of any age with certain underlying medical conditions are at an increased risk for severe illness from COVID-19.

Will People Get Vaccines?

People intending to get a vaccine decreased from 54 to 46% from the first to second survey.

The main reasons they did not intend to get a vaccine included: vaccine safety, vaccine effectiveness and high potential cost.

Information Seeking

Respondents stated that they received most of their COVID-19 information from television if using traditional media and Facebook if using social media.

Survey Administration

Qualtrics, a U.S.-based survey company, conducted the surveys through its online panels in which people sign up to take surveys for a fee.

Qualtrics implemented quotas to recruit a sample for each state that is roughly representative of the state’s age, race and ethnicity, and income demographics based on U.S. Census data.

Due to the attrition of about 900 respondents from the first survey of more than 3,000 individuals, there was a higher proportion of young, white, female respondents relative to census demographics for each state.

What’s Next?

The group will distribute the third survey in October, and the subsequent report will be available at the group’s website (https://www.riskandsocialpolicy.org/), where the survey one report can also be found.

In addition to UCF, other universities involved in the study included Duke University, Colorado School of Public Health, North Carolina State University, the University of Colorado Denver, Bentley University, University of Nevada Reno, University of Maryland, Montana State University and Wayne State University.

Neuberger earned her doctorate in communication with a specialization in health and politics from Michigan State University and her master’s in communication and bachelor’s in political science and communication from Wake Forest University. She is an expert in health, risk and strategic communication. Neuberger joined UCF’s Nicholson School of Communication and Media, part of UCF’s College of Sciences, in 2011, is a member of UCF’s Sustainable Coastal Systems Cluster, and is an affiliate faculty member in UCF’s Women’s and Gender Studies program.


Complications from diabetes linked to worse memory, IQ in children

Diabetic ketoacidosis (DKA), a serious but common complication of type 1 diabetes, is linked to lower IQ scores and worse memory in children with type 1 diabetes, according to a study led by UC Davis Health researchers. The study published Sept. 22 in Diabetes Care is also the first large-scale work to differentiate between DKA’s impact on children with a new diagnosis and children with a previous diagnosis of type 1 diabetes.

DKA happens when diabetes goes undiagnosed or is poorly managed. With DKA, blood sugar gets very high as acidic substances called ketones build up to dangerous levels in the body. Early signs of DKA include excessive thirst, frequent urination, and nausea, abdominal pain, weakness and confusion.

“We assessed the neurocognitive effects of DKA in children with known type 1diabetes as well as in those who were just diagnosed with it,” said Simona Ghetti, professor of psychology at UC Davis and the lead author on the study. “Our study uncovered that even one severe episode of DKA in children newly diagnosed with type 1 diabetes is linked to cognitive problems; and among children with a previous diagnosis, repeated DKA exposure predicted lower cognitive performance after accounting for glycemic control.”

The study included 376 children with type 1 diabetes and no DKA history and 758 children with type 1 diabetes and a history of DKA. These children, ages 6-18 years, were participating in a DKA clinical trial at the Pediatric Emergency Care Applied Research Network (PECARN) sites led by two of the study’s co-authors, Nathan Kuppermann and Nicole Glaser.

One severe DKA episode can hurt memory and IQ

The study found that among children newly diagnosed with type 1 diabetes, those who experienced moderate and severe DKA had lower long-term memory compared to children with diabetes and no exposure to DKA. Greater severity of DKA was also associated with lower IQ in these children.

Children with a previous diagnosis showed lower performance compared with children with new onset in measures of memory and IQ, suggesting that cognitive deficits may worsen over time.

The study’s large sample allowed the researchers to capture complex associations of DKA severity, socioeconomic status and glycemic control among previously diagnosed patients. These associations revealed that patients with repeated DKA exposure and poorly controlled type 1 diabetes are at substantial risk of cognitive deficits.

“The results from the study emphasize the importance of prevention of DKA in children with known type 1 diabetes and of timely diagnosis during new onset before the development of DKA,” said Glaser, professor of pediatrics at UC Davis Health and senior author of the study. “There is an opportunity to prevent DKA with proper management of the glucose level in the blood.”

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Suspension of fertility treatments during COVID-19 has mental health impacts

The suspension of fertility treatments due to the COVID-19 pandemic has had a variety of psychological impacts on women whose treatments were cancelled, but there are several protective factors that can be fostered to help in the future, according to a new study by Jennifer Gordon and Ashley Balsom of University of Regina, Canada, published 18 September in the open-access journal PLOS ONE.

One in six reproductive-aged couples experiences infertility, and many turn to treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF), which require many in-person appointments to complete. On March 17, 2020, the American Society of Reproductive Medicine and the Canadian Fertility and Andrology Society announced their recommendations to immediately and indefinitely suspend all in-person fertility treatments in the United States and Canada due to COVID-19.

In the new study, researchers used online social media advertising to recruit 92 women from Canada and the U.S. who reported having their fertility treatments suspended to participate in an online survey. The women, who were aged between 20 and 45, had been trying to conceive for between 5 and 180 months. More than half had had an IVF cycle cancelled and approximately one-third had been in the middle of IUI when treatments were suspended.

Overall, 86% of respondents reported that treatment suspensions had a negative impact on their mental health and 52% reported clinically significant depression symptoms. Neither age, education, income or number of children were correlated with the effect of treatment suspension on mental health or quality of life. However, other factors were found to positively influence these outcomes: lower levels of defensive pessimism (r=-0.25, p<0.05), greater infertility acceptance (r=0.51, p<0.0001), better social support (r=0.31, p<0.01) and less avoidance of infertility reminders (r=0.23, p=0.029) were all associated with a less significant decline in mental health.

The authors add: “This study highlights how enormously challenging the COVID-19 pandemic has been for women whose fertility treatments have been suspended. At the same time, it points to certain factors that may help women cope during this difficult time, such as having good social support.”

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Vitamin E needed for proper nervous system development

In research with key ramifications for women of childbearing age, findings by Oregon State University scientists show that embryos produced by vitamin E-deficient zebrafish have malformed brains and nervous systems.

“This is totally amazing — the brain is absolutely physically distorted by not having enough vitamin E,” said Maret Traber, a professor in the OSU College of Public Health and Human Sciences.

The study led by Traber, the Ava Helen Pauling Professor at Oregon State’s Linus Pauling Institute, was published today in Scientific Reports.

Zebrafish are a small freshwater species that go from a fertilized egg to a swimming fish in about five days. They are highly prized for studying the development and genetics of vertebrates.

Zebrafish share a remarkable similarity to humans at the molecular, genetic and cellular levels, meaning many findings are immediately relevant to humans. Embryonic zebrafish are of special interest because they develop quickly, are transparent and are easy to care for.

Vitamin E was discovered in 1922, identified because it was essential for fertilized rat eggs to culminate in live births.

“Why does an embryo need vitamin E? We’ve been chasing that for a long time,” said Traber, a leading authority on vitamin E who has been researching the micronutrient for three decades. “With this newest study we actually started taking pictures so we could visualize: Where is the brain? Where is the brain forming? How does vitamin E fit into this picture?”

In an embryo, a brain primordium and the neural tube appear early and will form the nervous system and “innervate” — supply with nerves — all organs and body structures. Without vitamin E, the zebrafish embryos showed neural tube defects and brain defects.

“They were kind of like folic acid-deficient neural tube defects, and now we have pictures to show the neural tube defects and brain defects and that vitamin E is right on the closing edges of the cells that are forming the brain,” Traber said.

In healthy organisms, neural crest cells drive the creation of facial bones and cartilage and innervate the body, building the peripheral nervous system.

“Acting as stem cells, the crest cells are important for the brain and spinal cord and also go on to be the cells of about 10 different organ systems including the heart and liver,” Traber said. “By having those cells get into trouble with vitamin E deficiency, basically the entire embryo formation is dysregulated. It is no wonder we see embryo death with vitamin E deficiency.”

Traber likens it to the children’s game KerPlunk, in which kids take turns pulling out the straws that support several dozen marbles in a vertical tube. When the wrong straw is pulled out, everything collapses; vitamin E is the straw whose extraction brings down the house on embryo development, especially with the brain and nervous system.

“Now we’re at the point where we’re so close being able to say exactly what’s wrong when there isn’t enough vitamin E but at the same time we’re very far away because we haven’t found what are the genes that are changing,” she said. “What we know is the vitamin E-deficient embryos lived to 24 hours and then started dying off. At six hours there was no difference, by 12 hours you see the differences but they weren’t killing the animals, and at 24 hours there were dramatic changes that were about to cause the tipping point of total catastrophe.”

Vitamin E, known scientifically as alpha-tocopherol, has many biologic roles and in human diets is most often provided by oils, such as olive oil. It is found in high levels in foods such as hazelnuts, sunflower seeds and avocados.

Vitamin E is a group of eight compounds — four tocopherols and four tocotrienols — distinguished by their chemical structure. Alpha-tocopherol is what vitamin E commonly refers to and is found in supplements and in foods associated with a European diet; gamma-tocopherol is the type of vitamin E most commonly found in a typical American diet.

“Plants make eight different forms of vitamin E, and you absorb them all, but the liver only puts alpha-tocopherol back into the bloodstream,” said Traber. “All of the other forms are metabolized and excreted. I’ve been concerned about women and pregnancy because of reports that women with low vitamin E in their plasma have increased risk of miscarriage.”

Joining Traber on the study were Brian Head of the Linus Pauling Institute, Jane La Du and Robyn Tanguay of the OSU College of Agricultural Sciences and Chrissa Kioussi of the OSU College of Pharmacy.

The Oregon Veterinary Diagnostic Lab supported the research with technical assistance, and the Ava Helen Pauling Endowment and the National Institute of Environmental Health Sciences of the National Institutes of Health contributed toward the study’s funding.


A better informed society can prevent lead poisoning disasters

Six years after it began, the Flint, Michigan, water crisis remains among the highest-profile emergencies in the United States.

Extensive iron and lead corrosion of the water distribution system in Flint, coupled with lead release, created “red water” complaints, rapid loss of chlorine disinfectant and an outbreak of Legionnaires Disease that killed 12 people. State and federal agencies have disbursed $450 million in aid so far. In August, the state of Michigan reached a mediated settlement in a civil suit and is expected to pay about $600 million to victims, many of whom are children.

“The Flint story is a cautionary tale of poor anticipation of risks, actions that were too little too late, reactionary and not driven by scientific data,” John R. Scully, University of Virginia Charles Henderson Chaired Professor of Materials Science and Engineering, said. Scully also serves as technical editor in chief of CORROSION Journal.

In a paper published Sept. 8 in the Proceedings of the National Academy of Sciences, Scully and Raymond J. Santucci, who earned his Ph.D. from UVA’s Department of Materials Science and Engineering in 2019, address unresolved scientific questions that can help avert future lead poisoning disasters. Lead poisoning from degrading lead pipes is a pervasive threat, and future incidents are likely.

“This requires a fresh perspective, to avoid just looking in the rearview mirror and instead focus on what lies around the curve ahead,” Scully said.

Commonly proposed strategies offer false comfort based on sparse water testing, rules of thumb, and traditional mitigation strategies rather than by rigorously challenged sound scientific principles, according to the paper’s authors.

“We need to better understand the scientific factors that govern lead release, and that starts with a better testing strategy and understanding of some fundamental truths,” Scully said.

Scully and Santucci argue that the people who manage and regulate public water systems should be using scientific data to predict the risks of lead release. Risk assessments based on scientific data should replace current reliance on water sampling, which is imprecise and often too late to prevent a disaster.

A predictive framework for lead corrosion would allow regulators and infrastructure managers to anticipate problems and manage the risk of water conditions associated with unacceptable lead release.

Santucci and Scully recommend better thermodynamic and kinetic calculations and models that can predict lead release and accumulation. The models proposed could generate risk assessments based on dynamic data such as water chemistry, reaction rates, scale formation and inhibitor corrosion mechanisms, as well as water stagnation and flow.

Citizen scientists can help meet the data-gathering challenge. “Rapid accurate testing, perhaps via mobile phone test kits, could provide more real-time data. Hand-held, mobile tech that enables citizens to monitor their own drinking water should have advanced already,” Scully said.

Santucci and Scully illustrate how chemical thermodynamics can predict the formation of thermodynamically stable lead-based compounds on lead pipe surfaces. Certain compounds form advantageous films that might act as kinetic barriers to hinder corrosion and function to sequester otherwise soluble lead.

“Stable film development depends on a certain equilibrium chemistry, with consequences for phosphate treatment,” Santucci said. “Add more phosphate and you can remove more soluble lead to form a protective lead phosphate film. Remove phosphate completely, and you then rely on hoping that other lead compounds (lead -carbonate, -sulfate, -oxide, etc.) can remove the levels of lead you need,” which is usually not the case.

In phosphate-treated water, a lead-phosphate film will form. “From our data, it is thermodynamically impossible to stay within the acceptable range of the EPA’s Lead and Copper rule without an inhibitor like phosphate. But it takes time for the scale to form. We need to explore new inhibitor chemicals and surface-altering agents that optimize the protective scale coverage on a pipe wall,” Santucci said.

The authors also suggest altogether new ideas to anticipate, monitor and prevent future lead in water crises. Artificial intelligence and machine learning could help identify relationships between water and pipe conditions and lead levels in drinking water. Santucci and Scully also propose a promising strategy of using isotope analysis to trace the sources of lead. “This strategy would enhance our understanding of how lead is released from lead pipes and other not so obvious sources, which is dearly lacking,” their paper states.

Public officials may argue that the investment in scientific research and modeling is unnecessary because lead-based pipes are being replaced, albeit at homeowners’ expense. Scully and Santucci disagree with that perspective. “Total replacement of lead service lines is a wonderful goal, but finding all sources of lead can be difficult,” Scully said.

Replacing lead in public water systems does not simply mean replacing lead pipes. Additional sources include lead-based solder used to join pipes together and commercial brass that commonly contains small amounts of lead, and lead ions that soak into the corrosion film of steel pipes over time. Partial replacement of lead pipes with other pipes such as steel or copper can actually increase lead release due to galvanic corrosion, a process where contact between two dissimilar metals causes protection of one and accelerated degradation of the other.

Santucci and Scully argue for holistic, kinetic models that incorporate the rate of lead release from all possible sources, under many real-world operating conditions.

“The root cause of the Flint water crisis can be found at the intersection of materials science, surface science, water chemistry and electrochemistry,” Scully said. “A better-informed society can prevent such disasters from happening in the future through improved risk assessment, anticipation and management of factors affecting lead release. We all have a part to play in averting future lead poisoning disasters.”