The start of 2021 is all about getting this COVID pandemic under control. Distributing vaccines as quickly as possible and continue to social distance, avoid large gatherings, wearing masks and washing our hands will be an essential part of  developing herd immunity and getting our lives back to what was once normal.

Another part of reducing the presence of SARS-CoV-2 (the virus that causes COVID-19) is to find ways to destroy the virus in the environment before there is an opportunity for it to infect us. Much research has looked at the benefits behind good filtration systems and higher humidity to reduce the virulence of the virus. We are now re-visiting the benefits of ultraviolet light and its ability to kill viruses, bacteria and mold. Scientists have known about the disinfectant capabilities of ultraviolet light for decades. More than a century after Niels Finsen in 1903 won the Nobel prize for discovering that ultraviolet (UV) light could kill germs, UV light started being used in hospital rooms and other public places.

There are 3 types of ultraviolet light based on wavelength. The longest wavelengths are UV-A (315-400nm) and UV-B (280-315nm) which are found in ordinary sunlight. These rays can cause sunburn if you are outside too long without protection. They have limited germ-killing ability. But UV-C light (200-280nm) is part of the ultraviolet spectrum that can inactivate pathogens like bacteria and viruses. Because of their effectiveness, they are incredibly useful for hospitals, senior living centers, fire and police stations, schools, airports, hotels, office buildings and pretty much everywhere. So what’s the problem?

Similar to UV-A and UV-B rays from the sun, UV-C can damage the skin and eyes. You need to follow strict safety guidelines when the products are being operated. Basically, UV lamps should not be run when anyone is nearby. Trained workers should use the right personal protective equipment (PPE) and make sure products are turned off before performing maintenance. So this is maybe not as simple as screwing in a lightbulb. Disinfection with far-UVC lamps remains largely experimental but it may be safer in that it does not cause temporary skin burns and eye damage.

The other main problem is that if a surface is in shadow, it will not be disinfected. In a recently published study, a standard UV-C lamp was placed in the center of a typical hospital room and some places were partly or completely in shadow and did not receive the full dose needed to assure 99.99% disinfection. To address this problem, UVD Robots, a company based in Odense Denmark, developed a UV system that moves around the room autonomously. These robots are now available in 2000 Chinese hospitals and they are being used in more than 50 countries.

A company called Healthe has made progress on far UV-C lighting. They have developed systems that will be affordable for bars, restaurants, and other small businesses while close to eliminating the potential for spreading viruses. An LED version of UV-C may eventually be in our homes and offices. This can stop all viruses and bacteria. Can this finally be the cure for the common cold?? We will have to wait and see, but I can’t imagine a better time to push the technology envelope to help eliminate this pandemic and any future infections.

References: Lindblad M., Tano E., Lindahl C., Huss F. Ultraviolet-C decontamination of a hospital room: amount of UV light needed. Burns. 2019;46(4):842–849. [PubMed] [Google Scholar] [Ref list]

Mauldin, John. The Grip tightens. Jan 15, 2021. Mauldin Economics. https://www.mauldineconomics.com/frontlinethoughts/the-grip-tightens/

Tornberg, B. Using UV Light to kill Viruses Like COVID-19. Dec. 16, 2020. https://insights.regencylighting.com/can-uv-light-kill-viruses-like-covid-19

Mackenzie, D. Ultraviolet Light Fights New Virus. June 27, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319933/

Many of us have had some minor injuries in our lives. Some of them may include sprains, strains, contusions (bruises), whiplash, nonsurgical fractures of ribs or toes. We typically reach for over-the-counter Tylenol (Acetaminophen) or Ibuprofen or other nonsteroidal anti-inflammatory’s (NSAID). But are there dangers to these drugs and which one is best to take?

Several sponsoring organizations reviewed 207 trials that included more than 30,000 participants, most younger than 40 with common musculoskeletal injuries that did not involve the lower back. The authors were evaluating best treatments for pain for these common injuries. The results were the following:

For immediate pain relief, best quality evidence supported the use of acetaminophen alone or combined with oral diclofenac (NSAID) or an opioid. Tramadol alone was not effective. The use of oral or topical NSAID’s alone also was supported by lesser quality evidence. For pain control during the first week after injury, acetaminophen plus opioids, topical or oral NSAID’s and acetaminophen alone were effective. Gastrointestinal side effects were associated primarily with opioids and NSAID’s. Neurological side effects were associated with opioids and the use of ibuprofen and cyclobenzaprine (muscle relaxant) together.

Among non-pharmacologic alternatives, massage and specific acupressure was supported by better evidence than was transcutaneous electrical stimulation (TENS).

What this meta-analysis did not tell you were the risks with using NSAID’s.  These drugs raise the risk for cardiovascular disease, GI bleeding and acute kidney injury (AKI).  This is why they need to be avoided or very closely monitored in people at high risk for heart disease (heart failure, congestive heart disease, hypertension, atrial fib, stroke), chronic kidney disease or gastrointestinal bleeding.

Now let’s look at more specific types of NSAID’s and their safety profile. A Danish study was done comparing diclofenac, ibuprofen, acetaminophen and naproxen and their risk for major cardiovascular (CV) events and gastrointestinal (GI) bleeding. Diclofenac was associated with excess short-term cardiovascular and GI bleeding risks compared with the other NSAID’s or acetaminophen (NEJM JW Gen Med Sep 15 2018 and Ann Rheum Dis 2018; 77: 1137). Also, in a U.K. study, diclofenac but not naproxen was associated with excess risk for myocardial infarction. Several studies have suggested that naproxen might pose the least CV risk, especially among patients with spondyloarthropathies (ankylosing spondylitis and psoriatic arthritis) and osteoarthritis. (NEJM JW Gen Med Aug 1 2006 and BMJ 2006; 332:1302; NEJM JW Gen Med Jul 15 2011 and Circulation 2011; 123:2226). So if an NSAID is going to be used, the best choice would be naproxen.

The best recommendations are the use of topical NSAID’s with or without menthol gel due to its effectiveness and lack of toxicity. Of course a combination of a topical anti-inflammatory and non-pharmacologic options (acupressure, massage, chiropractic, physical therapy, supplements) are the way to go. Avoid using NSAID’s long-term as well as opioids, including Tramadol because of substantial potential harms.

All medications have associated risks. Therapeutic doses for a limited time are considered safe and effective. But prolonged use of NSAID’s not only increases the risk of AKI and chronic kidney disease progression but puts those that are older who have diabetes or hypertension at a higher risk of developing these conditions. A clinical report showed that even young healthy adults with no risk factors of kidney disease had developed AKI due to NSAID use. With the opioid crisis still in the national news, nonnarcotic alternatives for pain control are more popular and effective for the most part. But we need to weigh the risks and benefits, and now we know that there are some NSAID’s (naproxen) and their delivery systems (topical) that are safer and should be the first choice in pain management. Make sure to discuss with your practitioner any over-the-counter medications, herbs, or supplements that you are taking. Not all over-the-counter products are safe or benign to adverse effects.

References: Qaseem A et al. Nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults: A clinical guideline from the American College of Physicians and American Academy of Family Physicians. Ann Intern Med 2020 Aug 18; [e-pub]. (https:/doi.org/10.7326/M19-3602)

Busse JW et al. Management of acute pain from non-low back musculoskeletal injuries: A systematic review and network meta-analysis of randomized trials. Ann Intern Med 2020 Aug 18; [e-pub]. (https:/doi.org/10.7326/M19-3601)

Riva JJ et al. Predictors of prolonged opioid use after initial prescription for acute musculoskeletal injuries in adults: A systematic review and meta-analysis of observational studies. Ann InternMed 2020 Aug 18; [e-pub]. (https:/doi.org/10.7326/M19-3600)

Schmidt M et al. Diclofenac use and cardiovascular risks: Series of nationwide cohort studies. BMJ 2018 Sep 4; 362:k3426. (http://dx.doi.org/10.1136/bmj.k3426)

Apple, A. The unsaid dangers of NSAIDs. Clinician Reviews. Sep/Oct 2018; ExpertQ&A p. 16.

Mariano F, Cogno, C, Giaretta F, et al. urinary protein profiles in ketorolac-associated acute kidney injury in patients undergoing orthopedic day surgery. Int J Nephrol Renovasc Dis. 2017;10:269-274.

This year has been one that we will never forget. And the core of this disruption has everything to do with our health and how to adapt to the fragility of life. But regardless of the pandemic, there is still plenty to talk about in reference to new breakthroughs in medicine. Here is my top 10 for 2020:

10. Telemedicine is a New Norm– Due to COVID-19, nearly a quarter of us had used a computer, app or phone for a telemedicine appt. Mental health counseling has also been done via Zoom which has been much needed, especially in areas where therapists are in short supply. Office visits are still important in certain circumstances (listening to lungs, abdominal exams, diagnosing the cause of joint pain, etc) but the shift to more online visits will become more common.

9. Biologics in Orthopedic Repair– It can take months or years to recover from orthopedic surgery.  Biologics are natural substances such as cells, blood components and growth factors that is injected to preserve tissue rather than cutting into it.        These can now be used to speed recovery and promote healing after surgery to improve patient outcomes.

8. Fast, Cheap Coronavirus Test– Abbott’s BinaxNOW rapid test received emergency-use authorization from the FDA in August. It detects COVID in fifteen minutes for around $5 per test—and without the need for specialized lab equipment.

7. New Class of  Migraine Medicine– Ubrelvy is the first FDA-approved new class of migraine meds known as Gepants, which has shown relief without the nasty downsides vs triptans. The drugs control the activity of a pain-regulating molecule called the calcitonin gene-related peptide (CGRP) whose levels elevate during an attack. Ubrelvy blocks CGRP’s ability to bind to its corresponding receptor in the body, effectively stopping a migraine in its tracks.

6. New HIV Prevention–  The HIV Prevention Trials Network study enrolled over 3000 women at risk for HIV across 7 countries in sub-Saharan Africa. It was very successful in preventing HIV. They found that a single shot given every 2 months could be more effective in preventing HIV in women than a daily pill.

5. Coronavirus Vaccine– The first of it’s kind with the UK being the first country to authorize the vaccine rollout. Sarah Lindsey, a critical care nurse at Long Island Jewish Medical Center in New York received the first coronavirus vaccine in the United States on December 14th.

4. Year of the Nurse and the Midwife– The World Health Organization (WHO) declared 2020 the year to honor nurses and midwives for their unrelenting work from refugee camps to rural towns to the front lines of COVID -19 and beyond.

3. Expanded use of Minimally Invasive Mitral Valve Surgery– A trans-catheter device has been FDA approved to repair the mitral valve in those with mitral valve regurgitation (MR). The FDA has broadened its approval to include those with an enlarged left ventricle, also known as secondary MR. This procedure can avoid major open heart surgery.

2. Immunology for Peanut Allergies– The FDA approved an oral immunotherapy treatment for peanut allergies in children. The oral capsule dose is increased over time to build a tolerance. This can lessen the fear of accidental exposure for kids with severe peanut allergy reactions.

1. New U.S. Leadership and a Renewed Focus on Global Health– President-Elect Biden announced his COVID-19 task force just days after election results. He promises to cooperate with countries around the world to coordinate coronavirus responses and join the international COVAX Facility, which is working on the development, production and access to COVID-19 tests, treatments and vaccines.

From Wellcast.org, we wish you a very healthy, hopeful and joyous New Year!

https://www.popsci.com/story/technology/best-health-innovations-2020/

https://www.globalhealthnow.org/2020-12/top-global-health-moments-2020