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New Trend or Passing Fad?
Smoking Rates will Drop with COVID Pandemic

This blog is the FOURTH in a series regarding the ‘unintentional consequences’ of the COVID-19 pandemic. As our lives have been abruptly altered due to social distancing requirements – both at home and in the workplace – unplanned ‘disruption’ of previous normal activities could permanently replace sacred elements once believed to be unyielding to any change. But COVID-19 just may have dictated new approaches to how we live and work.

In late April, over one month into the COVID-19 pandemic, a piece from Kaiser Health News (KHN) was published discussing how the virus may prompt some smokers to quit their habit, primarily to avoid respiratory risks. Past research has shown that smoking makes it more difficult to fight off respiratory infections. Because of this, one can reasonably assume that smoking will increase health complications, if infected by the virus. It was, therefore, a natural topic to cover how the pandemic may favorably shape smoking habits in the U.S.

Since publication of the KHN article, however, the science between smoking and COVID-19 is not as clear as one might think. Please read on…

Smoking and COVID-19

One early study about COVID-19 health factors suggests that smokers are 14 times more likely to need intensive treatment compared with nonsmokers. Such findings push doctors to use this connection between COVID and smoking, as yet another reason for people to quit this habit.

Yet, using the coronavirus as a valid reason to quit smoking, could possibly backfire. New research from UCLA’s psychology department shows that stigmatizing smokers may actually INCREASE their urge to smoke. Known as a ‘stereotype threat,’ people become anxious about being identified in a negative way and, consequently, end up confirming the behaviors they are trying so hard to disprove.

As we learn more about the impact of this virus on humans, more studies will likely ensue on how smokers are impacted by newly-evolved viruses. Perhaps the development of a reliable and widely-available antibody test could reveal connections between smoking and the coronavirus.

Countervailing Study – Smokers are LESS likely to contract COVID-19

There is contradictory evidence that smoking may actually keep smokers from contracting COVID. French researchers believe that nicotine protects cells from coronavirus attacks. In fact, the Pasteur Institute found that four times fewer smokers contracted COVID than non-smokers.

In lieu of this finding, the French government banned online sales of nicotine replacements – nicotine gum and patches – and warned that pharmacies that dispense treatment for tobacco addiction must limit the amount issued per person. The concern is that “excessive consumption or misuse in the wake of media coverage” may push people to inappropriately consume nicotine replacements to combat COVID.

How true is the French finding? There is much skepticism. More information is needed to learn the truth about nicotine and COVID. For now, a helpful piece can be found in USA TODAY regarding the facts associated with nicotine and COVID.

Conclusion

Given the varied lifestyle behaviors of individuals, some smokers may decide to curtail the habit, while others will maintain the status-quo regardless of having conclusive evidence that their health is at greater risk by holding on to this habit.

As we have found in the past few months in our country, science can play an important role for those who embrace well-documented research, but it can also be discarded by others. In 2017, smoking rates in Iowa mimicked national rates – 17.1 percent of adults smoked. Smoking rates have decreased over the years, and whether the pandemic will accentuate this trend in the future is, at best, uncertain.

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New Trend or Passing Fad?
Reliance on Foreign Drugs

This blog is the THIRD in a new series regarding the ‘unintentional consequences’ of the COVID-19 pandemic. As our lives have been abruptly altered due to social distancing requirements – both at home and in the workplace – unplanned ‘disruption’ of previous normal activities could permanently replace sacred elements once believed to be unyielding to any change. But COVID-19 just may have dictated new approaches to how we live and work.

NOTE: Running the risk of writing a xenophobia-like piece about foreign countries, this particular blog is intended to address a serious national security issue that has been neglected for at least two decades.

To borrow a phrase from the ‘Apollo 13’ movie, “Houston, we have a problem.” No, wait, we have a BIG problem!

If the COVID-19 pandemic has taught us anything, it’s that we must not become too dependent on outside countries for drugs and certain medical supplies – such as masks, gloves, ventilators and other personal protective equipment (PPEs). These dependencies can seriously undermine our health security, which is critical to our national security. But, over the past two decades, our country HAS increasingly become more reliant on foreign countries, especially China.

Interestingly, the pandemic just may serve as the catalyst to help remedy this problem.

The China Situation

A major event occurred in the year 2000 that triggered the U.S. to rely more on China for the supply of medications. Congress and the White House agreed to grant China access to the U.S. market, and permitted China to join the World Trade Organization. Shortly after, China developed the penicillin and Vitamin C ‘cartels,’ by basically replacing American manufacturers through the dumping of low-cost product into our country. As a result, American manufacturers could no longer compete against China’s government-financed manufacturers. China’s monopolizing behavior is also commonly found in many other manufacturing products from various industries. Pharmaceutical dependence on China can be found in an earlier blog that I wrote in 2019, “Dependence on China – The ‘Weaponization’ of our Medicine.

In 2019, The U.S. Food and Drug Administration (FDA) estimated that 80 percent of active pharmaceutical ingredients (APIs) and 40 percent of finished medications were manufactured overseas, primarily in China and India. Most generic drugs, including antibiotics, accounting for more than 90 percent of all U.S. prescriptions, are imported from India, but India imports 70 percent of their active ingredients from China.

Having a high concentration of our medicine coming from just one country, no matter the country, can become a major strategic risk to the health and security of our population. To function, the U.S. (and other countries) rely on having appropriately-manufactured medicine of high-quality with safe ingredients, reasonably-priced, and readily available. In fact, by ceding the manufacturing of medicine elsewhere, any country could be held hostage by a new warfare that has never been waged in the past – the weaponization of medicine.

During a congressional testimony in October of last year, Janet Woodcock, the FDA’s director of the Center for Drug Evaluation and Research, pointed out that drug production has moved out of the U.S. into other countries.  According to Woodcock, “The FDA doesn’t know whether Chinese facilities are actually producing APIs, how much they are producing, or where the APIs they are producing are being distributed worldwide, including in the U.S.” In short, the FDA does not know how dependent the U.S. is on China for its drugs!

National Emergency Order – Stafford Act

Addressing the pandemic on March 13, President Trump declared a national emergency under the Stafford Act, a 1988 law that presidents can use to declare disaster areas after storms and other natural disasters. This declaration granted that certain medical products and supplies, such as disposable gowns and drapes, be excluded from the 25 percent tariff imposed by the U.S. since September 24, 2018, on $200 billion goods imported from China.

These tariffs have increased concern about relying heavily on a single market (e.g. China) for critical medical and pharmaceutical products, forcing many U.S. organizations to rethink their China-based supply chains. It’s additionally anticipated that the Administration is preparing an executive order that would require certain essential drugs be made in the U.S. This executive order is believed to streamline regulatory approvals for “American-made” products and encourage the U.S. government, including the Departments of Defense, Health and Human Services and Veterans Affairs, to buy only American-made medical products.

To maintain independence from foreign control, streamlining regulatory approvals for American-made products and more detailed labeling of the origin of drug products could help facilitate American production at home.

Conclusion

Whether the novel coronavirus will be the tipping point for drug makers to adopt new technologies and resist the offshoring trend is yet to be determined. Preventing an interruption in the supply of vital medications and other medical products that save lives and treat diseases – whether during pandemics or in routine care – is a matter of national security. As our population ages, Americans will become even more dependent on medications indispensable for treating heart disease, cancer, stroke – and viruses. Mobilizing resources to mitigate the supply shortages is a strategy that must be paramount to our government and all policymakers.

The COVID-19 pandemic serves as a wake-up call for our government and the pharmaceutical industry to take notice – and act. If this particular opportunity is somehow tragically missed, then policy malpractice has been undeniably committed. Regardless of the political leanings one may have, we can all agree this should not be a red or blue issue – but an American one.

Next Week’s Discussion:  Fear of virus will propel smokers to quit.

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Straddling the Pandemic ‘Tightrope’ into the Future

All of us, I am confident, would like to know when we will eventually return to some type of ‘normalcy’ in our personal and professional lives – and inject more stability and certainty into our local and national economies. Whatever this new ‘normalcy’ will eventually look like, and when it will happen, remains to play out for various reasons.

Growing evidence suggests that our eventual ‘new normal’ will be different from the environment we had prior to the onslaught of COVID-19, just over a month ago. As the weeks accumulate, over 90 percent of Americans are staying home to work and practice social-distance living. Trying to jump-start ailing local and national economies while keeping the population safe from this contagious virus is akin to walking a tightrope over the Grand Canyon. As a country, this is the ‘balance’ we hope to obtain.

Some good news for Americans – the Grand Canyon tightrope was indeed completed in 2013 by Nik Wallenda.

Through the dedication of those researching a vaccine to treat COVID-19 and the brave medical workers serving our communities, our country will inch our way through this pandemic tightrope – but it will take precious time and patience.

One mathematical modeling study recently released by Harvard University’s T.H. Chan School of Public Health, predicting various scenarios for the pandemic, suggests that intermittent periods of social distancing in the U.S. may be required into 2022. Yes, 2022!  A number of factors will determine the path the virus will take in the coming years – such as, if transmission subsides this summer and resurges in the winter, and if some immunity is induced by infection and how long it will last. Taking delicate steps to avert a surge of severely-sickened people from overwhelming the U.S. healthcare system is paramount.

When implementing national policy and procedures, researchers from this particular study are not advocating any single course of action over another, but their modeling suggests it will require a number of actions to fight this virus into the future. As mentioned by the researchers, “Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available.” The researchers acknowledge that ongoing intermittent social distancing will have profound consequences on economic, social and educational outcomes.

The overall conclusion of this research? It is unlikely that life (as we once knew it) will return any time soon. An article that explains this study in greater detail can be found in Stat Reports. This modeling research is expected to be useful to public officials and disease experts when planning for the continued response to the COVID-19 virus.

Please understand, there will be competing projection models that will suggest more rosy prognostications while others will suggest more dire projections toward reaching a new level of ‘normalcy.’ Although performed by a prestigious institution, the Harvard modeling effort will likely be updated as more is learned about the impact of the virus in the weeks and months to follow.

Iowans and Americans will need to confront the brutal facts of what the long-term COVID-19 implications are in the next chapter of this worldwide pandemic. We must learn to adapt by having realistic expectations of living a ‘new normal’ life.

Despite having no practice, this tightrope performance will require stamina, courage, and a great deal of patience.

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