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California Prop 14 may change lives of sick kids, keep taxpayer funding of stem cell therapy research

Three-year-old Ava was constantly sick. Her gums were inflamed, and every time she got a scraped knee, it turned into a dangerous infection.

Her parents, Alicia and Jon Langenhop, were months pregnant with their third child when they learned that Ava’s constellation of symptoms added up to an extremely rare, inherited disorder of the white blood cells, called leukocyte adhesion deficiency-1. Although antibiotics and antivirals could prolong her life, the disease was considered fatal, usually before kindergarten.

Ava’s primary hope, doctors told the Langenhops, was a bone marrow transplant from someone who was a good match, probably a brother or a sister.

Two-year-old Olivia had inherited the same disease as her big sister. She had been hospitalized with infections, too.

The baby in Alicia’s belly would be the girls’ best hope. Since both parents were carriers of the rare genetic mutation, the new baby, a boy, had a 25% chance of inheriting it, too.

Alicia was still in the hospital last October when they found out baby Landon had the mutation. Around the same time, the couple learned of a research trial in California.

Children Ava, Olivia and Landon Langenhop were diagnosed with an extremely rare, inherited disorder of the white blood cells, called leukocyte adhesion deficiency-1. California Proposition 14, a citizen-initiated ballot measure, authorizes bonds continuing stem cell research.
Children Ava, Olivia and Landon Langenhop were diagnosed with an extremely rare, inherited disorder of the white blood cells, called leukocyte adhesion deficiency-1. California Proposition 14, a citizen-initiated ballot measure, authorizes bonds continuing stem cell research.

Doctors would take each child’s blood cells, fix the mutation and return them. It should be a permanent fix, with less risk than a bone marrow transplant because the healthy cells would be their own, so their bodies wouldn’t reject them as foreign.  

The approach had been tried in only one child, though.

This is the type of research reaching patients nearly two decades after President George W. Bush banned federal funding of stem cell research and 16 years after California residents approved a tax increase on themselves to support research.

Proposition 14 on Tuesday’s ballot asks whether Californians want to continue this work, providing $5.5 billion for stem cell research over the next three decades.

In the early 2000s, stem cell research was controversial because it often required the destruction of human embryos. Though embryonic stem cells remain essential for some therapies, in cases such as the Langenhops’, treatment focuses on manipulating a person’s own cells.

Stem cell science has made tremendous progress, but as in most new fields, the pace remains painstakingly slow. Every treatment has to be the subject of years of trial-and-error research, and many scientific hurdles linger. 

Stem cells have been used to treat rare diseases, such as severe combined immunodeficiency, also known as “bubble boy disease,” and they are being tested in more common conditions such as Parkinson’s disease, macular degeneration, Type 1 diabetes and even heart disease.

“Even if a subset of stuff in the pipeline goes all the way, it will change the world for patients who currently don’t have other good options,” said Sean Morrison, a stem cell biologist in Dallas.

“It’s a pivotal time in the field,” said

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COVID takes two more lives, 70th and 71st

Staff Reports, Pacific Daily News/USA TODAY Network
Published 9:13 p.m. ET Oct. 23, 2020 | Updated 3:42 p.m. ET Oct. 24, 2020

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Pacific Daily News

Two men died of COVID-19 Saturday, according to the Joint Information Center, including a man who died the same day he was admitted to the hospital. They are the island’s 70th and 71st pandemic deaths.

A man hospitalized Oct. 10 after contracting COVID-19 died Saturday morning, marking the 70th virus-related death on Guam.

According to the Joint Information Center, the patient at Guam Memorial Hospital was 55 years old and had underlying health conditions that were complicated by COVID-19. He was a known positive case and had been admitted to GMH Oct. 10. He died at about 4:50 a.m.

Saturday’s second death was a 67-year-old man with underlying health conditions, according to the JIC. He was admitted Saturday to Guam Regional Medical City and died the same day, at about 2:07 p.m.

Gov. Lou Leon Guerrero gave condolences to the families of both men.

Coronavirus news: 85 test positive for COVID-19, cumulative total rises to 4,141

“Scripture tells us that those who mourn will be comforted. As we join in sorrow with the families and friends who have lost so much to this virus, we must also do all that we can so no more of our fellow brothers and sisters suffer the same fate.”

The governor said: “You have heard it time and time again — wear your masks, social distance, and stay home.”

More: 7 COVID-19 bereavement grants approved

On Oct. 15, Dr. Felix Cabrera, who is part of the governor’s physicians advisory group, said patients who die from COVID-19 complications, on average, are hospitalized for about seven days.

Typically, those who need hospital care will be admitted eight days after they are first exposed, Cabrera said.

“Thankfully, most people do recover after being admitted to the hospital, but some don’t,” Cabrera said at the Oct. 15 press conference. “And they require to be put on a breathing machine, or a ventilator, and that can typically happen on Day 14 from the first day they were exposed.”

On average, people who die from COVID-19 complications die 17 days after exposure, Cabrera said.

One of two trajectory models Cabrera presented Oct. 15 projected that, by this time, there would be over 70 people hospitalized, if nothing changed. As of Saturday afternoon, there were 78 COVID-19 patients hospitalized, according to the Department of Public Health and Social Services.

This month has seen 22 COVID-19-related deaths thus far, or 30% of the total deaths to the virus.

  1. Oct. 2: A 72-year-old woman with underlying health conditions died at GMH, where she was admitted Sept. 16.
  2. Oct. 3: A 90-year-old female with underlying health conditions died at GMH. She was pronounced dead on arrival and was a known positive case
  3. Oct. 4: A 66-year-old female with
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Universal Mask Wearing Could Save Some 130,000 Lives In The U.S., Study Suggests : Coronavirus Updates : NPR

Midshipmen wearing face masks stand and salute before the Navy Midshipmen play against the Houston Cougars on Saturday in Annapolis, Md. Researchers have tried to estimate how many lives would be saved by universal mask-wearing.

Patrick Smith/Getty Images


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Midshipmen wearing face masks stand and salute before the Navy Midshipmen play against the Houston Cougars on Saturday in Annapolis, Md. Researchers have tried to estimate how many lives would be saved by universal mask-wearing.

Patrick Smith/Getty Images

Universal mask wearing in public could greatly reduce the number of Americans who die by COVID-19 by February, a study published Friday in the journal Nature Medicine projects.

Researchers at the University of Washington’s Institute for Health Metrics and Evaluation made estimates based on some assumptions under different scenarios.

In what they describe as the worst-case scenario, they project that COVID-19 deaths could exceed a million between September 2020 and February 2021 if what they call “the current pattern of easing” restrictions continues in states.

In a second scenario that they think is more likely, they say 511,000 could die between September and February under the assumption that “states would once again shut down social interaction and some economic activity” for six weeks once deaths reach a certain threshold per million residents.

But in a third scenario where 95% of the population dons face coverings and social restrictions are in place, the projection is for deaths to be about 381,000 — or about 130,000 fewer than under the second scenario.

If that mask percentage changes to 85% of Americans with restrictions, it could still save some 96,000 lives, they say.

The study analyzed previous COVID-19 deaths and cases between Feb. 1 and Sept. 21. Researchers also pulled information from various surveys — including ones by Facebook and YouGov — to estimate that as of Sept. 21, only 49% of Americans reported always wearing a mask.

The study also assumed a 40% reduction in risk of COVID transmission due to a mask usage. Earlier studies estimated masks can reduce transmission by at least 30%.

Researchers also noted that changes in policies and behavior could affect outcomes and that epidemics progress in a way that is are “difficult to observe directly and at scale.”

“It is unreasonable to expect any model to do everything well, so each model makes compromises to serve a purpose, while maintaining computational tractability,” researchers wrote.

According to data from Johns Hopkins University, more than 224,000 Americans have died from the coronavirus.

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Fall, winter surge; Trump rally; masks can save 63K lives

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We answer the often searched question: “What are the symptoms of coronavirus versus the flu?”

USA TODAY

A long-predicted surge in COVID-19 cases and deaths has begun in the United States, but Americans aren’t changing their behaviors to slow the virus’ spread, according to an influential virus model.

The University of Washington’s Institute for Health Metrics and Evaluation released their latest model updates this week and they paint a bleak picture of the coming months: A surge in cases will create “enormous pressure on hospital capacity” and deaths will reach nearly 2,200 per day sometime in January.

But even as cases and deaths are currently rising, mask use remains consistent and Americans aren’t staying at home more. If mask use became nearly universal, 63,000 lives can still be saved, the model found.

Meanwhile on Friday, the U.S. surpassed its record for most daily infections when more than 83,700 new COVID-19 cases were recorded. The previous high was set in July when the U.S. saw more than 77,300 new cases.

Here’s what to know today:

  • President Donald Trump is expected to hold a campaign rally in Pensacola, Florida, on Saturday night. A USA TODAY investigation found that Trump’s rallies during the past two months didn’t just defy state orders and federal health guidelines – they left a trail of coronavirus outbreaks in their wake. 
  • The Food and Drug Administration authorized trials of a vaccine being developed by pharmaceutical company AstraZeneca and Oxford University to restart in the U.S. on Friday.
  • In Europe, France surpassed 1 million confirmed cases of COVID-19 on Friday, and a patient from the Netherlands was airlifted to a German intensive care unit – the first such international airlift since the global pandemic began.
  • Citing multiple COVID-19 clusters connected to indoor ice hockey, the Massachusetts Department of Public Health ordered a two-week “pause” for ice rinks and ice skating facilities.

📈 Today’s numbers: The U.S. has reported close to8.5 million cases and 224,000 deaths, according to Johns Hopkins University data. The global totals: 42.2 million cases and 1.1 million deaths.

🗺️ Mapping coronavirus: Track the U.S. outbreak in your state.

Which activities have the highest and lowest risk? Scientists say 6 feet is not enough, so develop a system to help you make smart decisions about common activities.

When will there be a COVID-19 vaccine? Our panel of experts expects at least one COVID-19 vaccine will be approved in the coming months. Then things could really get complicated.

This file will be updated throughout the day. For updates in your inbox, subscribe to The Daily Briefing newsletter.

Nobel-Prize winning CRISPR technology delivers 5-minute COVID-19 test

Researchers say a test developed by a Nobel Prize winner using cutting-edge CRISPR technology has the potential to be rapid, accurate and inexpensive.

CRISPR, or clustered regularly interspaced short palindromic repeats, is a gene-editing technology studied for a wide range of uses from cancer and sickle cell disease treatments to improved food production. The test recognizes a sequence of RNA in SARS-CoV-2,

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Wearing masks could save more than 100,000 US lives through February, new study suggests

If 95% of Americans wore masks in public, more than 100,000 lives could be saved from Covid-19 through February, a new modeling study suggests.



a person standing in front of a store: A customer wearing a face mask exits a Walgreens pharmacy in South Beach on April 14, 2020 in Miami Beach, Florida. The city of Miami Beach put in place an emergency measure requiring all customers and employees at grocery stores, restaurants and pharmacies to wear face coverings to help fight against the COVID-19 pandemic.


© Cliff Hawkins/Getty Images
A customer wearing a face mask exits a Walgreens pharmacy in South Beach on April 14, 2020 in Miami Beach, Florida. The city of Miami Beach put in place an emergency measure requiring all customers and employees at grocery stores, restaurants and pharmacies to wear face coverings to help fight against the COVID-19 pandemic.

The study — from the Covid-19 forecasting team at the University of Washington’s Institute for Health Metrics and Evaluation — notes that, in September, only about 49% of US residents reported that they “always” wear a mask in public.

If mask-wearing is 49% through February and states continue with removing social distancing mandates, the Covid-19 death toll across the United States could reach about 1 million deaths by February 28, according to the study, published in the journal Nature Medicine on Friday.

Yet under the assumption that states shut down when their daily death rate exceeds 8 deaths per 1 million people in the population but mask-wearing doesn’t change, the study’s model projections forecast the death toll could reach 511,373 deaths by February 28.

The scenario that 95% of people in each state wear masks — in addition to states reinstating social distancing mandates if their daily death rates exceed 8 deaths per 1 million people — resulted in the lowest death toll projection, with 381,798 deaths by February 28, according to the study.

For the study, the researchers analyzed data on Covid-19 cases and deaths in the United States from February 1 through September 21. That analysis — along with other factors, such as pneumonia seasonality, testing rates and mask use — helped inform model projections for the course of the pandemic through February 28.

The study had some limitations, including that the findings are only forecast projections from models and not definitive about what the future holds — and mask wearing tends to fluctuate, so the 49% figure used in the study appears to now be outdated.

IHME Director Dr. Chris Murray also emphasized during a virtual press briefing on Friday that the institute’s weekly modeling projections provide more updated data than what is provided in the study. However, the study still helps offer insight into how mask-wearing can make a difference.

“We think the key point here is that there’s a huge winter surge coming and our models have been showing that for many months,” Murray said on Friday.

“You can see in the paper what universal masks can do and they blunt quite a bit of the surge or delay it,” he said. “I think it’s very difficult at the point where we are in the US — where there’s so much community transmission of the virus — to prevent some fall winter surge, but we can certainly make it much smaller.”

Murray said that “the long-range view” provided in the study “is

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Wearing masks could save more than 100,000 lives in the next few months: new study

The U.S. could avoid a devastating number of additional COVID-19 deaths if more Americans wear masks to reduce the spread of the coronavirus, a new analysis published in Nature Medicine projects. 

Researchers from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) estimate in an analysis published Friday that the coronavirus death toll in the U.S. could surpass more than half a million by March without universal mask-wearing — defined as 95 percent of the population wearing face coverings in public. The total death count would hit the grim milestone even if physical distancing mandates remained in place in every state. 


Our country is in a historic fight against the Coronavirus. Add Changing America to your Facebook or Twitter feed to stay on top of the news.


With universal mask-wearing, however, nearly 130,000 lives could be saved. The analysis also estimates more than 95,000 lives could be spared if mask compliance was only at 85 percent. Researchers analyzed the number of cases, testing rates, mask use and cellphone data from the first confirmed case in each state through Sept. 21, then estimated the death toll until March 2021 for each state with or without social distancing and mask use. 

“The potential life-saving benefit of increasing mask use in the coming fall and winter cannot be overstated. It is likely that US residents will need to choose between higher levels of mask use or risk the frequent redeployment of more stringent and economically damaging [social distancing mandates]; or, in the absence of either measure, face a reality of a rising death toll,” the analysis states. 

Public health officials have stressed for months the importance of mask use in slowing the spread of COVID-19 as the race for a safe and effective vaccine continues. Officials estimate a viable vaccine likely won’t be broadly available until several months into 2021. 

The projection comes as the U.S. is currently experiencing a new wave of infections heading into the colder months and flu season. The Washington Post reports the average number of COVID-19 hospitalizations has increased in at least 38 states over the last week, and 14 states have reported new highs in hospitalized COVID-19 patients. 

The U.S. has confirmed more than 8.4 million cases and more than 223,000 deaths, according to Johns Hopkins University data. 


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The most advanced Covid-19 vaccine trials won’t tell us if the shots save lives, expert notes

The most advanced trials for coronavirus vaccines cannot tell researchers if the shots will save lives, or even if they’ll prevent serious disease, a drug development expert pointed out Wednesday.



a woman smiling for the camera


© Reuters / University of Oxford


The ongoing trials are only designed to show if the vaccines prevent infection — and most infections are mild infections, Peter Doshi, an associate editor at the BMJ medical journal and a drug development specialist at the University of Maryland’s school of pharmacy, said.

“I think there are some pretty widely held assumptions about what we are getting out of Phase 3 studies,” Doshi told CNN.

“None of the trials currently under way are designed to detect a reduction in any serious outcome such as hospital admissions, use of intensive care, or deaths. Nor are the vaccines being studied to determine whether they can interrupt transmission of the virus,” Doshi wrote in the BMJ.

“Hospital admissions and deaths from Covid-19 are simply too uncommon in the population being studied for an effective vaccine to demonstrate statistically significant differences in a trial of 30,000 people. The same is true of its ability to save lives or prevent transmission: the trials are not designed to find out.”

Four vaccines being developed in the US are in the most advanced, Phase 3 stage of development: those being made by Moderna, Pfizer, AstraZeneca and Johnson & Johnson. They’re “event-driven” trials, meaning that the goal is to keep them going until a certain number of volunteers become infected. If more infections are seen among people who got placebo, or dummy shots, it’s an indication the vaccines prevented infection.

But that doesn’t mean the vaccines saved people from serious disease or death, Doshi argued.

“Severe illness requiring hospital admission, which happens in only a small fraction of symptomatic Covid-19 cases, would be unlikely to occur in significant numbers in trials,” he wrote.

The US Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee meets Thursday to discuss the ongoing coronavirus vaccine trials and what members would like the FDA to consider when reviewing any applications for either emergency use authorization for a vaccine, or full approval.

Doshi said they should consider asking the companies to reconfigure their trials to include data on preventing severe illness and death.

“People expect that the most severe part of the Covid iceberg — the ICU admissions and hospitalizations and deaths — that’s what a vaccine would put an end to,” he said.

But the current trials will just look for early infections. It’s possible to keep these current trials going and add onto them so that they will, eventually, answer the question of whether Covid vaccines save lives and prevent severe disease.

“The trials are ongoing,” he told CNN. “There’s a chance for that. It’s not too late.”

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Covid-19 vaccine trials won’t tell us if the shots save lives, expert notes

The most advanced trials for coronavirus vaccines cannot tell researchers if the shots will save lives, or even if they’ll prevent serious disease, a drug development expert pointed out Wednesday.



a woman smiling for the camera


© Reuters / University of Oxford


The ongoing trials are only designed to show if the vaccines prevent infection — and most infections are mild infections, Peter Doshi, an associate editor at the BMJ medical journal and a drug development specialist at the University of Maryland’s school of pharmacy, said.

“I think there are some pretty widely held assumptions about what we are getting out of Phase 3 studies,” Doshi told CNN.

“None of the trials currently under way are designed to detect a reduction in any serious outcome such as hospital admissions, use of intensive care, or deaths. Nor are the vaccines being studied to determine whether they can interrupt transmission of the virus,” Doshi wrote in the BMJ.

“Hospital admissions and deaths from Covid-19 are simply too uncommon in the population being studied for an effective vaccine to demonstrate statistically significant differences in a trial of 30,000 people. The same is true of its ability to save lives or prevent transmission: the trials are not designed to find out.”

Video: AstraZeneca vaccine trial volunteer dies (CNN)

AstraZeneca vaccine trial volunteer dies

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Four vaccines being developed in the US are in the most advanced, Phase 3 stage of development: those being made by Moderna, Pfizer, AstraZeneca and Johnson & Johnson. They’re “event-driven” trials, meaning that the goal is to keep them going until a certain number of volunteers become infected. If more infections are seen among people who got placebo, or dummy shots, it’s an indication the vaccines prevented infection.

But that doesn’t mean the vaccines saved people from serious disease or death, Doshi argued.

“Severe illness requiring hospital admission, which happens in only a small fraction of symptomatic Covid-19 cases, would be unlikely to occur in significant numbers in trials,” he wrote.

The US Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee meets Thursday to discuss the ongoing coronavirus vaccine trials and what members would like the FDA to consider when reviewing any applications for either emergency use authorization for a vaccine, or full approval.

Doshi said they should consider asking the companies to reconfigure their trials to include data on preventing severe illness and death.

“People expect that the most severe part of the Covid iceberg — the ICU admissions and hospitalizations and deaths — that’s what a vaccine would put an end to,” he said.

But the current trials will just look for early infections. It’s possible to keep these current trials going and add onto them so that they will, eventually, answer the question of whether Covid vaccines save lives and prevent severe disease.

“The trials are ongoing,” he told CNN. “There’s a chance for that. It’s not too late.”

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Coronavirus jab trials don’t reveal if it will save lives

Ongoing coronavirus vaccine trials cannot prove a jab could save lives, one expert has stressed.

An effective immunisation programme has long been hailed as a route back to life as we knew it.

Hopes were raised in July when scientists from the University of Oxford found a vaccine candidate induced “strong antibody and T-cell immune responses up to day 56 of the ongoing trial”.

Antibodies and T-cells make up part of the immune system, helping to prevent an infection from taking hold.

Russia’s controversial vaccine candidate also brought about an immune response within 21 days, however, some experts later called the results “highly unlikely”.

Read more: The risk factors for long COVID

Writing in The BMJ, the journal’s associate editor Dr Peter Doshi stressed vaccine trials are not set up to show a jab reduces the risk of hospitalisation, intensive care admission or death.

Another expert called Dr Doshi’s comments “questionable”, but added “a number of the facts are correct”.

One expert pointed out ongoing vaccine trials will not demonstrate a jab stems the spread of the coronavirus. (Stock, Getty Images)

Dr Peter Hotez from the Baylor College of Medicine in Houston has said: “Ideally, you want an antiviral vaccine to do two things.

“First, reduce the likelihood you will get severely ill and go to hospital, and two, prevent infection and therefore interrupt disease transmission.”

While Dr Doshi agrees, he has argued “current [coronavirus] trials are not actually set up to prove either”.

Several coronavirus jab candidates are in phase 3 of clinical development. At an advanced stage, significant results mean the vaccine may be considered for approval by the US Food & Drug Administration (FDA) or the European Medicines Agency.

Read more: Nurses describe working amid pandemic

“None of the trials currently underway are designed to detect a reduction in any serious outcome such as hospitalisations, intensive care use or deaths,” wrote Dr Doshi.

“Nor are the vaccines being studied to determine whether they can interrupt transmission of the virus.”

This echoes concerns voiced after the Oxford scientists released their vaccine results.

The research was hailed as “promising”, “encouraging” and “extremely positive”, however, some also pointed out an immune response may not translate to protection against complications when the coronavirus is encountered outside of a laboratory.

Watch: Can you catch coronavirus twice?

Not all clinical trials have released details on the participants they are analysing.

Dr Doshi claims those we know of are evaluating mild coronavirus cases.

Honing in on the pharmaceutical giant Moderna, Dr Doshi noted how the firm’s executives have listed the rate of hospitalisation as a “key secondary endpoint” of its coronavirus vaccine trial.

Dr Tal Zaks, Moderna’s chief medical officer, later told The BMJ the trial “lacks adequate statistical power to assess that endpoint”.

A lack of statistical power typically means the number of participants is too small or the trial’s duration too short to accurately gauge whether a jab influences a particular outcome.

Early research suggests four out of five coronavirus cases

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Robust contact tracing is saving lives of Apache tribal members

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As the new coronavirus ravaged the White Mountain Apache Tribe in eastern Arizona, Eugenia Cromwell did her best to stay home to keep herself safe. Visits to the grocery store and post office were instead passed off to her daughter, with whom she shared a home near Whiteriver.

So it came as a surprise to the 79-year-old Apache woman when she learned in August she tested positive for COVID-19 along with two other people in her home. Knowing the virus could severely impact older adults, Cromwell feared for her life.

More than 15,000 members make up the White Mountain Apache Tribe, whose reservation spans 1.6 million acres of land across Gila, Apache and Navajo counties. Whiteriver, the tribe’s largest community and capital, is home to about 4,000 residents.

The tribe in early June surpassed the Navajo Nation in total number of COVID-19 cases per capita, meaning it had one of the highest infection rates in the country. By mid-August, about the time Cromwell tested positive for the virus, there were more than 2,300 identified COVID-19 cases and 38 known deaths.

However, the tribe’s number of new daily and active COVID-19 cases dropped in the last few months. The tribe’s number of COVID-19 related deaths through the pandemic also remained consistently low with a fatality rate on Wednesday of 1.6%, which is less than the state’s rate of 2.5% and country’s at 2.7%.

Health officials lend credit, in large part, to its robust contract tracing efforts on the Fort Apache Indian Reservation. So does Cromwell, who tested negative for the virus about three weeks after her initial diagnosis. 

Eugenia Cromwell, 78, is a high-risk White Mountain Apache Tribe COVID-19 patient. (Photo: Nick Oza/The Republic)

“I’m crying because I’m happy, these are wonderful people,” she said last month with tears in her eyes. “I’m so glad that I’m alive today.”

Officials go beyond just tracing, visiting some almost daily for check-ups

A healthcare provider on the morning of Sept. 10 paid a visit to Cromwell’s home to do a wellness check, reserved for patients considered high risk for complications from COVID-19.

Like clockwork, Cromwell quickly set up a chair on her front patio, wheeled out an oxygen concentrator and masked up. Several cicadas buzzed from a tree overhead while Victoria Moses, a health tech at Whiteriver Indian Hospital, checked Cromwell’s oxygen levels and asked her questions.

It was one of several visits made to Cromwell’s home since members of her family began testing positive for the virus in August. The wellness checks, in large part, involve monitoring a patient’s oxygen levels while sitting and walking — which for Cromwell also meant dodging a handful of ducks and a pig roaming her front yard.

“The patients get so used to our team that we’ll receive phone calls saying no one’s come to my house yet today,

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