A new study released in JAMA Pediatrics reports on how US adolescents aged 13 to 18 are experiencing and reacting to the covid-19 pandemic. Researchers looked at psychological factors associated with news monitoring, social distancing, disinfecting, and hoarding behaviors among this population. With adolescence comes increased autonomy and a rise in the importance of peer relationships. Combined with the less severe disease presentations that have been observed among pediatric and adolescent covid-19 patients, it was hypothesized that adolescents might be less likely to engage in disease prevention behaviors and less frequently monitor covid-19 news. A total of 789 Adolescents completed surveys over three days in March 2020, shortly after the declaration of a national emergency. Adolescents were required to have access to social media in order to participate and recruitment of subjects was obtained through advertising on various social media platforms. Topics covered included attitudes about covid-19 severity, social responsibility, social trust, and self-interest values. Over half of all of the teens responding said they followed covid-19-related news coverage a "great deal" or "much of the time" (60 percent). 61 percent reported following recommended hand washing behaviors multiple times per day. In response to social distancing, teens also reported observing guidelines with friends (though only 54 percent) or extended family not living with them (71 percent). Approximately 1 in 5 teens reported hoarding behaviors in the days after the declaration of the national emergency. Those who believed covid-19 to be more serious exhibited more social distancing and disinfecting behaviors and also monitored the news more often. A small number of teens reported not knowing anything about covid-19. While younger persons are seen as less likely to spread SARS-CoV-2 (in addition to having milder symptoms, most of the time), the findings of this study indicate that a substantial fraction of teens are not observing many important guidelines. However, some skewed demographics of the respondents to the survey limits the generalizability of these findings. More girls (75 percent) responded than boys (20 percent), along with a smaller proportion recognizing as non-binary (5 percent). Additionally, the sample was predominantly self-identified as White (73 percent), followed by Hispanic/Latino (15 percent).

Last week the US Centers for Disease Control and Prevention updated its list of underlying conditions that increase a patients' risks of developing severe covid-19 illness. Unfortunately, the recommendations are not supported by large amounts of high-quality data for many common underlying illnesses. A paper in JAMA Neurology released late last week, adds some more information as pertaining to multiple sclerosis, the chronic degenerative disease of neurons in the brain and spinal cord. Given the concern over medicines known as disease-modifying therapies (DMTs) possibly increasing the risk of severe infection, French researchers retrospectively assessed an important registry of patients used by MS expert centers in France. The main outcome studied was the severity of covid-19 disease as determined by a 7-point ordinal severity score that has also been used in other covid-19 studies. A total of 347 patients were included and analyzed for this report. Women made up 72 percent of the patients with an average age 44.6. Among all patients, 21 percent had a severity score of three or greater, indicating that they required hospitalization but did not immediately require supplemental oxygen. Death occurred in 3.5 percent of patients. Among those patients receiving DMTs (82 percent), scores of 3 or higher were less frequent (15.5 percent) compared to MS patients not taking those medications (46 percent). Other risk factors for severe courses of illness were also noted, many of which have been observed in other covid-19 studies. Older age almost doubled the risk and obesity tripled it. The important insight of this study is the finding that there was no association between taking DMTs for MS and the risk of developing severe covid-19. These results should help guide ongoing treatment for MS patients who may have been worried about whether taking DMTs places them at higher risks of developing severe covid-19; it appears that these medications are not associated with any added risk and that MS patients should not routinely be instructed to cease taking them. However, because this was a retrospective study and therefore these conclusions are not irrefutable.

As covid-19 cases continue to increase throughout the southern United States, one frequent source of infection clusters is becoming more clear: churches. Last month, President Trump stated that all in-person religious services should be allowed to resume despite the ongoing pandemic. Since that time, several outbreaks have been linked to services including at a Pentecostal church in Oregon and churches in West Virginia and Texas. Some of these outbreaks have forced local officials to dial back their plans for reopening. The situation has been made more difficult by concerns from many that religious organizations are being treated differently than other public spaces; in some states, the US Department of Justice has intervened on behalf of aggrieved churches. Previous guidance from the Centers for Disease Control and Prevention encouraged limiting recitations and singing, halting any Eucharist (mass/communion) and other shared servings. However, concerns were raised that these policies might infringe upon freedom of religion rights guaranteed by the First Amendment of the US Constitution. On Sunday, a masked Vice President Pence attended a worship service at a large Dallas megachurch. A large choir behind him wore masks but removed them when it came time to sing. Singing is known to project droplets much further than breathing or conversational speech. Meanwhile, Texas continues to see an uptick in SARS-CoV-2 cases and hospitalization rates have also risen dramatically in recent days. The Texas Medical Center, the largest concentration of health care institutions in the world, announced last week that they had reached 100 percent capacity in their intensive care units.  Politico.