Clinicians are worried that skepticism about COVID-19 in local communities will harm their efforts to contain the pandemic, reports the Wall Street Journal . This adds to healthcare workers' already onerous load of their job's physical and mental stress. Such denial can include the beliefs that the virus is no more threatening than a routine cold, that face masks are ineffective at slowing the spread, and that the pandemic is a hoax. An Axios-Ipsos survey in September estimated that 36 percent of people believe fewer Americans are dying from COVID-19 than the number of deaths reported, up from 23 percent who believed that in May. Meanwhile, University of Southern California researchers polled 5,770 people in November, and found 4.6 percent agreed or strongly agreed that "wearing a mask is unnecessary because coronavirus is not a serious threat to people like me," versus roughly 5 percent in June. Many doctors fear the toll that widespread public skepticism and misinformation about the virus are taking on their ability to provide medical care, because individuals who fail to take precautions risk becoming sick and contributing to the spread.

CNBC reports that California Gov. Gavin Newsom announced that the state will impose a three-week stay-at-home order on certain areas if their intensive care unit capacity slips below 15 percent. California will be divided into five regions: the Bay Area, Greater Sacramento, Northern California, San Joaquin Valley, and Southern California. "The bottom line is if we don't act now, our hospital system will be overwhelmed by COVID-19," Newsom warned. "If we don't act now, we'll continue to see a death rate climb, more lives lost." None of the five regions have so far triggered the stay-at-home order, though every area in California is expected to at some point in December. The majority of Californians currently remains under the most restrictive "widespread" tier of the state's four-tiered reopening plan, and Newsom said the latest announcement would enact the restrictions in "a much more broad, much more comprehensive way." He added that this will represent the pandemic's "final surge" as vaccines approach authorization.

The Hill reports that health experts are warning that the holiday season threatens to elevate the risk of COVID-19 to older Americans. The U.S. Centers for Disease Control and Prevention (CDC) estimated that more than 1 million coronavirus cases have been reported since Nov. 23, despite recommendations that people skip traveling for Thanksgiving and limit celebrations to members of their household. Yet many Americans are still holding family gatherings outside of those guidelines with people in the high-risk 65-and-up demographic. "I anticipate that we'll see in the next two weeks after Thanksgiving an even higher spike in cases across the country because people are gathering and traveling," said Mariah Robertson at the Johns Hopkins Bayview Medical Center. "We'll see something similar near the Christmas holiday for similar reasons." University of North Carolina School of Medicine Professor Christine E. Kistler added that even mitigation efforts like getting screened prior to holiday travel may not work, as people may catch the virus a few hours beforehand, but the test will not register that they have COVID-19. Robertson acknowledged that while "social isolation is bad for anyone . . . we still need to find ways to connect during these really important holidays" via substitutes like virtual meetings or house drive-by greetings.

Miami Jewish Health geriatric psychiatrist Marc Agronin writes in the Wall Street Journal that Zoom chats are proving very helpful for easing older adults' loneliness and isolation during the COVID-19 pandemic. He offers suggestions for maximizing Zoom calls' value for this group, while acknowledging shortcomings like the platform's small sensory field, poor Internet connections, and the inability to capture subtleties and fine details of facial expressions and gestures. "If you typically use a small smartphone or tablet, consider some relatively inexpensive options to improve the experience," Agronin recommends. "For example, there are tablet-sized portable viewing screens that can sit in front of your smartphone and create a much larger picture. There are adaptors that can project a smartphone- or tablet-sized screen onto a larger computer screen or TV monitor. There are Bluetooth external speakers that can significantly amplify the sound." Agronin also suggests that people schedule Zoom calls and prepare as if they were in-person meetings, and attempt to make meetings fun and creative. "For example, if you are Zooming with extended family members, especially children or teenagers, have interesting or colorful stories, jokes, or family history to share," he notes.

Health IT Analytics reports that a study in the British Journal of Ophthalmology detailed how machine learning tools can analyze certain types of retinal images to detect Alzheimer's disease in symptomatic individuals. Duke University researchers designed a tool that reads combined retinal images to identify patients known to have Alzheimer's disease, based on earlier work that identified changes in retinal blood vessel density that correlated to changes in cognition. People with Alzheimer's disease had lower density within the capillary network around the center of the macula. The machine learning model was trained on four types of retinal scans as inputs, so it could discern relevant differences among images. The team fed scans from 159 study participants — 123 cognitively healthy and 36 with Alzheimer's disease — to the model. "We tested several different approaches, but our best-performing model combined retinal images with clinical patient data," said Duke's C. Ellis Wisely. "Our convolutional neural network differentiated patients with symptomatic Alzheimer's disease from cognitively healthy participants in an independent test group."

Healio reports that a study published in JAMA found delirium to be a common symptom among older adults with COVID-19 presenting to U.S. emergency departments (EDs), often observed in lieu of other typical symptoms. The multicenter cohort analysis involved seven U.S. sites, with participants including consecutive older adults presenting to the ED on or after March 13, 2020. The authors used a validated chart review tool to diagnose delirium, which Harvard Medical School Professor Maura Kennedy said "was necessary as most emergency departments do not routinely screen for delirium," and because research staff could not screen for delirium on account of COVID-19 restrictions. Among 817 older patients with COVID-19, 226 had symptoms of delirium at presentation, and Kennedy said incidence of delirium was "two to four times higher than most ED studies of delirium prior to the COVID-19 pandemic." Delirium also was the primary symptom in 37 patients and happened without fever, shortness of breath, or other typical signs and symptoms of COVID-19 in 84 subjects. Despite the frequency of delirium in the study cohort, Kennedy said "it is not clear whether this is because COVID-19 infection is more likely to precipitate delirium than other disease processes or because our study had a large number of individuals at higher risk of developing delirium. I suspect it is a combination of these two factors."

Metro Weekly reports that a Michigan State University (MSU) study published in The Gerontologist determined that lesbian, gay, and bisexual (LGB) people are more vulnerable to dementia than heterosexuals. Investigators considered 3,500 LGB and heterosexual adults' cognitive skills, and older LGB adults are more likely to exhibit symptoms of mild cognitive impairment or early dementia. The only distinction between LGB adults and heterosexual adults that were identified as the source of the discrepancy was higher rates of depression among gay and bisexual people. Less influential factors included higher rates of alcohol consumption or smoking, and reduced social connections. MSU Professor Ning Hsieh suggested that depression "may be one of the important underlying factors leading to cognitive disadvantages for LGB people," and that they suffer higher rates of depression "for many reasons, including not being accepted by parts of society, feeling ashamed of their sexual orientation, or trying to hide their romantic relationships and being treated unfairly in school or at work."

The Harvard Health blog reports that a study determined a low-carbohydrate, high-fat diet might offer special health benefits for overweight or obese older adults. The study, published in Nutrition and Metabolism , had 40 obese adults 60 to 75 years old follow an eight-week diet with 10 percent of calories derived from carbs, 25 percent from protein, and 65 percent from fat. Carbs came from leafy greens, non-starchy vegetables, fruit, and high-fiber grains, while protein sources included eggs, fish, pork, and poultry. Fat sources, meanwhile, included olive oil, coconut oil, nut oils, nut butter, cheese, coconut milk, and avocados. In comparison with controls, those on the low-carb, high-fat diet lost more visceral fat, and experienced a significant reduction in insulin resistance and better cholesterol levels. These changes are associated with a lower risk of stroke, diabetes, and heart disease. Reducing carb consumption could help older adults escalate their weight-loss efforts and improve their health in ways that weight measurements do not always indicate.

Variety reports that actor Ed Asner and nine other plaintiffs are suing the Screen Actors Guild-American Federation of Television and Radio Artists (SAG-AFTRA) Health Plan and its trustees in federal court over looming cuts to benefits and eligibility. The plaintiffs claim two counts of breach of fiduciary duty, one count of engaging in a prohibited transaction, and one count of failing to report information material to plan participants. The suit states that Asner will lose his coverage, even though he had more than $25,950 in yearly covered earnings with residuals and sessional earnings, because he will not meet the new qualifying threshold by sessional earnings that goes into effect next year. The health plan informed members that it would hike the earnings floor for eligibility from $18,040 annually to $25,950 starting Jan. 1, and trustees said without restructuring, the plan was forecasting a $141 million deficit this year and $83 million in 2021. Critics have calculated that the changes stripped coverage for about 11,750 of 32,000 participants, including 8,200 seniors. Participant-only quarterly costs will rise from $300 to $375, while participant plus one dependent costs will climb from $348 to $531, and participant plus two or more dependents will go from $375 to $747. The suit charges trustees with mismanaging the plan, adding that their blaming the COVID-19 pandemic "ignores the facts and readily available measures that could have addressed such a one-time event without dramatically ending SAG-AFTRA health coverage for primarily older participants."

The Hill reports that employed Americans 55 and older who have lost their jobs may find it difficult to secure another position due to their physical vulnerabilities, age, and perceived lack of technological familiarity, according to experts. Data from the U.S. Bureau of Labor Statistics of all working adults older than 55 determined that 5.4 percent are unemployed. Meanwhile, almost 11 percent of people ages 20 to 24 are unemployed, 6 percent of people 45 to 55 are unemployed, and 5.8 percent of people 35 to 44 are jobless — but older people's economic security could be temporary. As COVID-19 cases rise nationally, companies must face difficult questions about whether it is safe to return to work for all employees and how in-person work will be impacted moving forward. "All the data are showing that the numbers are going back up, the vulnerability has increased across the board for everyone," said AARP's Susan Weinstock. She highlighted the concern that companies will not hire back older people who lost their jobs because they are at high risk for contracting COVID-19.