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Pioneering treatment for dementia could be available in the UK in two years

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pioneering treatment for dementia could be available in the uk in two years

For millions living with dementia – and for their loved ones – the future may appear bleak.

Thanks to medical breakthroughs, more people than ever are surviving our other biggest killers – heart disease, strokes and cancer.

But research into dementia drugs have led to dead ends, and time and again, hopes have been dashed.

Now, finally, there is cause for cautious optimism. A host of exciting projects are under way that could result in new medications for people with the disease and, perhaps, a new understanding of how it develops in the first place.

¿Noticeable improvement¿: Aldo Ceresa with his wife Laura. His symptoms eased during a trial but 67-year-old had his treatment stopped last year when the trial was halted

¿Noticeable improvement¿: Aldo Ceresa with his wife Laura. His symptoms eased during a trial but 67-year-old had his treatment stopped last year when the trial was halted

‘Noticeable improvement’: Aldo Ceresa with his wife Laura. His symptoms eased during a trial but 67-year-old had his treatment stopped last year when the trial was halted

Dr John Skidmore, of the Alborada Drug Discovery Institute in Cambridge, funded by Alzheimer’s Research UK, said: ‘We know different types of dementia are caused by different disease processes. And because we understand the biology of those diseases, it gives us a chance to intervene.’

Last month, drugs giant Biogen submitted its pioneering treatment, called aducanumab, for approval in the US after trial results showed it could significantly slow the progression of Alzheimer’s disease, the most common kind of dementia.

It means that the drug could be available in the UK in two years and pave the way for a new wave of therapies.

Aducanumab targets amyloid, a protein that builds up in the brains of Alzheimer’s patients. Normally these proteins circulate in the blood, but if they become sticky they can clump together, forming what are known as plaques in the brain. It is thought that in some people with Alzheimer’s, too many of these toxic plaques form, while in others something happens which stops the plaques being flushed away as they should.

Aducanumab, fed into the bloodstream via a drip, works by sweeping away these plaques to prevent damage.

An initial trial found it was safe, significantly reduced levels of amyloid and reduced the rate of cognitive decline. But huge disappointment came after a second, larger study, launched in 2017, was abruptly stopped a year in when early analysis of one branch of the trial suggested the drug was not working. But when Biogen analysed all patients given the highest doses for the longest amount of time, from both branches of the trial, it found positive results.

A host of exciting projects are under way that could result in new medications for people with the disease and, perhaps, a new understanding of how it develops in the first place (file photo)

A host of exciting projects are under way that could result in new medications for people with the disease and, perhaps, a new understanding of how it develops in the first place (file photo)

A host of exciting projects are under way that could result in new medications for people with the disease and, perhaps, a new understanding of how it develops in the first place (file photo)

Dr Catherine Mummery, dementia expert from University College Hospital, London, who led the UK arm of the Biogen trial, said: ‘The research community is very cautious, although optimistic. Some people will call what Biogen did data manipulation, and others will agree it supports their original findings But the fact is that there are people who believe they’ve had a fantastic result.’

One such patient is retired dental surgeon Aldo Ceresa. The 67-year-old, who lives with his wife Laura near Oxford, had his treatment stopped last year when the trial was halted. He hopes it will now be reinstated, as he says the drug ‘noticeably improved’ his Alzheimer’s symptoms. Within months, he felt his condition stopped deteriorating. He also got better at the puzzles set by the trial leaders to assess his brain function. ‘I was beginning to get quite good at them,’ he says. ‘Laura noticed I was getting better too. I was less confused and could concentrate better.’

Leaving a shingles infection untreated for longer than three days increases dementia risk

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Since he stopped taking the drug, his condition has worsened, which has been ‘frustrating’, he says.

‘I know it’s not going to cure me, but it could offer so many people so much extra time without their symptoms progressing. Until it’s approved, I’m eating healthily and keeping my mind active by walking six miles a day and doing plenty of puzzles. My former colleagues are amazed I’m still doing so well despite being diagnosed with Alzheimer’s in 2011.’

Dr Mummery says the aducanumab results proves there is a link between the amount of amyloid in the brain and the level of decline – which opens the doors for other drugs to be developed.

A decision from the American watchdogs could come as early as next year, and discussions are said to be ongoing with the European Medicines Agency to license the drug on this side of the Atlantic.

There may also be hope on the horizon for patients with more advanced Alzheimer’s.

Another type of naturally occurring protein, called tau, normally helps the brain to function, but in advanced Alzheimer’s patients it can build up and form ‘tangles’.

When the tangles form, tau has the opposite effect, hindering the way brain cells work. These tangles are thought to develop later than amyloid plaques, and some scientists believe they could be a crucial target for drugs in the later stages of the condition. Experts are now also attempting to alter genes inside the body’s cells, to switch off the processes that cause these proteins to form in the first place.

Last month, drugs giant Biogen submitted its pioneering treatment, called aducanumab, for approval in the US (file photo of a Biogen facility in Cambridge, Massachusetts, US)

Last month, drugs giant Biogen submitted its pioneering treatment, called aducanumab, for approval in the US (file photo of a Biogen facility in Cambridge, Massachusetts, US)

Last month, drugs giant Biogen submitted its pioneering treatment, called aducanumab, for approval in the US (file photo of a Biogen facility in Cambridge, Massachusetts, US)

A study led in the UK by Dr Mummery involves a drug known as an anti-sense oligonucleotide, or ASO, produced by US pharma company Ionis. This targets the gene that produces tau. The drug is injected directly into the nervous system via the spine, and early trials have found it is safe. Further trials are needed to see how well it works.

‘There are promising results in terms of it meeting its target,’ Dr Mummery said. ‘Every single one of the patients in the first trial wants to continue taking it. Tangles of tau develop later than amyloid plaques, so the hope is we can intervene later in the disease and still see a difference.’

Scientists are also investigating whether the brain’s natural ability to clear away excess amyloid proteins can be improved.

It is important to develop new approaches in tandem, Dr Skidmore says. ‘None on their own are likely to be magic bullets. Most people think it will be a combination of treatments that will work.’

The scientists making mini-brains in a jar

Brains can only be properly examined after death when dementia has already done its damage.

This means it’s difficult to know what goes on in the early stages of disease.

But a team at University College London is creating mini-brains from skin samples. Selina Wray, professor of molecular neuroscience at University College London’s Institute of Neurology, who is leading the study, said: ‘With these mini-brains, we can look for the very earliest changes that are happening in dementia.’

Each pea-sized mini-brain, pictured, can be used to study the development of dementia

Each pea-sized mini-brain, pictured, can be used to study the development of dementia

Each pea-sized mini-brain, pictured, can be used to study the development of dementia

To make the mini-brains, skin cells are taken from volunteers, and modified in the laboratory so they become stem cells – ‘building-block’ cells that have the ability to transform into any type of tissue.

Scientists then use other chemicals to make them become brain cells, which naturally cluster together.

Each pea-sized mini-brain can be used to study the development of dementia. The volunteers who have donated their cells all carry mutations to genes known to cause Alzheimer’s disease and frontotemporal dementia – a dementia that usually affects people aged 45 to 65. But none of them has symptoms yet.

Prof Wray hopes the research will help scientists understand why no two people experience Alzheimer’s the same way, despite having the same genes.

‘It could help us explain why some people get symptoms at 50, and others at 60,’ she said.

‘We can also start using drugs to see if we can restore levels of proteins to normal, and at what stage we need to intervene to do that.’

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Coronavirus outbreak spread to 929 meat plant workers in five weeks

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coronavirus outbreak spread to 929 meat plant workers in five weeks

Meat plants in the US and abroad have been especially hard-hit by coronavirus – and an outbreak at one South Dakota facility spread like wildfire to more than 900 workers in just five weeks, a Centers for Disease Control and Prevention (CDC) report reveals. 

Dozens of meat and poultry processing plants across the US have overwhelmed by coronavirus, which is transmitted easily in confined spaces with a high density of people in them. 

The South Dakota plant’s outbreak quickly exploded from a first case diagnosed in March to 929 of its 3,635 employees by April 25. 

Two of those employees died of the disease that has ravaged the world. 

Yet, the processing plant did not begin to close down until April 12, by which point, 369 cases had already been confirmed, a fact that has the CDC urging similar facilities to take more aggressive action as soon as a first case is identified. 

An outbreak of coronavirus at a Souh Dakota meat plant exploded from one case confirmed in March to 929 employees and 210 contacts by late April, a CDC report reveals

An outbreak of coronavirus at a Souh Dakota meat plant exploded from one case confirmed in March to 929 employees and 210 contacts by late April, a CDC report reveals

An outbreak of coronavirus at a Souh Dakota meat plant exploded from one case confirmed in March to 929 employees and 210 contacts by late April, a CDC report reveals

The CDC report does not name the meat plant its report describes, but the details appear very similar to those of a Smithfield facility near Sioux Falls that was the biggest coronavirus hotspot in the US for a brief time in April. 

After the South Dakota Department of Health confirmed the first case of coronavirus at the plant on March 24, the meat plant did trace the person’s contacts there and tested them. 

By April 2, that process had led to the diagnosis of 19 cases of coronavirus. 

Following the identification of that considerable cluster, the facility stepped up its screening, testing anyone with coronavirus-like symptoms such as cough, fever or shortness of breath. 

Even that modestly increased effort in testing turned up a massive number of additional infections. 

As of April 11 – just two-and-a-half weeks after the first case was identified – 369 workers at the factory had coronavirus. 

Nealy 370 people at the plant had already been infected by the time it began its phased shut down on April 12, a CDC graph shows

Nealy 370 people at the plant had already been infected by the time it began its phased shut down on April 12, a CDC graph shows

Nealy 370 people at the plant had already been infected by the time it began its phased shut down on April 12, a CDC graph shows 

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A dozen cases had been cause to test. Hundreds were cause for closing the facility down, which it began to do on April 12. 

But the closure was done in phases and much of the damage had likely been done. 

By the time the CDC finished its investigation of the factory – at the request of the state’s health department – 929 people had been infected. 

That represented more than a quarter of the meat processing plant’s total workforce. 

According to the CDC report, an average of 67 new cases were being identified a day at the peak of the outbreak at the facility. 

Unsurprisingly, the virus spread most quickly through three departments where employees could not maintain six feet of distance between them throughout their long workdays.  

The infection spread fastest in departments like 'cut' portion of the facility where employees work less than six feet apart from one another (file)

The infection spread fastest in departments like 'cut' portion of the facility where employees work less than six feet apart from one another (file)

The infection spread fastest in departments like ‘cut’ portion of the facility where employees work less than six feet apart from one another (file) 

Nearly 40 employees and nine contractors had to be hospitalized. 

Two of the employees died. 

Infectious disease experts believe that people who are exposed over and over again to greater loads of coronavirus are more likely to get severely ill if they contract coronavirus. 

A meat plant, in that sense, is a perfect petri dish for infections, as it spreads to workers who return day after day to work shoulder-to-shoulder in the confines of the facility. 

In April, meat plants like the South Dakota one were considered the driving force of coronavirus hotspots across the US. 

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The CDC report sheds light on how outbreaks spread beyond the walls of the factories themselves. 

Of the 2,403 contacts of the meat plant workers, 210 – about 10 percent – contracted coronavirus, too, illustrating how the single facility fueled the larger community’s outbreak. 

‘This large outbreak of COVID-19 among employees at a meat processing facility highlights the potential for rapid transmission of SARS-CoV-2 in these types of facilities,’ the CDC investigators wrote in their report. 

‘Factors that might have contributed to infection among employees at this facility include high employee density in work and common areas, prolonged close contact between employees over the course of a shift, and substantial SARS-CoV-2 transmission in the surrounding community.’   

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Menopausal women may be denied entry to airports using temperature scanners for Covid-19

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menopausal women may be denied entry to airports using temperature scanners for covid 19

Menopausal women may be unfairly denied entry to airports, pubs and restaurants if they have their temperature checked, it is feared.

Temperature detection devices — used in the fight on coronavirus — measure heat in the skin, which experts say can spike during a ‘hot flush’.

Doctors behind an app for women going through say hot flushes could be mistaken for having a fever — a tell-tale symptom of Covid-19.

Dr Ornella Cappellari, of Meg’s Menopause, said: ‘It is paramount to put in place measures which will allow menopausal women unbiased treatment when entering places such as airports because they may be experiencing a physiological reaction.’  

Temperature detection devices, such as handheld forehead scanners being used in restaurants and offices, are not considered reliable for spotting coronavirus.

The gadgets are not accurate at measuring the core body temperature and only give a rough estimate, scientists say. 

And some people with Covid-19 never develop a high temperature, therefore would be allowed to breeze through temperature checks despite being contagious. 

Menopausal women are feared to be unfairly denied entry to airports, pubs and restaurants if they get their temperature checked by scanners. Heathrow has started trialling temperature screening of passengers (pictured)

Menopausal women are feared to be unfairly denied entry to airports, pubs and restaurants if they get their temperature checked by scanners. Heathrow has started trialling temperature screening of passengers (pictured)

Menopausal women are feared to be unfairly denied entry to airports, pubs and restaurants if they get their temperature checked by scanners. Heathrow has started trialling temperature screening of passengers (pictured)

Temperature check devices work by measuring the temperature of the skin, so in theory, would detect the changes caused by a hot flush. They do not measure the body's core temperature. Pictured, a nurse taking a travellers temperature at Sydney Airport

Temperature check devices work by measuring the temperature of the skin, so in theory, would detect the changes caused by a hot flush. They do not measure the body's core temperature. Pictured, a nurse taking a travellers temperature at Sydney Airport

Temperature check devices work by measuring the temperature of the skin, so in theory, would detect the changes caused by a hot flush. They do not measure the body’s core temperature. Pictured, a nurse taking a travellers temperature at Sydney Airport

Putting a thermometer into an armpit, mouth, ear or other body cavity is known to be the most accurate way to measure temperature. 

It gives a reading for the body’s core temperature, which may rise in order to help fight illness. A high temperature is regarded as anything within the range of 38°C and 41°C.

Temperature scanners — including thermal imaging and temperature ‘guns’ pointed at the forehead — do not measure the body’s core temperature. 

HOW DO TEMPERATURE CHECKS WORK? 

Temperature checks are done with either portable ‘guns’ pointed at the forehead or with thermal imaging cameras.

Both detect heat being radiated from the skin using infrared sensors.

Thermal cameras detect heat radiating from the body using infrared technology and estimate the core temperature. They measure heat distribution across the body.

Portable devices also use infrared sensors to detect skin temperature changes, but do not provide an image. They measure temperature in one spot, usually from the head, and give a number on screen.

However, both pieces of kit can only give an idea of temperature of the skin, and not inside the body, which is what a thermometer would do.

Therefore they are not as accurate as a medical device which takes a patient’s’ temperature. 

But they may have some usefulness during the Covid-19 pandemic for spotting potential sick people.

If a person is flagged as potentially having a high temperature, they may be denied entry to a venue. But this would depend on the policy of each place.

They are controversial because a temperature above the normal range does not necessarily mean someone has the coronavirus – they may be unwell with something else. And people have variations in their temperature daily and women see fluctuations through their menstrual cycle.

They can also miss Covid-19 patients who do not have the symptom of a high temperature, or not symptoms at all. 

The World Health Organization says thermal camera says temperature screening ‘may not be very effective’ as a singular tool for detecting Covid-19.  

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Instead, they measure skin temperature which, although tends to correlate with spikes in core body temperature, can vary depending on the environment and activity.

The devices can only make an estimation of core body temperature by measuring heat radiating from the skin using infrared technology.

For this reason, Dr Cappellari fears menopausal women will be picked up if they are having a hot flush.

A hot flush — which can last for several minutes — causes the skin to heat up. 

It starts when blood vessels near the skin’s surface widen in an attempt to cool the body down. 

Scientists believe the process is triggered by fluctuation in hormone levels, which drastically change during the menopause.

Dr Cappellari, a former University College London researcher, said: ‘Most women experience hot flushes, which can cause a rise in skin temperature detectable by Covid-19 temperature checks.

‘The menopause is a delicate phase of transition for most women. You can sail through it very easily — or not.’ 

Derek Hill, a professor of medical imaging science from University College London, agreed that a thermal camera may wrongly flag a hot flush as a high temperature.  

He told MailOnline: ‘Hormonal changes results in blood vessels dilating. The thermal camera might pick it up because the blood goes to the skin.’

But he insisted that it was unlikely because temperature checks often focus on the forehead — the most clearly exposed area of skin.

Hot flushes tend to centre around the chest and neck, which are often covered by clothing, Professor Hill said. 

Professor Hill added that it was unlikely any action would be taken against women going through the menopause for a number of reasons, and therefore is ‘not something to worry about’.

Firstly, if they were taken aside for further investigations, a thermometer would prove they do not have a fever. 

And he said a hot flush will be over quicker than the time it takes for a thermometer check to be taken. A fever, on the other hand, is prolonged.  

Professor Hill added that thermal imaging cameras are not designed to look for people who potentially have a fever, and are used more traditionally in medical research.

‘They aren’t designed or tested to do this,’ he said, adding that they are not medically approved, either.

An expert in medical imagine science admitted temperature detection devices may flag women having a hot flush as a potential Covid-19 case, but would unlikely result in any action (Fiumicino airport, Italy)

An expert in medical imagine science admitted temperature detection devices may flag women having a hot flush as a potential Covid-19 case, but would unlikely result in any action (Fiumicino airport, Italy)

An expert in medical imagine science admitted temperature detection devices may flag women having a hot flush as a potential Covid-19 case, but would unlikely result in any action (Fiumicino airport, Italy)

MHRA SAYS TEMPERATURE SCANNERS CANNOT DIAGNOSE COVID-19 

The UK medicine health regulators warned in July that thermal cameras and other such ‘temperature screening’ products, some of which make direct claims to screen for Covid-19, are not a reliable way to detect if people have the virus.

The Medicines and Healthcare products Regulatory Agency (MHRA) urged for manufacturers and suppliers of thermal cameras to avoid making such claims. 

There is little scientific evidence to support temperature screening as a reliable method for detection of Covid-19 or other febrile illness.

Temperature readings come from measuring skin temperature rather than core body temperature. In either case, natural fluctuations in temperature can occur among healthy individuals.

Furthermore, infected people who do not develop a fever or who do not show any symptoms would not be detected by a temperature reading and could be more likely to unknowingly spread the virus.

Graeme Tunbridge, MHRA Director of Devices, said: ‘Many thermal cameras and temperature screening products were originally designed for non-medical purposes, such as for building or site security. Businesses and organisations need to know that using these products for temperature screening could put people’s health at risk.

‘These products should only be used in line with the manufacturer’s original intended use, and not to screen people for COVID-19 symptoms.’ 

Health Minister Lord Bethell said: ‘As pubs and restaurants begin to reopen, it’s important businesses do not rely on temperature screening tools and other products which do not work.

‘The best way to protect customers and minimise the risk of catching the virus is to always follow social distancing guidelines, wearing a face mask on public transport and enclosed public spaces, and regularly washing your hands.’

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They can produce wrong results — either a ‘false positive’, when someone is detected as having a fever when they do not — or a ‘false negative’ — when they do have coronavirus but are not detected.

It can take several days for infected patients to develop a fever, meaning they may not show up on the devices. Some never develop a fever at all.

Therefore, they could be allowed entry into places while they are infectious.  

Considering the inaccuracies, Professor Hill believes it is unlikely venues will be allowed to turn people away based solely on the readings of no-contact temperature scanners.

But it cannot be ruled out that some supermarkets and workplaces may deny entry if the a person’s reading is even suggestive that they have a fever. 

The medicine regulator in the UK recently stressed that temperature screening products cannot be used to diagnose Covid-19 because there is not evidence to support their use — and reminded suppliers of they should not make such claims.

Health Minister Lord Bethell said in July: ‘As pubs and restaurants begin to reopen, it’s important businesses do not rely on temperature screening tools and other products which do not work.’

Temperature scanners are now in place at some UK travel ports, including Bournemouth Airport and Portsmouth ferry port, and are being trialled elsewhere. 

Heathrow is currently testing thermal imaging in terminal 2 and will feed the results to the UK government. 

It says for now there will be no action against holiday-makers who are detected. 

However, when the trial launched in May, John Holland-Kaye, chief executive of Heathrow Airport, told BBC Radio 4’s Today the technology ‘could be part of a future common international standard to get people flying again’. 

Professor Hill said there will be many people who disagree with this because thermal imaging is not a reliable measurement of body temperature. 

But he added: ‘Many people would argue, and I’d be one of them, it’s not necessarily wrong to use these device this way for mass reading. 

‘But you’d be much better to measure it with an infrared thermometer [one entered in the ear] with a CE mark.

‘They certainly shouldn’t be used to say if someone has a fever. But they might be useful for detecting people who need a real temperature check.’ 

Alex Casson, an electrical engineer at the University of Manchester, said thermal scanners are not very sensitive. 

He told MailOnline: ‘They’re only accurate to around 0.5 degrees so very difficult to get precise readings.’  

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Coronavirus US: Families east of Portland’s 82nd Avenue at risk

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coronavirus us families east of portlands 82nd avenue at risk

Portland neighborhoods with mostly minority families and crowded public housing have higher rates of the novel coronavirus

Stumptown has become a tale of two cities with blacks and Hispanics living east of 82nd Avenue, also known as Cascade Highway, at higher risk of contracting COVID-19, the disease caused by the virus.  

An analysis from Willamette Week found that residents of this area were more than twice as likely to fall ill compared to those living west of 82nd.

The towns with higher rates are far from where the nightly protests have been occurring, dispelling the myth that demonstrations are causing outbreaks.

Health experts say that people of color are more likely to have a lack of healthcare access, more chronic health conditions and are work so-called ‘essential jobs,’ putting them at higher risk of exposure.  

Neighborhoods east of 82nd Avenue in Portland have been seeing higher rates of coronavirus, more than double, than towns on the west side (above)

Neighborhoods east of 82nd Avenue in Portland have been seeing higher rates of coronavirus, more than double, than towns on the west side (above)

Neighborhoods east of 82nd Avenue in Portland have been seeing higher rates of coronavirus, more than double, than towns on the west side (above)

ZIP code 97233, east of 82nd, currently has a case rate of 115.7 per 10,000 people compared to ZIP code 97201, to the west, which has a rate of 21.5 COVID-19 cases per 10,000. Pictured: Cars wait in line to be tested for coronavirus in Portland, July 14

ZIP code 97233, east of 82nd, currently has a case rate of 115.7 per 10,000 people compared to ZIP code 97201, to the west, which has a rate of 21.5 COVID-19 cases per 10,000. Pictured: Cars wait in line to be tested for coronavirus in Portland, July 14

ZIP code 97233, east of 82nd, currently has a case rate of 115.7 per 10,000 people compared to ZIP code 97201, to the west, which has a rate of 21.5 COVID-19 cases per 10,000. Pictured: Cars wait in line to be tested for coronavirus in Portland, July 14

An analysis shows ZIP codes to the east of 82nd have more crowded public housing, with a population more than double many areas to the west. Pictured: Cars wait in line to be tested for coronavirus, July 14

An analysis shows ZIP codes to the east of 82nd have more crowded public housing, with a population more than double many areas to the west. Pictured: Cars wait in line to be tested for coronavirus, July 14

An analysis shows ZIP codes to the east of 82nd have more crowded public housing, with a population more than double many areas to the west. Pictured: Cars wait in line to be tested for coronavirus, July 14

For the analysis, Willamette Week looked at rental house density for more than 30 ZIP codes in Multnomah County, where Portland is located.

It found several ZIP codes in neighborhoods such as Fairview and Gresham had a higher percentage of overcrowded households than the average in the county.

These areas, located east of 82nd Avenue, also have a higher number of cases than some of the city’s wealthier neighborhoods.

According to data from The Oregonian, ZIP code 97233, located in Gresham, currently has a case rate of 115.7 per 10,000 people.

Meanwhile, ZIP code 97024 in Fairview has a rate of 146.4 coronavirus cases per 10,000 residents.

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The Willamette Week found that this means, east of 82nd Avenue, the rate of infection is 84 cases per 10,000. 

This is much higher than Multnomah’s countywide rate of 56.7 infection per 10,000 people and nearly double the rate on the other side of the avenue.

Neighborhoods located in inner Portland, west of 82nd Avenue and where more affluent families are located, had better rates.

The Oregonian data shows that ZIP code 97212, where Irvington is located, has a case rate of 18.0 per 10,000.

Additionally ZIP code 97201, which is downtown Portland has a rate of 21.5 COVID-19 cases per 10,000.

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The ZIP codes west of 82nd Avenue not only have higher average household incomes, but are also less dense.

For example, 97201 has a population of 18,145 residents, according to The Oregonian. By comparison, 97233 has a population of 41,047.

That’s more than double the number of people, and likely contributing to the spread, health experts say.

Kim Toevs, director of communicable disease for the Multnomah County Health Department, told Willamette Week that crowded housing is definitely a factor driving up cases. 

‘When folks are living together in a smaller house or when there’s more people in a household, it’s trickier for folks to figure out how to navigate not exposing their whole household if they get sick,’ she told the magazine.   

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