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Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.
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Paragraph: The analysis suggests the potentially harmful effect of Celebrex dosage is most pronounced in higher-risk patients, researchers said at the American College of Cardiology scientific meeting. “Patients at low cardiovascular risk should take some level of comfort,” said Dr. Scott Solomon, lead researcher of the National Cancer Institute-sponsored analysis. “That wasn’t so clear previously.”   Doctors should exercise caution in prescribing the drug, generally known as celecoxib, in high-risk patients, said Solomon, whose analysis was also published online in the journal Circulation. Celebrex belongs to a class of pain drugs known as cox-2 inhibitors and is the only such drug still on the market in the United States. Merck and Co Inc withdrew its widely used cox-2 drug, Vioxx, from the market in 2004 after a study showed it doubled the risk of heart attack and stroke in long- term users. Another cox-2 inhibitor from Pfizer called Bextra was also pulled from the U.S. market due to safety concerns. While the analysis sheds light on how the drug should be used, Solomon said he could not judge whether the data lift the cloud over this class of drugs. The six trials involving a total of 7,950 patients all studied Celebrex against a placebo for uses other than arthritis. Patients received either 400 milligrams once a day, 200 mg twice a day, or 400 mg twice a day. The primary goal of the pooled analysis was an assessment of the combined risk of cardiovascular death, heart attack, stroke, heart failure or events involving blood clots. Researchers found the heart risk was lowest at the 400 mg daily dose. They found nearly a two-fold risk of adverse heart events with the 200 mg twice daily dose and that jumped to about a three-fold risk at the 400 mg twice daily dose. “Even 400 mg once a day showed elevated risk” in the high-risk population, Solomon said, adding he could not extrapolate whether doses lower than 400 mg cut risk further. The increased risk was not affected by aspirin use, researchers said. “Most of the data used in this pooled analysis have previously been published and are consistent with what we already know about the cardiovascular risks of Celebrex and other prescription arthritis pain relievers,” said Gail Cawkwell, Pfizer’s executive medical director. “The analysis doesn’t provide any new conclusions on the FDA-approved doses of Celebrex, including the most commonly prescribed dose of 200 mg daily,” she said. Dr. Steven Nissen of the Cleveland Clinic, who has a study on lower doses underway, added: “There aren’t long-term randomized placebo-controlled trials for that dose, The only way we’re ever going to answer these questions is with good randomized prospective data,” he said. “We’ll tell it like it is when the data is in.” Claim: Celebrex risky in high-risk patients, study finds.
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Doctors should prescribe the lowest doses of Celebrex possible in patients at high risk of heart problems, researchers who did a combined analysis of six studies of the Pfizer Inc pain drug said on Monday.


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Paragraph: The N.C. Department of Health and Human Services said in a news release on Tuesday that it’s working with the Buncombe and Henderson County health departments to track down additional information. Legionella bacteria can become a health concern when they grow and spread in human-made water systems like hot water tanks, air conditioning systems and other sources that are not properly maintained. State Epidemiologist Dr. Zack Moore said it’s not yet known if people attending the fair might have been exposed to Legionella bacteria. Moore says people who attended the fair and are experiencing cough, fever or shortness of breath should call their health care provider right away. Claim: 2 health departments investigate Legionnaires’ disease.
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Health departments in two North Carolina counties are looking into multiple cases of Legionnaires’ disease at the N.C. Mountain State Fair.


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Paragraph: Two doctors and a hospital administrator have died and at least 51 staff members have been infected since the new coronavirus was detected at the IMSS General Hospital in Monclova in the northern state of Coahuila in late March, the state health department said. The hospital became Mexico’s first hot spot for the COVID-19 illness caused by the coronavirus. At least four of the infected workers are currently hospitalized as a result of the outbreak, which has fed concerns that Mexico’s underfunded healthcare system is ill prepared to cope with a major epidemic in the nation of nearly 130 million people. At the beginning of the outbreak, managers “said that protective equipment wasn’t necessary,” said nurse Charly Escobedo Gonzalez who works at the Monclova hospital. Answering questions from Reuters about the reports that hospital management told staff not to wear masks, a senior official at Mexico’s main public health service IMSS which runs the hospital said that the health workers should be believed, but he did not confirm details of the reports. “Specifically, if they are saying that then of course we have to believe it,” said the IMSS official, Raul Pena Viveros. He said there can be misunderstandings inside a hospital about where it is appropriate to wear protective equipment. “Not all of the workers have to wear the same equipment inside the hospital. And when this type of equipment is used badly...it runs out more quickly and they put workers who are in contact with patients at risk,” he said. Mexico has registered 4,661 people with the coronavirus and 296 deaths, a fraction of the figures in the neighboring United States, but the coronavirus arrived weeks later in the Latin American country. The Monclova hospital became a coronavirus focal point in the third week of March, highlighting a lack of masks and even soap and bleach there, staff said. As staff began to fall ill, hospital floor managers instructed healthcare workers not to use facemasks, which some had bought for themselves due to the lack of hospital equipment, seven workers told Reuters. Pena Viveros said the hospital had been short of protective equipment as well as other materials to fight the coronavirus in March. Health officials have not given a detailed explanation of why so many Monclova healthcare workers became infected. Hospital workers are at greater risk of contracting the coronavirus if they do not wear protective equipment like facemasks and gloves. The N95 respiratory masks offer more protection from other people who are infected while more simple surgical masks help the wearer avoid spreading the virus. Due to a lack of proper N95 masks, some staff at the hospital were also wearing inappropriate industrial-style masks that were donated to them, Pena Viveros said. The lack of N95 masks was later resolved, said Pena Viveros, who was sent by the head of the IMSS from Mexico City to investigate the Monclova hospital and spent a week there in early April. Staff say the hospital has more protective equipment now but that they still lack gear such as masks. Three nurses said that while some colleagues chose not to wear facemasks after being told by managers or supervisors that they were not necessary, other staff kept wearing them. On the night of March 22, one of the heads of the nursing staff told a group of doctors and nurses gathered in the emergency room to take off their N95 masks because they were not necessary, according to a nurse who heard the order. Another nurse, surnamed Hernandez Perez, was given a similar order by a deputy head of nursing a few days earlier. “In a morning clinical class, the sub-head told us not to create panic...that we shouldn’t wear facemasks because we were going to create a psychosis,” said Hernandez Perez, who did not want her full name used. She is now at home sick and has tested positive for the COVID-19 respiratory illness caused by the coronavirus. A second nurse confirmed Hernandez Perez’s account. Reuters was unable to speak to two of the nursing managers who nurses say spoke at that meeting. After media accusations that the Monclova hospital badly lacked equipment to deal with the virus, the head of the IMSS, Zoe Robledo, announced in early April that the director of the hospital had been temporarily replaced. Neither the suspended hospital manager, Ulises Mendoza, nor the current hospital director answered repeated requests from Reuters for comment. One nurse, who asked that her name not be used for fear of retaliation, said that during the second half of March she was repeatedly told by superiors not to wear a facemask while working in high-risk areas such as on the ground floor of the hospital, where the emergency room is located. As well as the 51 confirmed cases, Pena Viveros said more than 300 other workers were temporarily sent home as the hospital scrambled to contain the outbreak. He said the hospital contracted nurses and doctors from other facilities to address the personnel shortage, nevertheless the hospital’s ability to care for patients has been impeded, some staff said. Claim: Exclusive: Nurses at Mexico hospital hit by coronavirus say they were told to avoid masks.
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Nurses at a public hospital hit by Mexico’s worst coronavirus outbreak were told by their managers not to wear protective masks at the start of the epidemic to avoid sowing panic among patients, nurses and other medical workers said.