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As a kid growing up in White America, learning to embrace my Asianness has often felt like rebellion. During the COVID-19 pandemic, it feels more political than ever.

Added anxiety over the rise in anti-Asian violence has shaken my community's sense of security. I've heard and seen plenty of advice on how to stay physically safe-most of which prescribes assimilation and exceptionalism, which has proven ineffective for BIPOC throughout history. Rather than performing useless acts that take us further away from ourselves, I recommend practicing a form of radical acceptance.

We can and should call out racism, defend ourselves, and work towards policy change to improve racial justice. But with radical acceptance, we let go of the idea that it's our job to prove our worth as humans; to change who we are, or how we're perceived. It can help relieve pressure, remove victim blame and shame, and allow emotional safety that coincides with living authentically. It's what makes sense to me, and many other Asian Americans, as we navigate the additional backlash of the pandemic.

This feels especially poignant in a month set aside to celebrate Asian culture and heritage. May was chosen as Asian Pacific American Heritage Month, to commemorate the first Japanese immigrants' arrival to the U.S. on May 7, 1843, as well as Chinese immigrants' work that completed the transcontinental railroad on May 10, 1869. As with all BIPOC in the U.S., our history is rich with oppression and rising through it.

Like a lot of people these days, I've been spending more time in the kitchen. Instead of baking sourdough bread, I'm perfecting my soondubu jjigae. The spicy, savory broth nourishes and nurtures me from the inside. One sip transports me back to Korea, creating the sense that I'm more at home in my body. Feeding myself my culture is a soothing act of racial healing.

I've also been reading more Asian and diaspora novelists, too, and taking my time with Helen Zia's Asian American Dreams: The Emergence of an American People. To unwind, I've streamedKim's Convenience, a cute sitcom about a Korean-Canadian family that sometimes broaches racial dynamics with a light touch. Although zombies aren't typically my thing, I binged all three seasons of , awestruck by the costumes. No matter the genre, listening to the cadence of the Korean language repairs some of the disconnect I have as an Asian person living in the West.

Other Asian people tell me they're also further embracing their culture and people - having more open discussions with family, digging into their history, and studying the language of their homelands.

CY, the co-founder and chef of S+M Vegan tells me she's been taking time to perfect her family's bak chang recipe. I've been a huge fan of the Oakland eatery for years - for both its Teochew-Singaporean food and social consciousness. Like me, CY is reading more Asian-American authors, plus WeChating with family abroad.

A sampling of S+M Vegan's ever-changing menu. Photo by Jason Addy.

The necessary sheltering orders disrupted S+M Vegan's business, but through take-out, they're rolling with the times. They've been using their social media platforms to share Asian American and Pacific Islanders content and historical facts of our plight and resistance as a way to fight back against the heightened anti-Asian sentiments.

I've also noticed a lot of cross-promotion with other Asian businesses and causes. CY says, "We seek each other out. We often go out of our way to connect. I think we all understand that we're stronger together."

She and her partner, Shane, have been organizing food trades with other local AAPI businesses. After all, food is love, and a thread that weaves back through to our ancestors. CY adds, "We try to be more open about our feelings than our parents' generation but in the end, a Tupperware of dumplings or a head of Napa cabbage speaks a thousand words."

Through a friend, I've recently become acquainted with Rupert Estanislao, a Pinoy Punk musician and co-founder of Aklasan Records. Estanislao is Filipino and relayed how three White people recently shouted racist slurs at him while trying to throw him off a bus in San Francisco on his way to his essential job. When I asked how he was managing the aftermath, he said he's fired up to write more songs about how Asians-and immigrants of color-are often scapegoated. When it comes to anti-Asian violence, he says, "No [Asian]'s exempt. We should get angry" and funnel it through our art.

Rupert Estanislao, right, co-founder of Aklasan Records, with his late grandfather. Photo from Aklasan Records.

While he's always been proud of his heritage, I admire how his reaction to what happened has him even further embracing his identity. He's speaking more Tagalog with friends and family. His wife will give birth any day, and they've already chosen a Filipino name. He's amped up to support and release more music from Filipino American bands that speak to the politics of our time. He says, "Art shows we contributed something to this society," not that we need to do more than the rest.

There's no upside to the uptick in anti-Asian violence, but I'm glad to see more of us awakened and speaking out. There's less talk of White adjacency and how it "protects" us. And many of us who weren't previously moved to explore our histories or take our place in the community are doing so now.

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Opinion | How I Found Racial Healing During the Pandemic

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As a kid growing up in White America, learning to embrace my Asianness has often felt like rebellion. During the COVID-19 pandemic, it feels more political than ever. Added anxiety over the rise in anti-Asian violence has shaken my community's sense of security.

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA)

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#CombatCovid: Design Takes Over Times Square

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When the full impact of the COVID-19 pandemic began to come into focus, we partnered with Poster House and an array of the best designers working today to create a series of #CombatCovid PSAs. They...

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Dear Colleagues of the IPPC Community,
The WHO, yesterday, declared the evolving global COVID-19 outbreak a "pandemic", an indication that we are in the midst of a situation that none of us has ever experienced before. To be sure, there is worry and concern, and the IPPC Secretariat wants you all to know that we are hoping for the best, doing everything we can in a positive way in this crisis and wishing the best for all of us. We strongly urge you to take good care of yourselves, your families, your colleagues, and your friends, by taking all recommended preventive and protective measures against COVID-19.Read more

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The global COVID-19 pandemic is spreading quickly and is a global problem calling for a global response. In view of providing relevant information to the IPPC community, the IPPC Secretariat developed a thematic page with the following five key messages:

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UF College of Journalism and Communications

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University of Florida College of Journalism and Communications Journalism Professor Kim Walsh-Childers was quoted in " White House Voices Frustrations Over Pandemic Media Coverage," published in The Hill on Aug. 4, 2021.

The article discusses the Biden Administration's criticism of media coverage of new guidance on masks and COVID-19 breakthrough cases among vaccinated Americans. According to the article, "Media experts say the challenge for some news outlets is accurately conveying the nuance of pandemic science to a frustrated public that's now being asked to resume mask wearing in some parts of the country and as the delta variant sends cases soaring among the unvaccinated."

"The public does not generally understand the concept of mutation," Walsh-Childers said. "Science is not a fixed body of knowledge ... but the kinds of stories that really politicize, the kinds of stories that really hype the political conflict over the mask guidance, I fear that really plays into the whole tendency of many people to view the whole thing as a political issue when it's not."

Posted: August 6, 2021
Category: College News, Diversity News, Health Communication News
Tagged as: Covid-19, Kim Walsh-Childers, Vaccines

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Kim Walsh-Childers Comments on Criticism of Pandemic Media Coverage

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University of Florida College of Journalism and Communications Journalism Professor Kim Walsh-Childers was quoted in "White House Voices Frustrations Over Pandemic Media Coverage," published in The Hill on Aug. 4, 2021.The article discusses the Biden Administration's criticism of media coverage

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Webinars on Modeling COVID-19 Pandemic：Resources, Methodology and Applications

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This webinar series gave reviews on COVID-19 models and data and discussed methodology, aplications, and inetrnational comparative studies on COVID-19 modeling.

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People shop at a Lunar New Year market in Hanoi on Jan. 28. (Hau Dinh/AP)
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Before 2020, Vietnam looked particularly vulnerable to a pandemic. The Southeast Asian country, a single-party state with nearly 100 million people, scoredlow on international assessments of universal health coverage and had relatively few hospital beds for its population, as well as a closed-off political system.
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Instead, Vietnam emerged as an early pandemic success story. Long after the coronavirus began to spread in neighboring China, Vietnam maintained low levels of infections and fatalities even as wealthy countries with more robust health systems, including the United States and much of Europe, struggled.

A new study of pandemic preparedness across 177 countries and territories appears to have found a key element in Vietnam's success: trust.

Thomas Bollyky, one of the study's authors, said Vietnam should have failed in the fight against the coronavirus, according to traditional tenets of preparedness.

"What Vietnam does have, that seems to potentially explain what has happened, is that they have very high trust in government - among the highest in the world," said Bollyky, who is a senior fellow for global health at the Council on Foreign Relations, a think tank.

The peer-reviewed study was published Tuesday in the Lancet, a top medical journal, following 10 months of research by Bollyky, his colleague Erin Hulland, a scholar at the University of Washington, and a team of dozens.

The aim of the study was to answer a question that has been dubbed the "epidemiological mystery" of the pandemic: Why did the coronavirus hit some countries so much harder than others?

Coronavirus cases spiked globally in the first weeks of 2022, despite record-high vaccination rates. Here's how the omicron variant took off. (Video: Jackie Lay, John Farrell/The Washington Post)

Unraveling the mystery of Europe's uneven covid surges

With countries already looking toward the next major outbreak, and treaties designed to ramp up preparedness for pandemics through new agreements and funding already under discussion, the question is increasingly urgent. But in review data from across the world, the study's authors found that traditional models for pandemic preparedness didn't fit what they were seeing.

"We found no links between covid outcomes and democracy, populism, government effectiveness, universal health care, pandemic preparedness metrics, economic inequality or trust in science," Bollyky said.

These factors were key for pre-coronavirus rankings such as the Global Health Security Index, which in 2019 listed the United States and Britain as most prepared for a catastrophic biological event, like a pandemic - and Vietnam 74th out of 117 countries.

Instead, better outcomes appear to have gone hand in hand with high levels of trust in government and other citizens. Perception of government corruption was correlated with worse outcomes. Researchers measured trust with polling data from the World Values Survey and Gallup.

Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University Medical Center, and an expert who was not involved in the study, said the research was evidence for what many already argue.

"Trust in government and strength of community engagement is critical to public health response," Katz wrote in an email. "Experts from multiple disciplines have pointed to the importance of risk communication, community engagement and trust as critical to public health messages and policies being implemented. The findings in this paper emphasize just how important this is."

Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health said the research showed that "the battle of human being against pathogen was mediated by governments."

"It's really a Chicken Little situation," Sharfstein added. "If people don't believe what the government is saying, then people will be less likely to take the precautions that they need to take."

The study's authors came to their conclusion by looking at standardized infection rates across countries. In reviewing factors outside of government control, such as the age of the population, researchers found clear signs that some governments had done better than others.

The United States, for example, had the second-worst standardized infection rate of any high-income country. A calculation that showed a standardized ratio of infections to fatalities found the United States in the middle of the pack, which could suggest that the country's health-care system is relatively robust even if people were more likely to become infected.

The U.S. government struggled to persuade its population to take measures to combat the spread of the virus, whether it was social distancing or seeking medical intervention like vaccination. Multiple polls have shown that the United States has relatively low levels of trust in government compared with other high-income countries and high levels of political polarization.

"Trust in your government or your trust in others is strongly associated with vaccination rates," Bollyky said. "It is associated with decreased mobility, which is an indicator of social distancing policies. "

The Lancet study estimated that if every country had the same level of trust in government as Denmark, one of the countries with more trust among high-income nations, 13 percent fewer people would have been infected with the coronavirus globally.

"If the same were true for one's trust in others, the reduction would be even larger: 40 percent, or 440 million fewer infections over the 21-month period assessed in the study," Bollyky said.

The study has its limitations. Comparative international data can only go so far, Bollyky said, and the study focuses only on factorsin place before the pandemic.

In addition, later waves of infection have challenged some previous assumptions about how some countries have fared, with some high-trust countries that had evaded outbreaks, including New Zealand, seeing high case numbers. Vietnam, once a relative success story, struggled more with public trust as cases surged in the second half of the year.

Michael Bang Petersen, a professor at Aarhus University, said the study's findings fit into his understanding of how a high-trust country such as Denmark responded to the crisis, but his own research on falling levels of trust in countries amid the crisis left him with a tragic conclusion.

The pandemic has "eroded trust in the government," Bang Petersen said. "It actually seems as if the pandemic has worsened the problem that this study identified."

Coronavirus: What you need to know

The latest: Scientists are concerned about ahighly mutated form of the coronavirus that threatens to be the most adept yet at slipping past the body's immune defenses. Here's why the new BA. 2.86 coronavirus variant has caught the attention of virologists and health officials.

Covid hospitalizations: The United States is experiencing abump in coronavirus transmission for the first time since the public health emergency ended in May. It is exposing the challenges of avoiding the virus when free testing is no longer widely accessible.

Covid boosters: Health officials are unveiling a new arsenal of vaccines ahead of an expected wave of covid, flu and RSV as the fall respiratory virus season begins. This includes an updated covid booster, which is likely coming in late September. Here's what to know about the new covid booster, RSV vaccines and flu shots this fall.

New coronavirus variant: EG. 5, a new covid subvariant unofficially nicknamed "Eris," is becoming a dominant strain in countries including the United States and Britain. Here's what to know about EG.5.

Covid deaths: Covid-19 was the fourth leading cause of death in the United States last year, and covid deaths dropped 47 percent between 2021 and 2022.

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Researchers are asking why some countries were better prepared for covid. One surprising answer: Trust.

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A new study of pandemic preparedness across 177 countries and territories appears to show that trust in government plays a major role.

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In this episode, we set out to explore whether false narratives about the pandemic and the COVID-19 vaccines have overshadowed science or whether science has managed to hold its own, particularly in light of the politicization of the pandemic.

Politics has certainly influenced who has chosen to get vaccinated. According to the Kaiser Family Foundation, "there continue to be differences in COVID-19 vaccination rates along partisan lines, a gap that has grown over time." The Kaiser study showed that almost 53 percent of people who live in counties that voted for Biden were fully vaccinated compared to nearly 40 percent of people in counties that went to Trump.

To better understand why people continue to reject overwhelming scientific evidence supporting the safety of the vaccines when compared to the dangers posed by the virus, we spoke to three people to learn more about the false narratives surrounding COVID-19 and the vaccines. Our first guest is Dr. Katherine J. Wu, a staff writer for The Atlantic who has a PhD in microbiology and immunobiology from Harvard University and has covered many different aspects of the coronavirus since the pandemic began. She tells us that when there is a crisis like this pandemic, it's not unusual for misinformation to follow and spread confusion.

Our second guest is Texas resident Tony Green, a Republican voter who has written about his first-hand experience with COVID-19. In June 2020, Green and his partner invited six family members to spend the weekend at their home in Dallas. At the time, Green was still referring to the pandemic as a "scamdemic" - wildly blown out of proportion. But over the course of that weekend, he developed symptoms of COVID-19 that would eventually land him and some his extended family in the hospital. In all, the virus spread to 14 members of his family and took the lives of two of them. (Starts at 18:25).

Our third and final guest is U.S. Surgeon General Dr. Vivek Murthy who tells us why he issued his "Confronting Health Misinformation" advisory and a special toolkit to help people learn how to navigate their way through all the false and misleading information not just about the virus and vaccines, but about all kinds of health-related topics. (Starts at 35:32).
Related links:

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In this episode, we set out to explore whether false narratives about the pandemic and the COVID-19 vaccines have overshadowed science or whether science has managed to hold its own, particularly in light of the politicization of the pandemic. Politics has certainly influenced who has chosen to get vaccinated.

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Author Frederick Joseph Raises Nearly $300,000 To Help People Pay Their Bills With #RentRelief Campaign - Blavity

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Noted activist and author Frederick Joseph has raised more than $250,000 through his Coronavirus Rent Relief Fund for people in need of financial help due to the coronavirus crisis. The GoFundMe campaign began on March 26, and with his powerful social media following, Joseph was quickly able to ama…

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Dre Mathilde Bellon, Dre Cecilia Schweblin, Dre Nathalie Lambeng, Dr Pascal Cherpillod, Dre Jessica Varquez, Pr Patrice Lalive, Dr Manuel Schibler, Dre Christine Deffert
Département médical - HUG
Département diagnostique - Service de médecine de laboratoire

Département de médecine - Service des maladies infectieuses

Département des neurosciences cliniques - Service de neurologie
Faculté - UNIGE
Faculté de médecine - Département de médecine et Département de pathologie et d'immunologie

Résumé

Les manifestations cliniques typiques du SARS-CoV-2, responsable du Covid-19, comprennent une toux, une fièvre et de la fatigue. Chez une minorité de patients, la maladie évolue vers une pneumonie bilatérale entraînant parfois un syndrome de détresse respiratoire aiguë. Parmi les caractéristiques moins typiques, des patients infectés présentent parfois des complications neurologiques, y compris une méningo-encéphalite, une encéphalopathie et un syndrome de Guillain-Barré.

Actuellement, le tropisme du système nerveux central et la neuropathogénèse du SARS-CoV-2 n'ont pas été entièrement élucidés. Plusieurs articles ont décrit les manifestations neurologiques du SARS-CoV-2 chez de nombreux patients, mais les paramètres du liquide céphalorachidien (LCR) n'ont été analysés que chez un nombre limité d'entre eux.

L'objectif de cette étude consistait à rapporter les caractéristiques du LCR de 31 patients infectés au SARS-CoV-2 et présentant des complications neurologiques. Les chercheurs n'ont observé dans le LCR ni l'ARN du SARS-CoV-2 ni la synthèse d'immunoglobulines G intrathécales. Ils ont cependant trouvé des signes de perturbation de la barrière hémato-encéphalique. Ces résultats pourraient servir de base à une meilleure compréhension de la neuropathogenèse liée au SARS-CoV-2.

Institutions partenaires

Plus d'informations

"Cerebrospinal Fluid Features in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Reverse Transcription Polymerase Chain Reaction (RT-PCR) Positive Patients", Clinical Infectious Diseases, ciaa1165, https://doi.org/10.1093/cid/ciaa1165

Dre Aikaterini Fitsiori, Dre Déborah Pugin, Dr Camille Thieffry, Pr Patrice Lalive, Pre Maria Isabel Vargas
Département médical - HUG
Département diagnostique - Service de neuroradiologie diagnostique et interventionnelle

Département de médecine aiguë - Service des soins intensifs

Départements des neurosciences cliniques - Service de neurologie
Faculté - UNIGE
Faculté de médecine

Résumé

Le Covid-19, initialement décrit comme une infection du système respiratoire, est de plus en plus reconnu comme une maladie multi-organique qui se manifeste également au niveau neurologique. Il existe également des preuves du rôle potentiellement neuro-invasif du SARS-CoV-2, responsable de cette maladie.

L'objectif de cette étude consistait à décrire les découvertes observées lors d'imageries à résonance magnétique (IRM) de patients gravement atteints du Covid-19. À cette fin, les images IRM de neufs patients présentant des résultats anormaux ont été analysées. Tous ont été testés positifs au SARS-CoV-2 et ont présenté un retard dans la récupération de la conscience ou une agitation importante nécessitant une IRM du cerveau.

Cette enquête a démontré que tous les patients avaient souffert d'un syndrome de détresse respiratoire aiguë sévère ou modérée nécessitant un séjour prolongé en unité de soins intensifs. Leurs résultats d'IRM ont tous dénoté la présence de micro-saignements inhabituellement distribués dans le cerveau avec une prédilection particulière pour le corps calleux.

Institutions partenaires

Plus d'informations

"COVID‐19 is Associated with an Unusual Pattern of Brain Microbleeds in Critically Ill Patients", Journal of Neuroimaging , https://doi.org/10.1111/jon.12755

Dre Déborah Pugin, Pre Maria Isabel Vargas, Dr Camille Thieffry, Dr Manuel Schibler, Dr Olivier Grosgurin, Pr Jérôme Pugin, Pr Patrice Lalive
Département médical - HUG
Département de médecine aiguë - Service des soins intensifs

Département diagnostique - Service de neuroradiologie diagnostique et interventionnelle

Département de médecine - Service des maladies infectieuses et Service de médecine interne générale

Départements des neurosciences cliniques - Service de neurologie
Faculté - UNIGE
Faculté de médecine

Résumé

Cette étude rapporte l'évolution clinique de cinq patients suite à un syndrome de détresse respiratoire aiguë causé par le Covid-19. Après deux semaines de ventilation mécanique, aucun patient n'avait repris conscience. Une imagerie à résonance magnétique du cerveau avec séquences angiographiques a révélé chez chacun d'entre eux des signes d'inflammation des artères du système nerveux central (SNC) compatibles avec une endothélite. Un traitement de 500 mg de méthylprednisolone (un glucocorticoïde) par jour a alors été initié pendant 5 jours. Au bout de 48-72 heures, les chercheurs ont remarqué un réveil avec un changement spectaculaire du niveau de conscience chez tous les patients.

L'observation d'une encéphalopathie liée au Covid-19 et associée à une endothélite du SNC répondant à des doses élevées de stéroïdes chez les patients des unités de soins intensifs devrait être confirmée par des études cliniques.

Institutions partenaires

Plus d'informations

"COVID-19-related encephalopathy responsive to high-dose glucocorticoids", Neurology,

Dr Laurent Gétaz
Médecin adjoint agrégé, Service de médecine pénitentiaire, Département de médecine de premier recours, Hôpitaux Universitaires de Genève & Privat docent, Faculté de médecine, Université de Genève

Dre Stéphanie Baggio
Service de médecine pénitencière, Département de médecine de premier recours, Hôpitaux Universitaires de Genève & Privat-docent, Département de santé et médecine communautaires, Université de Genève

Résumé

Cette étude vise à préciser quelle proportion des personnes a été infectée à la prison de Champ-Dollon lors de la première vague de l'épidémie de COVID-19. Elle s'appuie sur les données collectées par d'autres études de séroprévalence (SERO-CoV-Vulnérable et WORK) et compare les distributions de séroprévalence des personnes détenues ou travaillant à Champ-Dollon afin de mieux comprendre la circulation du virus, d'anticiper les défis qu'il soulève et de planifier les mesures nécessaires pour contenir sa propagation dans les établissements pénitentiaires.

Institutions partenaires

Dr Laurent Gétaz
Médecin adjoint agrégé, Service de médecine pénitentiaire, Département de médecine de premier recours, Hôpitaux Universitaires de Genève & Privat docent, Faculté de médecine, Université de Genève

Dre Stéphanie Baggio
Service de médecine pénitencière, Département de médecine de premier recours, Hôpitaux Universitaires de Genève & Privat-docent, Département de santé et médecine communautaires, Université de Genève

Résumé

Cette étude vise à préciser quelle proportion de la population genevoise vulnérable au COVID-19 a été infectée lors de la première vague de l'épidémie en Suisse. Cette population comprend des personnes cliniquement vulnérables en raison de maladies chroniques susceptibles d'engendrer des complications sévères ou de leur âge, ainsi que des personnes socialement vulnérables de par leurs conditions de vie précaires (vie en promiscuité, impossibilité de garder les distances sociales ou de se confiner). L'enquête explore également leurs caractéristiques (socio-démographiques, médicales, respect des mesures de protection) et les conséquences de leur exposition au virus (par exemple le renoncement aux soins).

Institutions partenaires

Dr Hervé Spechbach, Médecin adjoint responsable de l'unité des urgences ambulatoires, Hôpitaux Universitaires de Genève.

Dr Julien Salamun, Médecin adjoint, Service de médecine de premier secours , Hôpitaux Universitaires de Genève

Dre Frédérique Jacquerioz, Médecin cheffe de clinique, Service de médecine tropicale et humanitaire

Dre Stéphanie Baggio
Service de médecine pénitencière, Département de médecine de premier recours, Hôpitaux Universitaires de Genève & Privat-docent, Département de santé et médecine communautaires, Université de Genève

Résumé

Cette étude de cohorte a pour objectif de mieux comprendre le profil démographique et clinique des personnes chez lesquelles une infection SARS-CoV-2 est suspectée et qui se présentent aux urgences ambulatoires et dans les centres de dépistage des HUG. Elle analyse notamment les facteurs prédictifs de l'infection SARS-CoV-2, le tableau clinique et les facteurs prédisant une évolution défavorable pour les personnes testées positives. L'enquête explore l'évolution au cours du temps de la symptomatologie des personnes venant se faire tester, les effets des différentes stratégies de dépistage ou encore la prise en charge ambulatoire (par exemple pour les pneumonies). De cette cohorte, uniquement ambulatoire, sont également extraites des données concernant les personnes testées négatives.

Institutions partenaires

Dr Laurent Gétaz
Médecin adjoint agrégé, Service de médecine pénitentiaire, Département de médecine de premier recours, Hôpitaux Universitaires de Genève & Privat docent, Faculté de médecine, Université de Genève

Dre Stéphanie Baggio
Service de médecine pénitencière, Département de médecine de premier recours, Hôpitaux Universitaires de Genève & Privat-docent, Département de santé et médecine communautaires, Université de Genève

Résumé

Cette étude a trois objectifs principaux. Le premier est de démontrer la faisabilité de l'utilisation d'un dispositif d'auto-prélèvement de sang capillaire pour détecter des anticorps IgG SARS-CoV-2 chez les adultes. Le deuxième est d'étudier la réponse sérologique au COVID-19 chez les personnes immuno-supprimées ou ayant des maladies auto-immunes. Enfin, le troisième est d'analyser l'utilisation et les performances d'un auto-test diagnostic rapide pour détecter des anticorps IgG anti-SARS-CoV-2 chez les adultes.

Institutions partenaires

Dre Pauline Vetter
Centre des maladies virales émergentes
Assistante médecine, Département de médecine, Faculté de médecine de l'Université de Genève
Médecin interne, Service des maladies infectieuses, Hôpitaux universitaires de Genève

Résumé

Ce projet vise à comprendre les mécanismes d'infection SARS-CoV-2, et notamment :

Comprendre les processus d'infection et de propagation du virus au niveau des cellules épithéliales des voies respiratoires supérieures et inférieures et de déterminer le mode de libération du virus pour connaître son degré de transmission;

Comprendre l'influence du tabagisme et des maladies chroniques respiratoires sur la réplication du virus;

Comprendre au niveau cellulaire, les effets d'une coinfection avec le virus de la grippe;

Comprendre le lien entre la charge virale et la gravité de la maladie et comment évolue la réactivité du système immunitaire tout au long de la maladie;

Développer des antiviraux contre le SARS-CoV-2.

Financement

Fondation du Groupe Pictet
Fondation Ancrage
Fondation privée des HUG
Fondation privée genevoise

institutions partenaires

Plus d'informations
Résumé de la Fondation privée des HUG Résumé sur le site des HUG

Partenaires du projet

Professeure Isabella Anne Eckerle
Responsable, Centre des maladies virales émergentes
Professeure associée, Département de médecine, Faculté de médecine de l'Université de Genève
Médecin adjointe agrégée, Service des maladies infectieuses, Hôpitaux universitaires de Genève

Professeur Laurent Kaiser
Directeur, Centre des maladies virales émergentes
Professeur ordinaire, Département de médecine, Faculté de médecine de l'Université de Genève
Médecin-chef du Service des maladies infectieuses, Hôpitaux universitaires de Genève

Résumé

Nous avons lancé mi-mars 2020 le recrutement de patients et de leurs proches. En collectant régulièrement des informations sur leur état de santé et des échantillons biologiques, nous voulons déterminer ce qui constitue une réponse immunitaire protégeant ou aggravant la sévérité du COVID-19. Nous voulons recruter 50 patients et 200 contacts suivis à intervalles réguliers. Nous mesurerons la quantité de virus dans le corps, leurs réponses immunitaires immédiates (innées) et celles qui s'installent plus tardivement (anticorps, réponses lymphocytaires B et T). Nous nous intéresserons aussi à l'influence positive ou négative de l'immunité existant au moment de l'exposition au virus du COVID-19. Il s'agit de définir ce qui constitue une réponse immunitaire protectrice ou au contraire aggravant la sévérité du COVID-19 afin de guider le développement de vaccins ou de traitements immunomodulateurs à donner à un moment précis de l'évolution de la maladie.

Financement

FNS

institutions partenaires

Plus d'informations

Dans le cadre de leur projet interdisciplinaire en 1ère année du Master en Sciences Pharmaceutiques, trois étudiant-e-s ont créé un site web fournissant des informations sur les vaccins ARNm pour la protection contre le COVID-19.

Ce site web ( www.vaccinarn.ch) se présente sous la forme d'une foire aux questions (FAQ) qui répond aux questions les plus fréquemment posées par la population suisse romande sur les vaccins ARNm et la vaccination contre le Covid-19 en Suisse. Les réponses sont basées sur des informations provenant de publications scientifiques et de l'OFSP, et ont été évaluées par des experts.

L'objectif est de répondre aux questions fréquentes de la population sur la vaccination contre le Covid-19 et sur ce nouveau type de vaccin.

PROJECT PARTNERS
Vaccine Formulation Institute
Dr Nicolas Collin, VFI Executive Director

Dr Patrice Dubois, VFI Scientific Director

Summary

This study aims at investigating the immunogenicity of various SARS-Cov-2 candidate vaccines in partnership with the Vaccine Formulation Institute (VFI, Geneva) supported by the Global Health Vaccine Accelerator Programme of the Bill & Melinda Gates Foundation.

The study is performed with four different sub-unit vacines candidates targeting the Receptor-Binding Domain (RBD) of the Coronavirus Spike protein, formulated with several adjuvants developed by VFI, including emulsion-based adjuvants and liposome-based adjuvants.

Neutralizing antibodies responses as well as cellular responses will be analyzed in mice. This will allow to downselect the best adjuvanted vaccine candidates to be included in clinical trials (planned by the end of 2020).

Funding

Vaccine Formulation Institute (VFI)

Bill & Melinda Gates Foundation

partner institutions

National/international, Vaccine Formulation Institute (VFI)

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Press release " Co-development of a GMP emulsion-based adjuvant for human prophylactic vaccines, including COVID-19 vaccines ", 27 April 2020.

Résumé

L'étude cherche à préciser quelle proportion de la population a été infectée depuis le début de l'épidémie en Suisse. Une " photographie " indispensable pour une gestion optimale de l'épidémie. Lorsqu'une personne a été infectée par un virus, elle produit des anticorps, que l'on peut retrouver dans son sang. Leur détection contre le coronavirus permet donc de savoir qui a déjà été infecté par le SARS-CoV-2. En effectuant cette analyse sur un échantillon représentatif de la population genevoise, il sera donc possible d'estimer quelle proportion de la population a déjà été infectée par le nouveau coronavirus. Ces informations permettront de comprendre dans quelle phase de l'épidémie nous nous trouvons, d'anticiper les défis à venir et de prendre les mesures adéquates pour lutter contre cette épidémie.

institutions partenaires

Financement

Office fédéral de la santé publique
Ecole suisse de Santé publique (programme Corona Immunitas)
Fondation de Bienfaisance du Groupe Pictet
Fondation Ancrage
Fondation Privée des HUG
Centre des maladies virales émergentes de la Faculté de médecine de l'UNIGE et des HUG

Plus d'informations

Communiqué de presse "COVID-19: moins de 11% des Genevois infectés" (9 juin 2020)

Article publié dans The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)31304-0.
Résumé complet sur le site des HUG Interview dans le e-journal de l'UNIGE

Résumé

A Genève, certaines personnes ne peuvent se confiner durant la pandémie et sont donc plus susceptibles d'être exposées : personnel soignant ou qui assure le fonctionnement du système des soins; employés des chaînes de grande distribution alimentaire; personnel chargé du service minimum dans les écoles, etc. Dès lors que le déconfinement doit être planifié et les mesures de protection optimisées. Il devient impératif de connaître la proportion de personnes qui ont été infectées et sont immunisées, ainsi que la distribution démographique et géographique. Le projet SEROCoV-WORK consiste à tester la présence d'anticorps IgG anti-SARS-CoV-2, en 3 phases.

1. employés de trois cliniques/hôpital partenaires (HUG, La Colline, Les Grangettes, L'Hôpital de la Tour)

2. travailleurs mobilisés non-confinables de trois entreprises de la place

3. inciter d'autres entreprises genevoises à participer.

institutions partenaires

En collaboration avec les cliniques privées des Grangettes et de la Colline, l'Hôpital de la Tour, l'EPFL et la Chambre du commerce, de l'industrie, et des services de Genève

Financement

Fondation privée des HUG

Plus d'informations
Résumé sur le site de la Fondation privée des HUG Résumé sur le site des HUG

Professeur Nicolas Mach
Professeur assistant, Département de médecine, Faculté de médecine, Université de Genève & médecin adjoint, Département d'oncologie, Hôpitaux universitaires de Genève
Dr Aurélien Lathuilière
Service d'oncologie et Service de réadaptation, Hôpitaux universitaires de Genève

Partenaires du projet

Professeur Denis Jabaudon
professeur ordinaire, Département des neurosciences fondamentales, Faculté de médecine, Université de Genève

MaxiVAX
Ksenija Pavletic, administratrice
Julien Grogg, directeur des opérations cliniques

Université Laval
Pr Gary Kobinger, Directeur du Centre de Recherche en Infectiologie

Résumé

L'objectif de cette étude est de développer un vaccin contre le Sars-Cov-2 combinant un immunostimulateur puissant et une cible spécifique du coronavirus. La cible est la protéine de surface Spike, administrée sous la forme d'ADN par une injection intradermale alors que le stimulateur du système immunitaire consiste en une capsule produisant un adjuvant puissant implantée sous la peau. Cette technologie d'encapsulation cellulaire fait déjà l'objet d'essais cliniques de Phase II dans le domaine de l'immunothérapie des cancers.

institutions partenaires

Plus d'informations

Communiqué de presse "COVID-19 : Un vaccin genevois contre le SARS-CoV-2 en cours d'étude", 2 juin 2020.

Professor Isabella Anne Eckerle
Coordinator, Geneva Centre for Emerging Viral Diseases
Associate Professor, Department of Medicine, Faculty of Medicine, University of Geneva
Senior Consultant, Divison of Infectious Diseases, Geneva University Hospitals

project partners

summary

Although coronaviruses are known to frequently cross species barriers, we still lack knowledge on the genomic alteration for host adaptation. If metagenomic data are readily available to track the epidemic in real-time, in silico analysis based on sequence data alone cannot sufficiently predict viral phenotypes. Potential changes in the replicative capacity, in receptor affinity, interferon susceptibility or escape from adaptive immune response will have significant impact on public health, treatment or vaccine strategies. Here, we aim to set up a biobank of virus isolates and assess key phenotypic traits of low-passage strains. Our functional data on key traits of evolving virus variants complement viral metagenomic data and can help to guide and adapt immediate response strategies to this pandemic. All SARS-CoV-2 isolates and surrogate viruses will be made available to the research community. With the proposed project, we will be able to centralize and maximize the collaborative output of our Centre necessary to rapidly address this complex and challenging situation.

funding

FNS

partner institutions

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Professor Alexandra Calmy
Vice-Dean, Associate Professor, Department of Medicine, Faculty of Medicine, University of Geneva
Head of HIV consultation, Division of Infectious Diseases, Geneva University Hospitals

Professor Niklaus Labhardt
Swiss Tropical and Public Health Institute & Senior Physician at the University Hospital of Basel

Professor Enos Bernasconi
Service of Infectious Diseases, Ospedale Regionale di Lugano

Project partners

Thomas Agoritsas, professeur assistant, Département de médecine, Faculté de médecine UNIGE & Médecin adjoint agrégé, Service de médecine interne générale, HUG

Dr Marcel Stöckle, Service d'infectiologie et hygiène hospitalière, Hôpital universitaire de Bâle & Université de Bâle

Dr Dan Lebowitz, Assistant médecin, Département de médecine, Faculté de médecine UNIGE & Chef de clinique, Service de prévention et contrôle de l'infection HUG

Dre Mikaela Smit; Suppléante cheffe de clinique scientifique, Département de médecine, Faculté de médecine UNIGE & Cheffe de clinique scientifique, Service de prévention et contrôle de l'infection HUG

Thomas Perneger, professeur ordinaire, Département de santé et médecine communautaires, Faculté de médecine UNIGE & Médecin-chef du service d'épidémiologie clinique, HUG

Dre Annalisa Marinosci; Médecin interne, Service des maladies infectieuses, HUG

summary

The availability of simple and effective post-exposure prophylaxis (PEP) to prevent either SARS-CoV-2 infection and/or resulting clinical Coronavirus Disease (COVID-19) will play a crucial role both for the rapid containment and to protect at risk individuals including front-line health care workers now and in future outbreaks. We propose to assess the efficacy, safety and acceptability of a five-day course of Lopinavir/ritonavir-based PEP compared to standard of care for asymptomatic individuals exposed to individuals diagnosed with SARS-CoV-2 in a category C open-label cluster randomized clinical trial. A simple and effective PEP strategy, that can be prescribed the same day with limited laboratory exams, will help contain both the current pandemic and future COVID-19 outbreaks. Even if effective vaccination and treatment become available, PEP will play an important role in safeguarding individuals at highest risk, including front-line health care workers, and will be crucial for rapid containment of future outbreaks. The PEP candidate we are proposing to investigate is cheap, safe and globally available, including in Switzerland.

Funding

FNS
Fondation privée des HUG
partner institutions

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Dre Nathalie Vernaz-Hegi
Direction médicale et qualité, Hôpitaux universitaires de Genève & Privat docent, Faculté de médecine, Université de Genève

Dre Stéphanie Baggio
Service de médecine pénitencière, Département de médecine de premier recours, Hôpitaux Universitaires de Genève & Privat-docent, Département de santé et médecine communautaires, Université de Genève

Résumé

Cette étude observationnelle rétrospective compare les différentes stratégies thérapeutiques (hydroxychloroquine, lopinavir/ritonavir) pour les patients positifs au COVID-19 en comparaison aux normes de soins (sans stratégie thérapeutique). Elle vise à mettre en lumière l'issue clinique (durée d'hospitalisation et mortalité intra-hospitalière) et les coûts engagés (analyse médico-économique) par ces thérapies.

Institutions partenaires

Professor Chantal Csajka
Full professor, Pharmaceutical sciences section, Faculty of sciences

Summary

Retrospective analysis of the frequency of use of preventive and therapeutic practices, and their associations with occurrence of respiratory infections, Covid-19, and disease outcomes based on a international survey.

Project Partners

Dr Bertrand Graz, Antenna Foundation (CH)
Dr Houriet, University of North Carolina, Greensboro, US

Summary

To cure the viral infection and prevent the spreading of the SARS-CoV-2, inhibiting its main protease is a viable strategy. The SARS-CoV-2 main protease is essential for proteolytic processing of viral polyproteins, and its inhibition constitutes a conventional therapeutic strategy.
The aims of this proposal that uses NMR combined with molecular modelling as the screening tools are to:
1. Repurpose approved drugs against the main protease of SARS-CoV-2
2. Provide structure-activity relationship insights to the medicinal chemistry community to quickly improve existing drugs
3. Explore allosteric binding sites
Besides the immediate benefit toward the discovery of a cure against SARS-CoV-2, the expected outcome should immediately fuel medicinal chemistry for an efficient response to the pandemic.

Project partners

Dr. Julien Orts, Department of Chemistry and Applied Biosc., Laboratory of Physical Chemistry, ETH Zurich

Funding

Proposal submitted to SNF NRP_COVID19

Professor Caroline Tapparel Vu
Associate Professor, Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva

project Partners

Professor Isabella Anne Eckerle
Coordinator, Geneva Centre for Emerging Viral Diseases
Associate Professor, Department of Medicine, Faculty of Medicine, University of Geneva
Senior Consultant, Divison of Infectious Diseases, Geneva University Hospitals

summary

Testing the activity of nano material based antivirals mimicking widely used viral attachment receptors (heparan sulfate and sialic acid) against SARS-CoVs and the other coronaviruses. Developing new antivirals to fight COVID19. Testing antivirals targeting cellular pathways hijacked by the virus.

Partner institutions

EPFL

Funding

Fondation privée des HUG
Fondation CARIGEST
SNF

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résumé

L'apparition du nouveau coronavirus en début d'année a pris de court les Etats par la rapidité de sa propagation et les risques de débordement de leurs systèmes de santé. Depuis 2012, la Suisse dispose d'une nouvelle loi fédérale sur les épidémies, qui a précisément été conçue pour réagir à l'apparition de nouvelles maladies transmissibles. La présente contribution propose une première analyse de l'application de cette loi dans la lutte contre le nouveau coronavirus ; ce faisant, elle s'interroge sur la mise en oeuvre du renforcement de la responsabilisation individuelle et du désenchevêtrement des compétences entre la Confédération et les cantons.

Plus d'informations

Professeur Jean-Michel.Bonvin(at)unige.ch Professeur ordinaire, Institut de démographie et socioéconomie, Faculté des sciences de la société, Université de Genève

résumé

À Genève, les conséquences sociétales et économiques du semi-confi-nement ont touché de plein fouet les populations qui connaissaient déjà des difficultés à satisfaire leurs besoins élémentaires. Leur situa-tion s'est profondément dégradée, révèle une étude de l'Université de Genève (UNIGE), réalisée à la demande de la fondation Colis du Cœur et avec la collaboration de l'Etat et de la Ville de Genève, du Centre social protestant et du CAPAS. Impact de la crise sanitaire sur l'ali-mentation, la perte d'emploi, le niveau de revenus ou la dégradation de la santé, l'étude dresse un bilan de la situation deux mois après le début du semi-confinement et identifie des pistes d'intervention pour les services sociaux et associatifs. La majorité des personnes in-terrogées vivent dans des ménages en surdensité et, malgré leurs dif-ficultés, ne font pas appel aux aides. Les sociologues recommandent un renforcement des mesures conjoncturelles de crise, une meilleure information sur les aides existantes, et des initiatives rappelant les responsabilités des employeurs et les droits des travailleurs.

Plus d'informations

Communiqué de presse, "À Genève, le COVID-19 a fait plonger les personnes précaires", 22.09.2020.

Summary

The COVID-19 pandemic represents the most challenging public health crisis in recent memory. This may well be one of the few times in history when all governments have had the same priority, namely, to contain the spread of the SARS-CoV-2 virus. Many countries adopted lockdown policies, even to the known detriment to trade and the economy, in order to stop the spread of the virus, and protect their citizens' health.

WTO-related issues such as health (and environmental) restrictions or regulations, import and trade facilitation measures, patents, standards, mutual recognition mechanisms, export restrictions, subsidies and domestic support schemes, and values and social choices, all have a role to play during this pandemic. These issues operate with several other international norms and guidelines, for example, the World Health Organization's "International Health Regulations", the International Telecommunication Union's "Global Network Resiliency Platform", the World Intellectual Property Organization's "Covid-19 IP Policy Tracker", the World Customs Organization's "List of priority medicines for customs during Covid-19 pandemic", the International Aviation Organization's "Biosafety for Air Transport: A Roadmap for Restarting Aviation". States and international actors have made collaborative statements and expressed the need to protect health while at the same time minimizing the distortion of international trade to prevent dire consequences for people's livelihoods. All these issues have brought the WTO to the forefront of the fight against the pandemic.

This research summarizes the WTO rules relevant to human, animal, or plant health, and to the current pandemic in particular. It describes some of the actions WTO Members have taken to provide access to medical goods, and to protect their citizens' health, their economies and workforce. It recalls the collective and collaborative statements, declarations and commitments from WTO Members resolved to combat and win the pandemic fight. Finally, the paper concludes that attaining a broad-based, sustainable health and economic recovery will require open and transparent trade in order to ensure efficient and fair access to health treatment and the necessary return to normal economic activities.

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Article "From shock and rescue to recovery - moving forward thanks to efficient and transparent trade", To be published in"Building Back Better, A Call for Courage in the post‐COVID‐19 World", Friedrich Ebert Stiftung, 31 August 2020.

Didier Wernli
Senior lecturer, Global Studies Institute, University of Geneva

project partners

PHD Dr. Tediosi Fabrizio
Schweizerisches Tropen- und Public Health-Institut, University of Basel Professor Karl Blanchet
Full Professor, Geneva Centre for Education & Research in Humanitarian Action, University of Geneva

Professor Didier Pittet
Full Professor, Department of Medicine, Faculty of Medicine, University of Geneva & Head, Division of Infection Prevention and Control, Geneva Universty Hospitals

summary

The current COVID-19 crisis is causing widespread disruption in health, economic and social systems worldwide. The response to this ongoing pandemic is unprecedented. As stressed by WHO Director General, "all countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights". Over the past couple of decades, globalization and growing interdependencies have benefited the many. However, the financial crisis of 2008, the Ebola crisis in 2014-2015 and now COVID-19 are examples of systemic crises that can threaten modern societies. Based on insights from the governance of complex systems and resilience, this project aims to assess the initial impact of and responses to the current COVID-19 systemic crisis from an interdisciplinary perspective combining insights from public health, economics and law and understand how we can improve the resilience of our governance systems.

Funding

FNS

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Read FNS full summary

Summary

We will analyse retrospectively adherence to chronic medications in patients during the COVID pandemic. We will compare medication adherence before - during - after the confinement, and analyse how the confinement, as an independent variable, influences adherence to chronic treatments.

Project partners

Pr. Matthias Cavassini, CHUV, UniL;
Pr. Chantal Csajka, ISPSO, UNIGE, UniL;
Dre Dorothea Wagner, oncology, CHUV;
Dre Anne Zanchi, diabetology and nephrology, CHUV.

Funding

Part of funding for research in medication adherence (2 grants)

Professeur Antoine Flahault
Professeur ordinaire, Institut de santé globale, Faculté de Médecine, UNIGE

résumé

La corrélation entre la concentration élevée en particules fines et la gravité des vagues de grippe est bien connue des épidémiologistes. Une équipe interdisciplinaire de l'Université de Genève (UNIGE) et de Meteodat, spin-off de l'École polytechnique fédérale de Zurich, a étudié les interactions possibles entre des niveaux très élevés de particules fines et la virulence de la maladie COVID-19. Leurs résultats, publiés dans la revue Earth Systems and Environment, suggèrent que les fortes concentrations de particules fines de moins de 2,5 micromètres peuvent moduler, voire amplifier, les vagues de contamination du SARS-CoV-2 et expliquer en partie le profil particulier de la pandémie de la maladie COVID-19. L'augmentation en particules fines est généralement favorisée par les inversions de température de l'air, caractérisées par les situations de brouillard, ou par les intrusions de poussières sahariennes. L'étude donne des pistes préventives liées à la pollution de l'air pour limiter les futures flambées de morbidité et de mortalité dues au coronavirus.

institutions partenaires

Plus d'informations

Communiqué de presse "COVID-19: la qualité de l'air influence la pandémie", publié le 24 novembre 2020.

Article "Peaks of Fine Particulate Matter May Modulate the Spreading and Virulence of COVID-19", Earth Systems and Environment, DOI: 10.1007/s41748-020-00184-4

Résumé

Alors que les certificats d'immunité et de vaccination au COVID-19 sont discutés dans la population générale, les HUG ont mené une étude pour élucider l'opinion publique sur l'acceptabilité et la faisabilité de tels certificats immunitaires et sur la vaccination. Un questionnaire a été proposé, entre le 27 mai et le 27 juin 2020, aux 1520 participants de l'étude SEROCoV-POP, une enquête de séroprévalence des anticorps anti-SARS-CoV-2 dans la population du canton de Genève.

Sur 1425 sujets ayant répondu à l'enquête, environ 80% pensent que le statut sérologique entraînerait un changement de comportement chez la population générale. Si la présence d'anticorps était corrélée à une immunité prouvée, 60% des participants sont d'accord de proposer des certificats d'immunité à la population générale. Les résultats ont mis en évidence des variations de perception selon le contexte : 73% trouvent une utilité des certificats pour voyager, 72% pour traverser des frontières nationales et 32% pour avoir le droit de travailler. Environ 68% des participants ont signalé un potentiel risque de discrimination si des certificats immunitaires sont proposés et 28% un risque d'infection délibérée. A condition qu'un vaccin efficace soit disponible, 55% des participants sont pour rendre obligatoire la vaccination et 49% pour qu'un certificat de vaccination le soit également. Des différences ont été observées selon l'âge, le sexe et le niveau d'éducation.

Cette étude montre que la population adulte genevoise peut envisager des scénarios dans lesquels des certificats d'immunité et de vaccination au COVID-19 seraient utiles. A ce jour, les estimations de la séroprévalence des anticorps anti-SARS-CoV-2 restent faibles et l'interprétabilité des tests sérologiques et de l'immunité reste indéfinie. Toutefois, si des certificats liés au COVID-19 étaient mis en œuvre, les résultats de cette étude devraient être pris en compte.

institutions partenaires

Plus d'informations

Article "Perceptions of immunity and vaccination certificates among the general population: a nested study within a serosurvey of anti-SARS-CoV-2 antibodies (SEROCoV-POP)". DOI: https://doi.org/10.4414/smw.2020.20398 publié le 17.11.2020.

Dr. Jorge Cors
Laboratoire de Technologie Avancée, Faculté des sciences, Université de Genève

résumé

Ces couches minces sont utilisées pour l'observation directe des virus par microscopie à sonde locale. De nombreuses ressources ont été investies par le LTA pour l'optimisation de l'élaboration de ces couches.

institutions partenaires

Plusieurs universités et institutions dans le monde

HES-SO Genève Hepia

Professor Fernando Prieto Ramos
Full professor, Faculty of Translation and Interpreting (FTI), University of Geneva

Summary

This study presents a sociosemiotic analysis of practices of naming COVID-19 and its causative virus as reflected in eight influential newspapers of four countries in three languages in January-February 2020. It focuses on the impact of the names established by the WHO and the ICTV on the newspapers' naming patterns, and the implications of inappropriate names. This is further illustrated by the coverage of a subsequent political controversy on COVID-19 naming in the USA.

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Full article Summary in French

Informations UNIGE

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Recherche sur le COVID-19 à l'UNIGE // UNIGE Research on COVID-19

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Dre Mathilde Bellon, Dre Cecilia Schweblin, Dre Nathalie Lambeng, Dr Pascal Cherpillod, Dre Jessica Varquez, Pr Patrice Lalive, Dr Manuel Schibler, Dre Christine Deffert Département médical - HUG Département diagnostique - Service de médecine de laboratoire Département de médecine - Service des maladies infectieuses Département des neurosciences cliniques - Service de neurologie Faculté - UNIGE Faculté de médecine - Département de médecine et Département de pathologie et d'immunologie Les manifestations cliniques typiques du SARS-CoV-2, responsable du Covid-19, comprennent une toux, une fièvre et de la fatigue.

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Eating disorder symptoms and self-harm linked to higher levels of depression and anxiety during COVID-19 pandemic

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Young adults who have previously experienced self-harm or eating disorders reported higher levels of depression and anxiety during the pandemic, even when restrictions had eased, according to new research.

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Columbia University Irving Medical Center

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Columbia researchers found that babies born during the pandemic's first year scored slightly lower on a developmental screening test of social and motor skills at 6 months-regardless of whether their mothers had COVID during pregnancy-compared to babies born just before the pandemic.

The study, which included 255 babies born at NewYork-Presbyterian's Morgan Stanley Children's Hospital and Allen Hospital between March and December 2020, was published in the journal JAMA Pediatrics.

"Infants born to mothers who have viral infections during pregnancy have a higher risk of neurodevelopmental deficits, so we thought we would find some changes in the neurodevelopment of babies whose mothers had COVID during pregnancy," says Dani Dumitriu, MD, PhD, assistant professor of pediatrics and psychiatry at Columbia University Vagelos College of Physicians and Surgeons and lead investigator of the study.

"We were surprised to find absolutely no signal suggesting that exposure to COVID while in utero was linked to neurodevelopmental deficits. Rather, being in the womb of a mother experiencing the pandemic was associated with slightly lower scores in areas such as motor and social skills, though not in others, such as communication or problem-solving skills. The results suggest that the huge amount of stress felt by pregnant mothers during these unprecedented times may have played a role.

"These were not large differences, meaning we did not see a higher rate of actual developmental delays in our sample of a few hundred babies, just small shifts in average scores between the groups," Dumitriu says. "But these small shifts warrant careful attention because at the population level, they can have a significant public health impact. We know this from other pandemics and natural disasters."

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Developmental trajectory of infants begins early

When the first wave of COVID hit New York City in early 2020, Dumitriu led a group of pediatric researchers at Columbia University Irving Medical Center and NewYork-Presbyterian in organizing studies investigating the impact of the virus on infants through the COVID-19 Mother Baby Outcomes ( COMBO) Initiative.

In one early study, the researchers discovered that mothers do not pass the COVID virus to their fetus. However, it is known that viral illnesses during pregnancy increase the risk of neurodevelopmental delays in children through activation of the mother's immune system, which in turn affects fetal brain development.

"The developmental trajectory of an infant begins before birth," says Dumitriu, who is a pediatrician in the Well Baby Nursery at NewYork-Presbyterian Morgan Stanley Children's Hospital. "With potentially millions of infants who may have been exposed to COVID in utero, and even more mothers just living through the stress of the pandemic, there is a critical need to understand the neurodevelopmental effects of the pandemic on future generations."

In the current study, the researchers analyzed responses from a questionnaire that pediatricians give to parents to evaluate aspects of infant development, such as communication and fine and gross motor, problem-solving, and social skills.

Nearly half of the mothers in the study had COVID at some point during their pregnancies, though most of the illnesses were mild or asymptomatic.

No differences were found in scores between infants who were exposed to COVID in utero and those born during the pandemic whose mothers did not contract COVID during pregnancy. However, average scores among infants born during the pandemic-whether their mothers had COVID during pregnancy or not-were lower than the gross motor, fine motor, and social skills of 62 pre-pandemic infants born at the same hospitals.

"We want parents to know that the findings in our small study do not necessarily mean that this generation will be impaired later in life," Dumitriu says. "This is still a very early developmental stage with lots of opportunities to intervene and get these babies onto the right developmental trajectory."

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Could COVID-related stress affect brain development?

Though the study did not measure maternal stress during pregnancy, Dumitriu says it's possible that the stress caused by the pandemic and experienced by the mothers during pregnancy explains the drop in motor and social skills found in babies born during the pandemic.

Previous studies have shown that maternal stress in the earliest stages of pregnancy has a bigger effect on socioemotional functioning in infants than stress later in pregnancy, and a similar trend was found in the new study: Infants whose mothers were in the first trimester of pregnancy at the height of the pandemic had the lowest neurodevelopment scores.

Other factors, including fewer play dates and altered interactions with stressed caregivers, may help explain why babies born during the pandemic have weaker social and motor skills than babies born before the pandemic.

The researchers will continue to follow these infants in long-term studies.

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Babies Born During Pandemic's First Year Score Slightly Lower on a Developmental Screening Test

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Columbia researchers found that babies born during the pandemic's first year scored slightly lower on a developmental screening test of social and motor skills at 6 months-regardless of whether their mothers had COVID during pregnancy-compared to babies born just before the pandemic.

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Dental patients and practitioners could be better protected from COVID-19 and other airborne viruses and bacteria thanks to the development of a new environment-friendly shield by a multidisciplinary team from the University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust (UHBW). The shield could also increase the number of patients seen by dentists and help reduce procedure wait times.

The device, called NoPaS (Novel Patient Shield), is designed to protect patients and practitioners from harmful diseases including COVID-19, which can be spread through aerosols generated during dental procedures. The device could also significantly cut clinical waste, including the use of disposable personal protective equipment (PPE).

Dr Mojtaba Dorri, Consultant in Restorative Dentistry in the Bristol Dental School and University Hospitals Bristol & Weston NHS Foundation Trust (UHBW), who led the development of NoPaS, said: "During the COVID-19 pandemic the development of innovative environmentally-friendly solutions have been much needed to allow routine dental care to be delivered in a safe environment without risking virus transmission. With the virus still circulating and the chance of future pandemics, it is important routine dental care continues to ensure public oral health is not affected.

"With minor modification, NoPaS can be used for medical procedures on the head and neck, including endoscopy, anaesthetics and ear, nose and throat.

"Thanks to the Elizabeth Blackwell Institute, MRC Confidence in Concept and Bristol and Weston Hospitals Charity (formerly Above & Beyond) grants, our NoPaS prototype has been fully tested. With the device now patented, we are actively seeking partnerships to take NoPaS into mass production."
Read the full story

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New environment-friendly shield could offer better protection during dental surgery

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Dental patients and practitioners could be better protected from COVID-19 and other airborne viruses and bacteria thanks to the development of a new environment-friendly shield by a multidisciplinary team from the University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust (UHBW).

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Omicron may produce fewer serious illnesses, but this wave is far from ‘mild’ - Poynter

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Plus, the CDC defines ‘up to date’ versus ‘fully vaccinated’, the Mayo Clinic fires hundreds of unvaxxed workers, and more.

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Coronavirus COVID-19 pandemic | 100+ best free covid-19, pandemic, coronavirus and covid photos on Unsplash

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See the best 1138 free high-resolution photos of Coronavirus COVID-19 pandemic | 100+ best free covid-19, pandemic, coronavirus and covid photos on Unsplash selected by Unsplash Archive. These HD images are free to use for commercial projects.

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The Coronasode we've been waiting for! Vaccines. Finally. But what does this mean? Vaccine Infodemiologist and science communication lead for The COVID Tracking Project, Jessica Malaty Rivera specializes in infectious disease epidemics and the surge of misinformation that accompany them. The very first human trials of the COVID-19 vaccine occurred in March 2020, and Alie asks Jessica one million questions about the differences between the two available vaccines, rollout schedules, herd immunity, mRNA, vaccine hesitancy, mutated virus strains, picnics, vision boards, the post-holiday spike, how history can influence current vaccine rates, whether you should wipe down your groceries and more. Consider it a critical booster shot to the info we've gathered all year.

Listen via Stitcher, Apple Podcasts, Spotify or wherever you get podcasts.

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Vaccine Infodemiology (COVID-19 IMMUNITY) with Jessica Malaty Rivera - alie ward

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The Coronasode we've been waiting for! Vaccines. Finally. But what does this mean? Vaccine Infodemiologist and science communication lead for The COVID Tracking Project, Jessica Malaty Rivera specializes in infectious disease epidemics and the surge of misinformation that accompany them. The very fi

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Getty Images | 2021 Year in Review: The Year of the Vaccine

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Getty Images | 2020 Year in Review: Covid-19

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SHANGHAI : Thousands of people left messages on the social media account of the late Chinese COVID-19 whistleblower Li Wenliang on the anniversary of the day he learned of possible pneumonia-causing virus cases in Wuhan and shared the information with fellow doctors.

On Dec. 30, 2019, Li, an ophthalmologist at a hospital in Wuhan where the Sars-CoV-2 virus outbreak was first detected, saw a medical report showing potential SARS coronavirus cases were confirmed in the city, he wrote in a post on his Weibo account on Jan. 31.

In early January, after the information on "SARS cases" was shared in a WeChat group, Li was reprimanded by the local police, according to the same Weibo post.

On Jan. 12 he went to hospital, infected with the virus that causes the COVID-19 disease and died on Feb. 7, 2020.

His death led to an outpouring of grief on social media at a time when people were on edge about the virus and authorities were under fire over a perceived lack of transparency and a hardline approach taken to whistleblowers like Li.

Since then confidence has grown in China's response to the pandemic, but people have continued to post to Li online, especially on certain anniversary days as they did on Thursday.

"Happy new year Dr. Li, we will remember you forever," wrote a user called Tdby.

Others posted candle emojis, brief messages of thanks and exclamations of how two years have gone by so quickly, in the comments section of one of Li's posts on Weibo, China's equivalent of Twitter. Many wrote conversationally as if they were speaking to him beyond the grave.

Fang Kecheng from the Chinese University of Hong Kong said Li's Weibo microblog has become a place online where people express their feelings they are not comfortable expressing elsewhere.

"Such places for anonymous expression are needed in any society, and this is especially true in today's China," said the communication researcher.

Mainland China has reported 101,683 confirmed cases as of Dec. 28, with the death toll at 4,636.

(Reporting by Martin Quin Pollard)

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Thousands message late Chinese COVID whistleblower doctor 2 years on

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SHANGHAI : Thousands of people left messages on the social media account of the late Chinese COVID-19 whistleblower Li Wenliang on the anniversary of the day he learned of possible pneumonia-causing virus cases in Wuhan and shared the information with fellow doctors. On Dec. 30, 2019, Li, an ophthalmologi

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Once they turn 18, youth in foster care are required to fend for themselves. This includes finding shelter and services. Credit: Shutterstock

During the pandemic, Canadians have been asked to stay home to stay safe, yet thousands of youth are facing homelessness. Each year in Ontario, 800-1,000 youth age out of the child welfare system.

For most of these young people, turning 18 coincides with an abrupt withdrawal of their social supports as they simultaneously have to secure affordable housing, manage finances and finish high school.

Youth exiting the child welfare system are significantly less prepared to face these challenges than their peers, and many fare poorly. In Ontario, 58 percent of these youth experience homelessness, 46 percent report coming into conflict with the law and only 44 percent of youth exiting the system graduate from high school.

In the early months of the pandemic, the Ontario Children's Advancement Coalition (OCAC) and allied partners lobbied the Ontario government to stop the practice requiring youth to leave their care placements when they turn 18. In June 2020, the Ontario government placed a moratorium on this policy until March 31, 2021. Yet the pandemic continues and the clock is running out.

We research policy and work with youth and adults who are ensnared in the Canadian criminal justice system-many of whom have had contact with the child welfare system.

"Too many young people 'age out' to poverty, to homelessness. It's a pipeline to the criminal justice system for some. And it exacerbates mental health conditions," says Ratnam, co-founder of the non-profit Ontario Children's Advancement Coalition (OCAC). https://t.co/MzP7WgHkj7
- YWCA Toronto (@YWCAToronto) July 6, 2020
Challenging conditions in state care
Children who are deemed by child protective services (CPS) as experiencing abuse or neglect may be removed from their caregivers and placed under the guardianship of the state. Based on 2011 census data, there are 11,375 children in the child welfare system in Ontario. Black and Indigenous children are highly represented, with Indigenous children comprising 30 percent of kids in care in Ontario.

Many children and youth under state guardianship report moving among multiple homes and sometimes cities. Youth reported to us that they can count on having at least one move for every year that they're in the child welfare system, and some move multiple times in a year. Frequent moves can disrupt education, resulting in low rates of high school completion. Youth who don't complete high school face challenges and are more likely to experience poverty and rely on government assistance.

This instability can create low levels of attachment, trust and relationship-building. Many youth contend with mental-health challenges, such as post-traumatic stress disorder, that have an impact on their mental, emotional, social, spiritual, physical and occupational wellness and development. It's unsurprising that many youth describe feeling vulnerable and angry in these circumstances. Often youth are labelled oppositional and criminalized due to the way they behave, but this is in response to trauma and their circumstances.

From a youth we interviewed: "[Being in the child welfare system] really changed my character. It really just changed who I was as a person.... I've been in [at least] 20 different places and you know, it's just so much [stuff]. And that's the thing. Like all this stuff, people don't realize ... for somebody like me, I've been so thrown around, like [basically] tossed around, like here, there, everywhere."

A CTV Report on aging out of foster care from March 2020.

Emerging adulthood
When youth under guardianship of the state turn 18, they are required to leave their foster care or group home placements. Some young people may continue to receive financial support after they turn 18 through the Continued Care and Support for Youth (CCYS) program. This financial support stops abruptly when they turn 21.

Psychologist Jeffrey Arnette's theory of emerging adulthood recognizes a period of prolonged transition between late adolescence and fully independent adulthood. Emerging adulthood helps to explain shifting societal trends in recent decades.

Many emerging adults rely on their families for financial, housing and social support longer than in the past, often well into their 20s. More young people seek post-secondary education, face higher rates of unemployment and rising housing costs, and marry and have children at a later age, on average.

Despite these broader societal trends, currently youth in the child welfare system are required to leave their placements when they turn 18. While other young adults are able to gradually transition to independent adulthood, young people leaving care are abruptly forced into adulthood.

When asked how prepared they were for "independence," one young person shared: "We all got like a Tupperware container, or a tub full of pots and pans and dishes and stuff like that. But yeah, there wasn't really any preparation."

Another added: "I just had to learn how to be a human on my own. Like, I had to learn everything that like a mom or like a parent or guardian is supposed to teach a kid from young."
After the moratorium
Once the moratorium lifts on March 31, 2021, there will be a flood of young people leaving their homes and heading into a decimated housing and employment market.

Heather O'Keefe, executive director at StepStones for Youth, says: "The devastating impacts of the COVID-19 pandemic have created further vulnerability for youth from the child welfare system with the lack of safe housing options, the loss of jobs, the inability to make rental payments and purchase essential items, and increased isolation and seclusion. The toll on the mental health of these youth has been exacerbated with the closure of libraries and schools, reduced services for people living in poverty, fewer opportunities to meet with counsellors and psychotherapists in person, and increased anxiety and suicide ideation."

Our work with these young people underscores that the moratorium should be extended indefinitely. Rather than maintaining arbitrary age cut-offs for support, the provincial government should implement a readiness model.

This approach would work with every young person from the minute they enter the child welfare system to encourage better outcomes once they decide they are ready to be fully independent rather than being forced to leave care once they turn 18.

Youth leaving state guardianship have always been vulnerable. And with the ongoing coronavirus pandemic, youth aging out of care will be in a much more vulnerable position, with potentially more severe impacts.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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COVID-19 leaves youth forced out of foster care even more vulnerable

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During the pandemic, Canadians have been asked to stay home to stay safe, yet thousands of youth are facing homelessness. Each year in Ontario, 800-1,000 youth age out of the child welfare system. For most of these young people, turning 18 coincides with an abrupt withdrawal of their social supports as they simultaneously have to secure affordable housing, manage finances and finish high school.

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA)

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA)

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The ferocity of the covid-19 pandemic did what Black Pittsburgh - communities that make up a quarter of the city's population - thought impossible. It shook the norms.

Black researchers, medical professionals and allies knew that people of color, even before covid, experienced bias in public health policy. As the deadly virus emerged, data analysts from Carnegie Mellon and the University of Pittsburgh, foundation directors, epidemiologists and others pooled their talents to configure databases from unwieldy state data to chart covid cases.

Their work documented yet another life-threatening disparity between white and Black Pittsburgh: People of color were at higher risk of catching the deadly virus and at higher risk of severe disease and death from that infection.

More than 100 weeks after advocates began pinging and ringing one another to warn of the virus' spread, these volunteers are the backbone of the Black Equity Coalition, a grassroots collaboration that scrapes government data and shares community health intel.

About a dozen members of its data team of 60 meet twice weekly to study hospitalization rates and employment statistics. Social media advisers turned health equity into a buzzy online effort, with videos and weekly Facebook town halls, to encourage vaccinations. Local ministries are consulted, and volunteers take surveys at pop-up clinics, sponsored by other groups, at barbershops and hair salons. Elected lawmakers seek its counsel.

"We came together because we were concerned about saving lives," said Tiffany Gary-Webb, associate dean for diversity and inclusion at the University of Pittsburgh, who oversees the data effort. "It evolved, with us realizing we can do more than address covid."

Advocates within the Black Equity Coalition ― a grassroots collaboration of volunteers, community leaders, and data analysts ― gather to discuss their ongoing mission to uncover the life-threatening disparities between white and Black Pittsburgh. (Left to right) Karen Abrams, Tiffany Gary-Webb, Fred Brown and Mark Lewis(Martha Rial for KHN)

Covid ravaged communities across the United States - more than 787,000 Americans have died, including Colin Powell, the first Black secretary of state and a decorated Army general - and laid bare how marginalized populations lose out in the scrum for public health dollars and specific populations were left vulnerable.

Months before the pandemic began, the Rev. Ricky Burgess led the Pittsburgh City Council to declare racism a public health crisis.

"Institutional racism is for real," the councilman said in a recent interview. "You are talking about generational disproportional investment and generational disproportional treatment. And it impacts all that you see."

The covid pandemic proved how structural inequities have been missed or ignored, Burgess said.

"I've lost friends, family and a lot of church members. My son had covid. For me it's personal," he said. "I knew immediately it would have a disproportionate effect."

In 2020, covid reduced overall U.S. life expectancy by 1.5 years, according to the National Center for Health Statistics. Black and Hispanic people fared the worst, losing more than three years in life expectancy. White people saw a 1.2-year drop.

Using county data, the Black Equity researchers found a sobering racial gap in the Pittsburgh area: Black residents of Allegheny County saw disproportionate hospitalization rates - and were more likely to land in the ICU or on a ventilator - in the pandemic. Weekly hospitalization rates were higher during surges of infection in April, July and December 2020 and again in March and October 2021. Deaths, too, were disproportionate but fluctuated after December 2020.

For much of the pandemic, death rates were higher for African Americans than for other racial groups, the coalition said.
'It's All a Shade of Bad'
Kellie Ware has long considered health inequity a deadly problem. She graduated from Pittsburgh public schools, left for law school in Boston, and months before covid began its global assault she was working in her hometown mayor's office as an equity and diversity policy analyst.

Ware was at her desk in late 2019 when her phone started ringing. A damning report, compiled by university sociologists and the city's gender commission, had yet again detailed glaring disparities.

The blandly titled report, "Pittsburgh's Inequality Across Gender and Race," jolted emotions in the city of 303,000 people - and underscored how health disparities track with income.

Among the findings: Black people in Pittsburgh earned far less than their white neighbors and suffered far worse from disease. For every dollar white men earned, the report found, Black women earned 54 cents, making them five times as likely to live in poverty as white men.

With notably higher cardiovascular disease and cancer rates, Black residents' life expectancy was about eight years less than white Pittsburghers'.

The report sparked a furor, which Ware met with perspective shaped over years away from the former steel town. "The report was factual," Ware said, "but I know this: There's not a ton of places where it's great to be a Black woman. Those earnings? It's 54 cents to a dollar for women in Pittsburgh. It's 68 cents nationally. It's all a shade of bad."

Kellie Ware is the director of community partnerships and sustainability for the Forbes Funds. A Pittsburgh native, Ware worked in the mayor's office as an equity and diversity policy analyst months before covid-19 began its global assault. (Martha Rial for KHN)

Karen Abrams is a program officer for Heinz Endowments, a foundation in Pittsburgh that spends $70 million a year on community programs. (Martha Rial for KHN)

The first signs of the pandemic supercharged Ware and others. As covid devastated New York in March 2020, Karen Abrams, a program officer at the Heinz Endowments, a foundation in Pittsburgh that spends $70 million a year on community programs, began connecting the dots in texts and calls with nonprofits, business owners and university researchers.

Covid spread quickly in dense multi-generational households and in Black neighborhoods in Chicago, Washington, New Orleans and Detroit. Abrams was among the advocates in Pennsylvania who watched county and state health systems race to prepare and who feared that Black residents would be underserved.

Subscribe to KHN's free Morning Briefing.

In Philadelphia, early on in the pandemic, volunteer doctors in mobile units began distributing protective equipment and covid tests in Black neighborhoods. In Pittsburgh, Abrams asked tech-minded allies to document the reality of covid infection in Pittsburgh. "We intuitively knew what was happening," she said. "But without that data, we couldn't target our attention and know who needed the help most."

Within days, volunteers were on daylong rounds of video calls and appealing to county and state bureaucrats for more race-based statistics to bolster their research.

Fred Brown, president of the nonprofit Forbes Funds, and Mark Lewis, who heads the Poise Foundation, were stalwarts of a "huddle," a core of longtime advocates who eventually founded the coalition.

Fred Brown is the president and CEO of the Forbes Funds, which assists the Pittsburgh area's human services and community-based nonprofits in building their management capacity and outreach. (Martha Rial for KHN)

Mark Lewis is president and CEO of the Poise Foundation, which supports Pittsburgh's Black community through collective giving, grant-making and advocacy. (Martha Rial for KHN)

Brown emphasized pulling labor statistics to show that the essential workers keeping the city running - among them nursing homes aides and home care staff - were overwhelmingly Black or Latino.

Mapping covid testing centers and analyzing data proved sobering, he said. It turned out that the people most likely to be tested lived in Pittsburgh's predominately white neighborhoods. Largely employed in tech, academia and finance, they could easily adapt to lockdowns. They had round-the-clock internet at home and could afford food deliveries to limit the chance of infection. Later, they could access vaccines quicker.

"The communities that had the most tests were the affluent ones," Brown said. And those with the fewest "were the most resilient, the people who had to go out there and work."

Lewis, a certified public accountant who spent years as a corporate auditor, focused on standards. County and state health professionals worked mightily to control the spread of covid but didn't always gather data to ensure fairness in distribution, he said. "We realized that, as testing was done, it was not being recorded by race," Lewis said. "Why? A lot of the issue was - at the state and the local level - there was no requirement to collect it."

Gary-Webb said researchers had a sense of where the inequities would be found because they knew the neighborhoods. They first layered in percentages of Black families in poverty as well as data on the locations of federally qualified health centers to advise health authorities on where and when to increase testing.

University and nonprofit researchers found anomalies as they worked. For instance, race was noted on some testing data, with patients designated as Black, white or, inexplicably, unknown. The "unknowns" were a significant percentage. So researchers began layering additional census, labor and ZIP code data, to identify neighborhoods, even streets, at risk.

The ZIP code data took months to shake loose from state databases, largely because government software was slow in the fast-moving pandemic and government data was not updated regularly or formatted in ways that could be easily shared.

Their efforts paid off: The group was able to winnow down Allegheny County records that omit race to 12% of positive covid cases; 37% of statewide records are missing race details, the coalition reported.

Robert Gradeck, who runs the Western Pennsylvania Regional Data Center, a data collaborative managed by the University of Pittsburgh, said covid should play a lasting role in improving public health reporting. "We kept thinking: What can we learn from this?" Gradeck said. "It's not that you can't answer questions. But you can answer only part of them."

Robert Gradeck manages the Western Pennsylvania Regional Data Center, an open-data collaboration nonprofit and one of the Black Equity Coalition's early allies. (Martha Rial for KHN)

Among the top recommendations to health authorities: adopt software practices to ensure that race and other demographic data must be entered into electronic records. And then refine how to share data among counties, states, research institutions and the public.

The coalition attracted support in monthly calls with state Health Secretary Rachel Levine, recently sworn in as a four-star admiral in charge of the U.S. Public Health Service Commissioned Corps, which responds to health crises on behalf of the federal government.

"I thought what they did was critically important," Levine said, noting that officials recognized the coalition's research as revelatory. With "a diverse group of professionals, they were able to use and collect data in a very effective way."

Their early research found the covid rate among Black people in Allegheny County, which encompasses Pittsburgh, was three times the rate of white people. Hospitalizations among Black people have been as high as seven times the rate of whites, according to "Missing Our Shot," the coalition's 2021 report.
A Vaccine Clinic Campaign Stop
Ed Gainey, a state legislator from Pittsburgh, was among the first politicians to say African Americans in his hometown were missing out on covid protections. Last month, Gainey was elected the city's first Black mayor, after winning a primary, within months of the murder of George Floyd, that pointed to inequities in health care and policing.

A Democrat who worked for two Pittsburgh mayors, Gainey admits he and other Black elected officials were somewhat ill-equipped in the first weeks of the pandemic.

"I fought hard to get the vaccine into the community last year, but I really didn't know the language - the health language - to be able to get it," Gainey said during an interview at a pop-up vaccine clinic in the city.

Vaccinations have risen because of community efforts, he said, but children are still a source of worry. Gainey, who grew up in a low-income housing complex, said he understands when some youngsters shrug when asked about covid risks. "But I will tell you I know this: If you can make a kid believe in Santa Claus, you can make them believe in the vaccine. And you know, I understand some of the young kids' reluctance. I didn't grow up going to the doctor regularly either," he said. "I came from the same kind of environment."

As the 2019 report made clear, many of the benefits of Pittsburgh's tech-based economy - a vaunted "ed-and-meds" renewal against the industrial decline of the 1980s - still was largely bypassing African Americans.

The first year of covid was an iterative process of trying to stay ahead of the virus. Gary-Webb, who earned a doctorate from Johns Hopkins' public health school, said it was also a time for Black residents to be heard about what they knew and saw in their neighborhoods.

The coalition, sustained by thousands of volunteer hours, attracted some funding earlier this year, notably for outreach and to pay for running datasets. Last month, the Poise Foundation was approved for a three-year, $6.99 million grant, federal money to be administered by the state health department to support an array of health partnerships in the region and, notably, to improve covid vaccine uptake in ZIP code areas the Black Equity Coalition identified as vulnerable. Among its goals: demographic messaging, data analysis on covid testing and education outreach in dozens of counties.

Gary-Webb counts herself among a group of "boomerang" Pittsburghers who have lived other places - in her case, Baltimore, New York and Philadelphia - and covid has helped them recalibrate how Black residents can participate in public health.

As she put it: "The health planners were saying, 'Help us get out the message.' We said, 'No, we are not just getting out the message. We want to be talking about equity at the same time.'"

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Data Science Proved What Pittsburgh's Black Leaders Knew: Racial Disparities Compound Covid Risk

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The ferocity of the covid-19 pandemic did what Black Pittsburgh - communities that make up a quarter of the city's population - thought impossible. It shook the norms. Black researchers, medical professionals and allies knew that people of color, even before covid, experienced bias in public health policy.

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How many people get 'long COVID?' More than half, researchers find. | Penn State University

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More than half of the 236 million people who have been diagnosed with COVID-19 worldwide since December 2019 will experience post-COVID symptoms - more commonly known as "long COVID" - up to six months after recovering, according to College of Medicine researchers.

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Frustrated and bored during the pandemic, a Midwestern dad brings his nostalgia for weekend movie rentals to life. Just don't forget to rewind.

Some planted a garden during the pandemic, others decluttered their closets. Brian Hogan, a father of two in suburban Des Moines, Iowa, built a video store in his basement. It was an act of pure whimsy, undertaken "out of necessity and boredom," Mr. Hogan said.

Last fall, Mr. Hogan was fairly miserable. He'd had some health problems over the summer. The pandemic all but obliterated business at his barbershop. To top it off, his favorite local video store, Video Warehouse, where he had spent countless hours growing up, announced it was going out of business after 34 years.

It was during this personal rough patch that Mr. Hogan, 38, snapped, in a Midwestern dad sort of way, and came up with a home-improvement project "to keep my sanity," he said.

"All these stores were closing and I was getting fed up with my own hoarding issue with film and not being able to find things," he said, referring to his collection of around 5,000 DVDs, 1,500 VHS tapes and 400 Laser discs. They had long been piled on the kitchen counter, in his car, on mismatched media shelving. "You had to try and remember, 'Where did I see that last?'"

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Mr. Hogan browsing his collection of 5,000 DVDs, now organized by genre. Before, they were piled on the kitchen counter, in his car, on mismatched media shelves and everywhere else. Credit... Kathryn Gamble for The New York Times

He added, "I spent a lot of days sitting in my chair hoping people would come and get their hair cut. I'd go home and catalog and start hanging shelves. It took my mind off things."

In March, when his wife, Erin, created a TikTok account, @thevideobunker, and posted a clip of the basement video store, it went viral. Mr. Hogan's Video Bunker became the pandemic lockdown version of the baseball diamond from "Field of Dreams" (which, coincidentally, is also in Iowa) - a half-crazy idea made manifest. The bunker even landed the couple in an episode of Jimmy Kimmel Live.

His wife has been pretty tolerant, Mr. Hogan said: "She recognized this was going to be a rough year. She saw the benefit to keeping me busy."

A former construction worker, Mr. Hogan designed and built the space himself, converting what had been the bedroom of an older daughter who had moved out. He was able to buy shelving cheaply from stores that were closing. The main room houses DVD and Blu-ray, organized by genre and format. Off the main room is a smaller viewing room with VHS and Laser disc titles. There are a couple of recliners in there, a flat-screen TV and a couple of old tube TVs that he found on Facebook Marketplace.

The vibe is less Blockbuster or Suncoast and more like the mom-and-pop video stores found throughout the country in the 1980s and early '90s. There's a candy counter, a tape return slot, movie posters and memorabilia and a neon open sign. There's a half-hidden adult section, on the very top shelf behind the counter.

Mr. Hogan rescued the Tape Return sign from his local video store, which is closing after 34 years. Credit... Kathryn Gamble for The New York Times

Some retro details, like the wood paneling and faux-brick MDF walls, were already part of the house, a 1950s one-story ranch. Naturally, there's a "staff picks" shelf - Mr. Hogan, his wife and their two daughters, Bickley, 19, and Stella, 13, each get to pick a title. Current picks include "Ferris Bueller's Day Off" and "Night of the Creeps" (Mr. Hogan is a horror fan who co-hosts a podcast, the Fright Zone, devoted to the genre).

Does Mr. Hogan allow the public to rent his collection?

"It's more of a time capsule," meant for family and friends, he said. "Friends who come over get to pick out a movie and we watch it."

Since becoming a hit on TikTok, Mr. Hogan has received overwhelmingly positive response, including from Dennis Dugan, the director of "Happy Gilmore" and "Big Daddy," who mailed him a box of DVDs of his films to add to the inventory. This at a time when movie theaters are closed, few video stores are left in the country and we've all supposedly joined the streaming revolution.

"I was surprised that it took off the way that it did," Mr. Hogan said. "I'm not surprised by the response. I spent a good part of my childhood in the video store. That was a Friday night thing. You didn't just go to the video store. You went to the video store."

He added, "My kids are old enough to have that rental store experience. They stream a lot, but they watch movies, too."

Stella has already internalized one of the cardinal video rental rules. "She watched 'Bye Bye Birdie' in our viewing room," the other night, Mr. Hogan said. "Not only was the tape back on the shelf where she got it from, but she ran it through the rewinder."

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A Barber's Viral Pandemic Project: Turning His Basement Into a Video Store

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Frustrated and bored during the pandemic, a Midwestern dad brings his nostalgia for weekend movie rentals to life. Just don't forget to rewind. Some planted a garden during the pandemic, others decluttered their closets. Brian Hogan, a father of two in suburban Des Moines, Iowa, built a video store in his basement.

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transcript

The Agony of Pandemic Parenting

Hosted by Michael Barbaro; produced by Michael Simon Johnson, Diana Nguyen and Luke Vander Ploeg; edited by Lisa Chow and Paige Cowett; and engineered by Chris Wood.

A single mother in Spokane, Wash., opens up about what it's really been like to raise a child over the past year.

mom

This is my primal scream.

interposing voices

[SCREAMING]

michael barbaro

From The New York Times, I'm Michael Barbaro. This is The Daily.

michael barbaro

Several months ago, The Times opened up a phone line to ask americans what it's really been like to parent during the pandemic.

michael barbaro

It's Friday, April 16.

elizabeth halfhill

It's the morning.

We are up and ready to go almost. I'm making French toast for Max. And I have to drink coffee, of course. My name's Elizabeth Halfhill. I live in Spokane, Washington. I'm a full-time family law paralegal and a single mother of an 11-year-old kid named Max. Say hi.

max

Hello, New York Times News. My name is Max Noakes. I'm 11 years old. My mom is Elizabeth's Halfhill. She's 30 years old.

elizabeth halfhill

Max is very kind. He is very creative. So I just had to tell him to stop sawing cardboard in the background because he's building something right now while I do this.

max

I like drawing, building LEGOs, a lot of forms of art, mainly clay and drawings. Sometimes I do a little painting.

elizabeth halfhill

So he's creative. He's kind. He's really funny. He makes me laugh all of the time. I mean, I just - even if he wasn't my kid, I love him as a person.

max

I have a drawing of a squirrel that I made.

elizabeth halfhill

You have other ones, too. I'll grab one.

max

No. No, Mom.

elizabeth halfhill

Yes, yes, yes.

max

No, those are just doodles. Stop.

elizabeth halfhill

The weekend of March 13, I remember March 13 was the date that everything, like the state of emergency came down. It almost felt, I don't want to say fun, but like exciting. Like, oh, school's out for two weeks. And then we get two weeks off, and it'll all go back to normal. And so that was the first moment. But the next moment was when I had made it through the summer with almost no childcare and still having to work and all these things. And then the school announces two weeks before they were supposed to be back in session that no one would come back in person. And I don't know if it was a news article or a friend texted me, but I was sitting at home, and I just started bawling.

elizabeth halfhill

I got pregnant at 18, and Max was born when I was - I turned 19 right after he was born actually. So I gave birth to him when I was 18. I was home schooled by my parents religiously until fourth grade, like actual religious curriculum. And then I went to public school from that point on. And I ended up dropping out of high school in my sophomore year and getting my G.E.D. Max's father and I were not married until he was three years old. But we did get married when he was three, and then we divorced when he was, I think, six. He was actually in jail from the time Max was six months old. So he missed a lot of the first holidays. We were together after that, but I embodied a lot of the old-fashioned ideals of the mother doing most of the parenting. You know, and I worked, too. I worked full-time, so yeah.

elizabeth halfhill

Max was playing a game on his phone during class time. I got a little upset with him.

elizabeth halfhill

I kind of go back and forth between knowing I need to be upset that he is not paying attention or this or that, and then having total empathy. Like, if I had to be on a Zoom meeting for five hours, I would definitely mess around on my phone, too, right? So it's trying to find the line between enforcing the right boundary and also letting him know that I understand it's a struggle.

elizabeth halfhill

There are days where he didn't want to pay any attention to his laptop class. And it's hard to enforce that sometimes.

[new scene]

elizabeth halfhill

I had just gotten divorced, and I had a pretty good job working for Apple, but I knew I needed something long-term career-wise. And I didn't even know what I wanted to do, but I was like, you have to get back into college, you have to get a degree, you have to do something. So I just enrolled at the local Spokane Community College. And right around that time, I started working as a legal assistant part-time as well for the attorney that sort of got me started on the path. And she was telling me about the paralegal program, which was at the same college I was attending. And so I just enrolled in the program and sort of took it from there, I guess.

elizabeth halfhill

I'm still going to school, so I am always tired like 100 percent of the time.

michael barbaro

We'll be right back.

elizabeth halfhill

Susan is a very dear friend, and I would venture to say sort of chosen family-style friend. Max and I, before we moved into the house we are in now, lived in a neighborhood where there were a lot of kids and a lot of parents living in a block radius. And Susan was one of them. They all homeschooled prior to the pandemic. So they were already set for all of this. But all of our kids are best friends. They run all over the neighborhood together. And Susan was home, and she said Max can come and be on his laptop here while I teach my kids, and then he can play with them in the afternoon. So she's a part of my essential community. Like, I could not have gotten through the pandemic without these other women in my neighborhood.

[new scene]

elizabeth halfhill

So I had Susan, and then I ended up working from home from November through January. And then I use Boys and Girls Club until he went back to school February 17th. And now he is back at school two days one week, three days the following week. And I have to find care the other few days.

max

I think we've gotten closer over this little while. We get into arguments sometimes, but other than that, we're pretty close.

elizabeth halfhill

You're gonna make me cry! All of the stresses that caused us to be annoyed with each other or anything like that were all outside stresses of the situation. And we handled them OK. I don't think it's changed at all, really. It feels the same. We get along decently. And we enjoy spending time with each other. It's like - it's like we had a relationship beforehand, and the situation around has shifted, but we're just mother and son, best buds. And it's still that way.

I think I was always this way, but I think I now realize I'm absolutely unstoppable. Just nothing. I'm always going to figure out a way to make it work. Like, nothing will stop me. Nothing can stop me from just keeping on keeping on, I guess.

michael barbaro

We'll be right back.

Here's what else you need to know today.

archived recording

Have you made a decision today whether you intend to testify or whether you intend to invoke your Fifth Amendment privilege?

archived recording (derek chauvin)

I will invoke my Fifth Amendment privilege today.

michael barbaro

On Thursday, Derek Chauvin declined to testify on his own behalf, and his defense lawyers rested their case, ending the testimony phase of his murder trial in the death of George Floyd. Closing arguments will begin on Monday, after which the jury will begin deliberations.

michael barbaro

On Thursday afternoon, the judge in the case, Peter Cahill, began preparing jurors for that process.

michael barbaro

Today's episode was produced by Michael Simon Johnson, Diana Nguyen and Luke Vander Ploeg. It was edited by Lisa Chow and Paige Cowett, engineered by Chris Wood, and contains original music by Marion Lozano. Special thanks to the editors behind the Primal Scream Project, Jessica Grose and Jessica Bennett.

That's it for The Daily. I'm Michael Barbaro. See you on Monday.

A single mother in Spokane, Wash., opens up about what it's really been like to raise a child over the past year.

Hosted by Michael Barbaro; produced by Michael Simon Johnson, Diana Nguyen and Luke Vander Ploeg; edited by Lisa Chow and Paige Cowett; and engineered by Chris Wood.

This episode contains strong language and emotional descriptions about the challenges of being a parent during the pandemic, so if your young child is with you, you might want to listen later.
Several months ago, The Times opened up a phone line to ask Americans what it's really been like to raise children during the pandemic.

Liz Halfhill, a single mother to 11-year-old Max, detailed her unvarnished highs and lows over the past year.

Image

Despite the stresses of the pandemic, Liz Halfhill and her 11-year-old son, Max, said they still remained close. Credit... Brenda Ann Kenneally for The New York Times

The Times followed Liz and two other mothers in different parts of America who shared their experience of pandemic parenting over dozens of interviews. What emerged was a story of chaos and resilience, resentment and persistence, and of course, hope.

Take a look at "The Primal Scream," a series from The Times that examines the pandemic's effect on working mothers in America.

There are a lot of ways to listen to The Daily. Transcripts of each episode are available by the next workday. You can find them at the top of the page. Here's how.

The Daily is made by Theo Balcomb, Lisa Tobin, Rachel Quester, Lynsea Garrison, Annie Brown, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Larissa Anderson, Wendy Dorr, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, Sindhu Gnanasambandan, M.J. Davis Lin, Austin Mitchell, Neena Pathak, Dan Powell, Dave Shaw, Sydney Harper, Daniel Guillemette, Hans Buetow, Robert Jimison, Mike Benoist, Bianca Giaever, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Alix Spiegel, Diana Nguyen, Marion Lozano and Soraya Shockley.

Special thanks to the editors behind "The Primal Scream" project, Jessica Bennett, Jessica Grose, Melonyce McAfee and Farah Miller, with research by Sharon Attia and Dani Blum.

Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Mikayla Bouchard, Lauren Jackson, Julia Simon, Mahima Chablani, Nora Keller, Sofia Milan, Desiree Ibekwe, Laura Kim, Erica Futterman and Shreeya Sinha.

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transcript A single mother in Spokane, Wash., opens up about what it's really been like to raise a child over the past year. mom This is my primal scream. interposing voices [SCREAMING] michael barbaro From The New York Times, I'm Michael Barbaro. This is The Daily.

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The COVID pandemic led many people to reevaluate, even change their priorities. For some, it inspired them to try something new. Special correspondent Jared Bowen of GBH Boston has the story of people who used the last year to bring their artistic dreams to life. It's part of our arts and culture series, "CANVAS."

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How the pandemic helped bring artistic dreams to life | PBS NewsHour

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The COVID pandemic led many people to reevaluate, even change their priorities. For some, it inspired them to try something new. Special correspondent Jared Bowen of GBH Boston has the story of people who used the last year to bring their artistic dreams to life. It's part of our arts and culture series, "CANVAS."

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When the Botswanan scientists saw the sequences, they were stunned.

Four international travelers had tested positive for COVID-19 on Nov. 11, four days after entering the country. But when the cases were genetically sequenced, where the genetic code of the virus is analyzed to look for worrying changes, the scientists discovered a variant they had never encountered before.

And soon, they alerted the world to what would become known as the omicron variant.

The team in Botswana was headed by Sikhulile Moyo, the laboratory director at the Botswana-Harvard AIDS Institute Partnership and a research associate with the Harvard T.H. Chan School of Public Health. Moyo is quick to give credit to his entire team and to scientists working simultaneously on similarly alarming sequences in South Africa, for the discovery of omicron.

He spoke with NPR about the identification of the new variant, travel bans, what southern Africa needs from the rest of the world and what may come next. This interview has been edited for length and clarity.
When did you first suspect you might be dealing with a new variant? How long did it take for you to get concerned?
When we looked at it, we compared it with other sequences circulating in Botswana, and we realized this is an unusual pattern of mutations. The number of mutations that it had was just unbelievable.

We immediately alerted the Minister of Health on Monday, [Nov.] 22. We searched the databases as well, and we realized it was not [previously] seen in Africa. The closest that could be seen as a lineage was called B.1.1.207, which was a lineage common in United Arab Emirates. We got concerned because when we inquired to the Department of Health, we got notice that these individuals were traveling together.

Other groups [in South Africa] were also sequencing [samples] at the same time. On Tuesday, they saw that we had deposited some sequences [in a regional database] that looked similar to them. So, on the 23rd, we loaded our sequences to the public database.

On the 24th, South Africa went ahead and reported to the WHO, and on the 26th, the WHO convened a meeting and it was called a variant of concern.
Botswana and South Africa alerted the world to this variant, but it was found among travelers who reportedly flew in from Europe. And it was subsequently found that the variant was reported in the Netherlands a week before the announcement from Africa. How do you feel about the world reacting by banning travelers from southern Africa?
We were saddened. For me, personally, I felt that after two years into the epidemic, clearly as the global health community, we could be responding better and coordinating better.

How do you reward the countries that alert you of a potential dangerous pathogen with travel bans? My country was put on a red list, and I didn't feel good about that.

We know the repercussions. Flights were canceled, goods were not coming into the country, a lot of businesses lost millions. And our vaccine supply was being threatened because of delays on the way. Quite a trail of destruction.

So it was a roller coaster for us. On the one extreme, we felt [we were] contributing to the world in a small way. And on the other end, we felt, is that how you reward scientists or scientific progression?
What's the reaction been within Botswana?
A number of people are saying, "You scientists, you bigmouths, look what you've done. You've locked out Christmas."
Was the African ban outright racism?
I would call it an unfair treatment of African countries.

The alpha variant was raging in the U.K. [months ago], and none of the countries put the U.K. on the red list. Because we understand that it's a global village. Of course, we enhanced border screening, enhanced requirements for entering into the country, including maybe a quarantine and testing. But it was never shutting our door, because we understand that these viruses don't respect our natural borders.
What does Botswana want and need from the rest of the world? Is it vaccines? Is it better sequencing support? All of the above and more?
Other countries are going into boosters, and we are still struggling to reach all our population. We still have to vaccinate a large segment of our population. The government of Botswana has been very proactive in reaching out to other countries for procuring [vaccines]. But sometimes the delays are beyond whether you have the money to buy or not.

The health care system [in Botswana during the pandemic] has been battered, and strengthening the health-care system, making sure that we have adequate resources in case we enter into a serious time [will be important]. Right now, the infections have jumped. Every day, we have about two to three times more infections than we've seen the previous day. [Note: The average daily count is 298 new cases.]

But most important, we need to make sure that we more than multiply our sequencing capacity by 10 times.
How much sequencing are you able to do now?
The kind of resources we have are just a tiny drop in the ocean as compared to other countries in terms of sequencing capacity and sequencing strength. The U.K. generally can sequence more than 500 times the sequences we can generate in Botswana in a day.

As African scientists, we've come together and formed the Pathogen Genomics Initiative and the Africa CDC. We are using our little resources to make sure that countries are trained. The investment in HIV really helped us to be where we are. Because it was easy to come from HIV to do COVID sequencing.

We came up with a genomic surveillance plan which was very intentional. This is the reason why we were able to catch [the variant]. It's not luck. It's because we were able to implement some level of surveillance - very small surveillance, very few samples - but randomly selected and very representative of the entire country.
There are theories the omicron variant could have developed in an immune-suppressed patient over several months. Do you agree? And if there is any possibility that it could be true, what does that tell us about failure to diagnose and treat people with illnesses like HIV?
It's just a hypothesis. One study in South Africa recognized that an individual with uncontrolled HIV infection developed quite a number of [COVID] mutations. And that's what is supporting the hypothesis around immune-compromised [individuals].

One of the successes of Botswana is that they've been able to take care of the population in terms of HIV. You are trying to reach the last mile, maybe less than 5% of the people who are living with HIV but do not know their status.

If we prioritize in those areas, we vaccinate as many people as possible [against COVID], then we are making them less likely to die from either of the diseases.
What's your reaction to the unequal distribution of vaccines?
Just look at the statistics, you will be shocked. Look at Guinea, Guinea has 6.2%. Libya, 11%. Ghana, 2.7%. Kenya, less than 10%. You're talking about so many people not vaccinated.

How do we explain in a global village that it matters for an ordinary U.S. citizen that someone in Ethiopia or someone in Guinea is vaccinated? Why does it matter? The story of variants and the movement of variants is one story that tells us that it matters because we are a connected world.
So what's the story to tell?
We have a significant part of the world that is less than 20% vaccinated. If we increase vaccination in those countries, we are going to reduce the chances of this virus - giving it room to circulate in other parts of the world and generate more mutants.
I have one last question for you: Where do you think we will be one year from now?
If we really do our best and cover the world, I think we can win it together. But if we try and do our own corners and not take care of what's happening in other countries, I think we'll still have another two, three years of this pandemic.

Melody Schreiber (@m_scribe) is a journalist and the editor of What We Didn't Expect: Personal Stories About Premature Birth.

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The scientist in Botswana who identified omicron was saddened by the world's reaction

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When the Botswanan scientists saw the sequences, they were stunned. Four international travelers had tested positive for COVID-19 on Nov. 11, four days after entering the country. But when the cases were genetically sequenced, where the genetic code of the virus is analyzed to look for worrying changes, the scientists discovered a variant they had never encountered before.

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In a pluralistic society committed to personal freedom, how can the humanities help us take action to ensure the common good?

Vaccine mandates, quarantines, and other measures intended to slow the spread of disease and ensure public safety have been a part of U.S. culture since George Washington commanded that his troops be inoculated against smallpox in 1777, ordering a strict quarantine of the affected troops and any civilians showing signs of the disease. ¹ In the nearly two and a half centuries since, government authorities at the federal, state, and local levels have enacted numerous laws and regulations aimed at protecting the public from dangerous diseases, and courts have repeatedly sided with government authorities when these laws have been challenged, asserting that while the Constitution prioritizes individual freedom, that freedom does not allow citizens to endanger colleagues, friends, and other members of society. Most notably, in 1905, the U.S. Supreme Court ruled in Jacobson v. Massachusetts that the state could enforce immunization requirements and quarantines to defend against diseases that threatened the safety of their communities, establishing standards for when it is acceptable to do so, ² and later, in Zucht v. King, ruled unanimously that states can require children to be vaccinated to attend school. ³

However, while public health mandates have been a part of American culture since the country's founding moment, resistance to immunization treatments has an even longer history, dating back to Westerners' suspicious assessment of Chinese inoculation practices that had been used to protect children against smallpox since the eleventh century. ⁴ Suspicion, hesitancy, and organized resistance have accompanied vaccination regimes implemented to fight smallpox, measles, and polio as well as other common diseases over the past two centuries on the basis of religious and ethical beliefs, cultural biases, anger about government overreach, and skepticism of science despite overwhelming evidence that vaccinations saved lives and reduced suffering. So, perhaps, it is not surprising that resistance to vaccinations, mask-wearing mandates, and other public safety measures have played a significant role in the trajectory of the COVID-19 pandemic in the U.S. and elsewhere.

On Friday, October 1, 2021, the U.S. death toll from COVID-19 crossed the 700,000 mark, surpassing the 675,000 deaths from the influenza pandemic of 1918 and 1919 over a century before ⁵ and totaling more than all the deaths in America's wars in the twentieth and twenty-first centuries combined. ⁶ This grim milestone occurred in spite of freely available, highly effective vaccines and scientific consensus around the effectiveness of social distancing and mask-wearing in public spaces to reduce the spread of the highly contagious pathogen. It also serves as a reminder that epidemics are as much social phenomena as they are biological ones.

The COVID pandemic is not merely a crisis of public health, it is a crisis of faith in American institutions and in our civil society. Political polarization has confounded efforts to build consensus about how to combat the disease and increased distrust and resentment. The perspectives and resources collected here provide a humanistic context to help understand the complexities of the current crisis. They also suggest ways the humanities can ameliorate suffering and mitigate future crises by forging connections that simultaneously recognize and transcend our individual needs and identities by encouraging us to embrace our role as citizens and community members.

Notes

1. "How a Public Health Crisis Nearly Derailed the American Revolution," Andrew Lawler, National Geographic, April 16, 2020 (accessed 10/3/21)

2. "Individual Rights and the Public's Health: Constitutional, Ethical, and Political Aspects of COVID-19 Measures and Their Enforcement," The Network for Public Health Law, February 24, 2021 (accessed 10/3/21)

3. "On this Day, the Supreme Court Rules on Vaccines and Public Health," Nicholas Mosvick, The National Constitution Center, February 20, 2021 (accessed 10/3/21)

4. "Rash Decisions: Anti-vaccination Movements in Historical Perspective," Jim Harris, Origins: Current Events in Historical Perspective, November 2019 (accessed 10/3/21)

5. "U.S. Coronavirus Death Toll Surpasses 700,000 Despite Wide Availability of Vaccines," Julie Bosman and Lauren Leatherby, The New York Times, October 1, 2021 (accessed 10/3/21)

6. "The Real Reason this Pandemic is the Deadliest to Ever Hit the US," Jeffrey Sachs, CNN.com, September 22, 2021 (accessed 10/3/21)

Find out how you can get informed, get involved, and take action on this and other issues.

Get Involved

Voices

What some experts are saying:

"How to Talk About Freedom During a Pandemic," Graham Mooney, The Atlantic, May 19, 2020

"Can a Virus Undermine Human Rights?" Olivier Nay, The Lancet, April 20, 2020

"Individual Freedom or Public Health? A False Choice in the Covid Era," Jonathan Cohen, Hastings Bioethics Forum, June 9, 2020

"Individual Liberty, Public Health, and the Battle for the Nation's Soul," Scott Burris, The Regulatory Review, June 7, 2021

"The Limits of 'My Body, My Choice'," Tish Harrison Warren, The New York Times, September 26, 2021

"What's the Law on Vaccine Exemptions? A Religious Liberty Expert Explains," Douglas Laycock, The Conversation, September 15, 2021

"Humanities as Essential Services," Kirsten Ostherr, Inside Higher Ed, May 21, 2020

Resources

Materials for further exploration:

The Continuing Tensions between Individual Rights and Public Health.Talking Point on Public Health versus Civil Liberties, Ronald Bayer, EMBO Reports, December 2007

Ethics Guidance and Resources on Covid-19, The Hastings Center

Resources Archive, The Network for Public Health Law

Public Health Law Academy, Change Lab Solutions

Humanities in the Time of Covid: The Humanities Coronavirus Syllabus, Sari Altschuler and Elizabeth Maddock Dillon, ISLE: Interdisciplinary Studies in Literature and Environment, Autumn 2020

Pandemics: Past, Present, and Future, Origins: Current Events in Historical Perspective

History of Vaccines, The College of Physicians of Philadelphia

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Individual Rights vs. Social Responsibilities in a Pandemic - Humanities in Action

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In a pluralistic society committed to personal freedom, how can the humanities help us take action to ensure the common good? Vaccine mandates, quarantines, and other measures intended to slow the spread of disease and ensure public safety have been a part of U.S.

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A recent film by a Nunavut director is getting noticed.

As the global pandemic reached into the Arctic, an Inuk filmmaker in Nunavut made a documentary on how the unfamiliar new protocols affected her family and community.

Carol Kunnuk's 10-minute short film is a richly detailed and tender account of disruption and adjustment - specifically within her Igloolik home.

"This film is about the COVID situation we went through when we were first heard in Nunavut that COVID was now active and everyone had to isolate and follow health restrictions," Kunnuk said.

"I wanted to show the kind of situation we were in, in a small community, where there's no hospital, where there's no emergency room, and how we had to deal with COVID 19."

The film shows an intimate clip of her family at home - one child washing her hands and doing a craft, a baby being sung too, and most of it overlaid with audio of COVID-19 news announcements in both Inuktitut and English.

Kunnuk said at the time, children in the community could no longer attend school. She remembers that period as "a scary time for all of us."

"We couldn't visit our family anymore because of restrictions from the Health Department. Even though we were in the same community, I did not see my grand-kids for almost three months," she said.

"This was a film of me in a small house with two kids not able to go anywhere for about a couple months. And I had my daughters improvise, or to take the camera themselves," she said.

Part of the film shows family out on the sea ice checking fish nets.

The film is called Being Prepared and is being broadcast Monday night on Uvagut TV at 7 p.m. ET.

"The title of the film is 'Being Prepared' because we were getting ready and how we were going to adapt to this COVID-19 and to be prepared for emergency situations when it comes into a small community," she said.

The film is also featured on The National Film Board of Canada website.

"I am very honoured and pleased because I know National Film Board ... supports Aboriginal filmmakers."

Kunnuk is a filmmaker, director, editor, producer and actor. She produces Inuit-style content released in Inuktitut.

"I like that they like what I have been producing or releasing in other projects."

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Boats and boating--Equipment and supplies

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Nunavut filmmaker documents life in lockdown in her Igloolik home | CBC News

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Carol Kunnuk's short film shows an intimate clip of her life at home during a COVID-19 lockdown in Nunavut - one child washing her hands and doing a craft, a baby being sung too, and most of it overlaid with audio of COVID-19 news announcements.

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Voices from the Frontlines: Episode 2 | Innovation

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The pandemic has tested principals' resolve to an unprecedented degree, even as it's offered many of them valuable lessons in school leadership.

Presiding over this lengthy and ever-evolving crisis has left many school leaders questioning their ability or desire to continue leading. In a May 2020 survey, 42 percent of principals polled indicated that they were considering quitting their jobs, a 110 percent increase over past years.

But despite the threats, many educators stayed put-more than in pre-pandemic times. An estimated 470,000 public-education employees quit their jobs between April and August of 2019, compared to approximately 300,000 in 2021 during the same months, according to the U.S. Bureau of Labor Statistics.

And those who stayed often are determined to apply what they've learned from the experience. Principals who Education Week interviewed talked about how they managed through the crisis, and how their responses could serve as important lessons long after the pandemic ends.

Don't assume too much, listen more, and ask what parents and students need

Daman Harris, principal at Wheaton Woods Elementary School in Montgomery County, Md., thought he knew what his community members needed when schools closed their doors in March 2020.

Wheaton Woods has a high concentration of poverty among its families, many of whom are recent immigrants. Harris, assuming that food insecurity was a top priority, partnered with a community resource to provide dry goods to families once a week. While some families welcomed the assistance, the need wasn't as widespread as he anticipated.

"We were doing things based on what we believed folks needed, based on stereotypes and what we took for historical knowledge," he said. "But we didn't ask."

That strategy, Harris said, was a carryover from a pre-pandemic decision model that he has since reevaluated.

Recently, Harris began to make a more concerted effort to listen to his school's families. He conducts virtual parent coffees over Zoom where he asks participants directly what they need. The school also employs community liaisons available to students' caregivers during arrival and dismissal throughout the week.

Through these multiple efforts, Harris learned that families' top needs included "wraparound supports" like physical access to medical services and opportunities for students beyond what the school day provided. Armed with this knowledge, the school helped families organize around these needs and shared their wish list with local politicians. They listened, and now the school has a county-sponsored after-school program that focuses on academic help, group games, and sporting activities.

"We need to make sure we are plugged in a way that honors the needs of the community we serve," Harris said.

Get to know the people in your community, and meet them where they are

Understanding the nuances of a school community can make an enormous difference in effective communication. The pandemic offered countless opportunities for school leaders to act on this critical lesson.

Some were more successful than others, as revealed by one of several research briefs based on an analysis derived from interviews with 120 principals' responses to the pandemic. For instance, one principal surveyed recounted how, early in the pandemic, the school district wanted to learn which families were in need of computers. It sent an electronic message to gauge the need, failing to recognize that families without computers would be unable to respond to the inquiry.

Another principal surveyed demonstrated a better understanding of her audience. She displayed signs with school announcements at local businesses frequented by families, knowing they'd be more likely to see them there than on a school website, as many didn't have access to computers.

Principal Jennifer Halter has served at two different schools in Clay County, Fla., during the pandemic, and learned quickly that she needed to respond differently to each. While the schools themselves were just a few miles from each other, their community members were far apart in their response to pandemic safety protocols.

In the school that Halter led during in the first part of the pandemic, students and faculty unequivocally followed the district's mask mandate, which was in effect through the 2020-21 school year.

She then became principal at another school in the same district, less than two miles away.

Halter describes her new school community as very rural and conservative. She estimates that about one-third of her staff and students choose to wear masks. In July 2021, the Clay County School Board approved a plan that recommends but does not mandate masks in school buildings for the current school year.

"It's a different belief system," said Halter of her new school community, adding, "I model what I expect. But I'm building trust, so I don't broach the topic [of vaccines or masks]."

Lean on your teachers' and staff members' passions to maintain your priorities

As school leaders confronted a host of new challenges during the pandemic, such as revised and ever-evolving student schedules and health and safety protocols, it could be easy to let go of priorities considered nonessential. Harris, in Montgomery County, Md., found a way to hang on to initiatives that he cared deeply about.

"In the flurry of [pandemic-related] activity, George Floyd was no longer in the headlines. It would have been easy to let anti-racism slide," he said, referring to the Minneapolis man whose murder generated nationwide activism over the issue of police-related killings.

Harris leaned on the passions of his staff to stay the course.

"I said to our staff: Hey, anti-racism is still a focus. How can we make it fit into what you're already excited about?" Already, Harris says, a few staff members have stepped forward as early adopters of these efforts.

Harris sees his role in developing an "anti-racist infrastructure" within his school building as multi-pronged: establishing a vision for the work, finding any available funding for materials or payment, carving out time in the school schedule and promoting the efforts, and supporting staff members who take on the work. Recently, Harris has set aside some Title I funding toward these efforts and extended the duration of staff meetings by 15 minutes to allow time for content that connects to the school's anti-racism outcomes in some way.

Having a supportive district makes it easier for Harris to champion these efforts. "It publicly promotes a culture of collaboration, equity, and cultural proficiency. Therefore, I had no concern about articulating a vision, allocating funds, or allowing my staff to partner with high school students [on anti-racism initiatives]," Harris said.

Recognize your 'sphere of control'

The pandemic's unpredictability and its impact on how to plan and what to do was a common source of frustration among both school leaders and their staff.

"My staff is used to me talking about our sphere of control," said Halter. "We can't control a lot of things, like students doing their work. But we can call students and check up on them."

She also recognized that personally thanking staff members for their commitment was something within her control that she could do to help alleviate their anxiety and discontent.

"You need to support your staff; that's what the job's all about," Halter said. "One thing we have learned, as educators, is grace."

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The pandemic has tested principals' resolve to an unprecedented degree, even as it's offered many of them valuable lessons in school leadership. Presiding over this lengthy and ever-evolving crisis has left many school leaders questioning their ability or desire to continue leading.

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA)

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Welcome

Join us in documenting our uncertain moment. We are acting not just as historians, but as chroniclers, recorders, memoirists, as image collectors. We invite you to share your stories about how the pandemic has affected our lives, from the mundane to the extraordinary, including the ways things haven't changed at all. Share your story in text, images, video, tweets, texts, Facebook posts, Instagram or Snapchat memes, and screenshots of the news and emails--anything that speaks to paradoxes of the moment. Imagine, as we are, what future historian might need to write about and understand this historical moment.

Our curatorial team spans the globe; below is a partial list of our curatorial team, a photographic directory will be forthcoming soon.

Also we are sharing related materials about Podcasts, exhibits, and other public engagements by the project.

Check out the curatorial team and learn about Podcast of a Plague Year by following these links.

What Stories Should You Share?

Images: photographs, screen captures (including from your phone or laptop) of social media, media, communications, memes, and other expressions of the moment

Audio histories

Video clips--taken of the world, including yourself speaking, or of social media memes

Links

Text

Files: emails, announcements, text messages, scientific documents, and flyers

Allow this Journal of the Plague Year to become your personal diary--a place where you share moments of your life, along with hundreds of others to create a historical record of the pandemic.

We imagine that there will be both traumatic and dislocating moments in this year of the pandemic, and ask you to share as you encounter them. The same is true for moments of unexpected joy--of spending more time with family or friends. Your contributions can and should come from the landscapes of your daily life, both in suburbs and cities, but also through the social media and interwebs that increasingly connect us. Stories can be deeply personal, political, or mundane. Help your communities to understand the extraordinary, as well as the ordinary of this moment. In the future, historians will be able to use this record of daily life to better understand the changing nature of our lives.

This archive took its title and inspiration from Daniel Defoe's novel of the same name. First published in March 1722 the novel, A Journal of the Plague Year, tells story of one man's experiences of the year 1665, in which the bubonic plague shook London.

A Journal of the Plague Year: An Archive of Covid-19 was initiated by Catherine O'Donnell, Richard Amesbury, and Mark Tebeau in the School for Historical, Philosophical, and Religious Studies at Arizona State University. The archive was seeded by funding from the public history endowment at Arizona State University, endowed by Noel Stowe. The project has emerged as a curatorial consortium that includes faculty and graduate students from around the United States and now the world.

Additional and sigificant funding for curators and design has been provided by Arizona State University: the Humanities Dean of the College for Liberal Arts & Sciences; the School of Historical, Philosophical, and Religious Studies; the Institute for Humanities Research; and the Center for the Study of Religion and Conflict through the Luce Foundation.

Curatorial Projects
Journal of a Plague Year features our partners through a series of archival collections that reflect localized and thematic collecting across the world.

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Join us in documenting our uncertain moment. We are acting not just as historians, but as chroniclers, recorders, memoirists, as image collectors. We invite you to share your stories about how the pandemic has affected our lives, from the mundane to the extraordinary, including the ways things haven't changed at all.

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The Riken research institute's Fugaku supercomputer, the world's fastest, is back in the global spotlight with a special award for its simulations of how aerosol droplets disperse and educating the public on ways to prevent the spread of COVID-19.

The Gordon Bell Special Prize is given by the Association for Computing Machinery. In announcing this year's Special Prize, the award committee said the visualization of how droplets disperse based on the Fugaku's simulations helped to change the way people around the world acted during the pandemic.

The Fugaku supercomputer went into full-scale mode from March and this is the first time research based on the supercomputer has been recognized with an international prize.

Using the world's fastest supercomputer, researchers were able to estimate the complicated changes that occur to the droplets, even through minor changes in air flow, and when only miniscule amounts were involved.

The research team in June 2020 began examining how saliva droplets disperse in a range of situations, such as coughing or choral singing.

Over the course of its research, the team announced about 1,000 different simulations of aerosol dispersal in 50 separate situations, including in classrooms or during commutes. The team has also looked at differences arising from the type of face mask worn.

The awards committee based its decision on the fact that governments and companies have used the results from the Riken research to encourage the use of face masks and to maintain social distancing as ways of decreasing the risk of COVID-19.

"We are very happy that Fugaku has received such a positive assessment for the impact it had on dealing with a real-time crisis," said Satoshi Matsuoka, director of the Riken Center for Computational Science.

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Supercomputer Fugaku wins prize for COVID-19 research | The Asahi Shimbun: Breaking News, Japan News and Analysis

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The Riken research institute's Fugaku supercomputer, the world's fastest, is back in the global spotlight with a special award for its simulations of how aerosol droplets disperse and educating the public on ways to prevent the spread of COVID-19. The Gordon Bell Special Prize is given by the Association for Computing Machinery.

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This article discusses the student exhibitions curated as part of the 'Managing Collections and Exhibitions' module on the MA Art Gallery an

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Inside the world's tropical forests, there are the agents of disease that have the power to bring our way of life to a halt. How we learn to live with these forests will determine our fate, hastening or slowing the onset of future pandemics and the climate crisis. BBC Travel and Future Planet explore two sides of our relationship with forests in two stories; this story is the first, and you can read the second here.
Levi Sucre Romero remembers hearing the news back in January about a novel coronavirus infecting people in China. "I honestly didn't believe it would make it this far," he said. "I felt like it was really far away."

A member and leader of the Bribri, one of Costa Rica's largest indigenous groups, Romero lives in Talamanca, a remote, mountainous region in the south of the country full of meandering rivers, dense jungle canopies and a near-constant drizzle of warm rain. Though the thatched-roof wooden homes of Talamanca Bribri, the group's territory, are far removed from the country's popular tourist hubs, Romero soon realised that it was only a matter of time until the virus reached them.

Romero also realised something else: the virus, he believes, was unleashed by human greed and ill treatment of the planet. "We're unbalancing the habitat of species, we're cutting down trees, we're planting monocultures, we're filling the world with cities and asphalt and we're using too many chemicals," Romero said. "It's a cocktail of bad practices."

Like Sars and Mers, two other recent, deadly coronaviruses, Covid-19 is a zoonotic disease that came from an animal. Evidence points to its likely origin in a bat, followed by a potential crossover into an intermediary species - possibly a pangolin - before transmission into humans at a wet market in Wuhan, China. While Covid-19's exact origins have yet to be pinpointed, overwhelming research shows that deforestation and commercial wildlife trade heighten the risk of zoonotic diseases that can potentially cause pandemics. And according to Romero, both are human activities that entail the destruction of nature.

"My people have cultural knowledge that says when Sibö, our God, created Earth, he locked up some bad spirits," Romero said. "These spirits come out when we're not respecting nature and living together."

Romero coordinates the Mesoamerican Alliance of People and Forests, one of the most important land-rights platforms for indigenous communities in Central America and Mexico, which represents more than 50,000 people who live in the most densely forested lands in the region. He knows for a fact that there is another, more sustainable and respectful way to live in relation to the Earth - because the Bribri and many other indigenous groups around the world practice it.

For years, Romero and other indigenous leaders have been urging the rest of the world to adopt a more indigenous-inspired way of coexisting with nature, including leaving habitats intact, harvesting plants and animals at sustainable levels and acknowledging and respecting the connection between human and planetary health. Now, they are reiterating that message in light of the coronavirus.

At a March panel sponsored by the global journalism initiative Covering Climate Now in New York City, held days before the city shut down and later became the global epicentre of the worldwide pandemic, Romero and other indigenous leaders from Brazil and Indonesia emphasised the role that traditional knowledge, practices and land stewardship can play in protecting the planet. These protections, they said, extend not just to lessening climate change and biodiversity loss, but to reducing the risk of future pandemics.

"We are convinced that this pandemic is the result of a wrong use of natural resources and a wrong way of living together with these resources," Romero said. "I do not believe this will be the last pandemic of this type."

A wealth of research supports the link between novel disease emergence and environmental destruction. Many viruses naturally occur in animal species, and deforestation increases the odds of people coming into contact with an animal carrying a virus that is new to humanity, potentially resulting in a spill-over event. A 2017 Nature Communications paper revealed that emerging zoonotic disease risk is highest in tropical forests that are experiencing land-use changes, including from logging, mining, dam building and road development. As the authors report, such activities carry an intrinsic risk of disease emergence because they disrupt ecological dynamics and increase contact between humans, livestock and wildlife.

"It's a stochastic process," said Erin Mordecai, a biologist at Stanford University. "It's driven by chance encounters between particular people and particular animals, and what pathogens they're carrying at that time."

Deforestation can also spread existing diseases. In October, Mordecai and co-author Andrew MacDonald reported in the Proceedings of the National Academy of Sciences that an increase in deforestation in Brazil tends to increase the rate of malaria transmission, with about six-and-a-half new cases occurring per square kilometre of cut-down forest. The reason, they believe, is that cutting trees creates more forest edge - the favourite breeding habitat for Brazil's malaria-transmitting mosquitoes. Development in frontier regions also brings more people closer to the forest and draws pioneers in from other parts of the country who have never been exposed to malaria and thus have no resistance.

While every disease is different, the general pattern, Mordecai told me, is that deforestation disrupts ecosystems and creates edge habitats hovering between domesticated and wild, in which the human and natural world overlap. "Deforestation tends to lead to these opportunities in which species that don't normally come into contact are coming into contact," she said. "That creates opportunities for pathogens to spill over."

Studies reveal that the both legal and illegal commercial wildlife trade also increase the risk of new diseases emerging by subjecting wild animals to stressful, unhygienic conditions. Still-living species are often mixed together, allowing them to exchange viruses. Trade also often takes place in urban centres, where many people may come into contact with the animals - and with each other - further encouraging a new disease's spread.

How travellers can help protect indigenous land

"Indigenous tourism" directly engages indigenous people to let them share their culture and land on their own terms. According to the United Nations' World Tourism Organization, "indigenous tourism can spur cultural interaction and revival, bolster employment, alleviate poverty, curb rural flight migration, empower women and youth, encourage product diversification, and nurture a sense of pride among indigenous people."

To ensure that your travel will directly benefit the people whose culture and land you experience, the World Indigenous Tourism Alliance recommends booking indigenous-owned-and-operated tours. Fortunately, indigenous-led travel experiences have recently surged in places like Australia, Canada and the US. In the last few years, the Bribri launched Costa Rica's first indigenous-operated tour agency, which teaches visitors about the group's worldview and spiritual connection to the land, with all funds going back to the community.

The wildlife trade itself is also linked to deforestation. Hunters and poachers tend to access wilderness areas through roads. As formerly remote areas are opened up by new transportation corridors, wildlife trade tends to follow.

Medical experts and conservationists have been warning of the health risks posed by both deforestation and wildlife trade for decades, but to no avail. In 2003, for example, China briefly banned wildlife trade in response to Sars, but business resumed within a year and has only grown since.

As land stewards, many indigenous groups help to guard against these threats. "By protecting indigenous landscapes, you're protecting not only those people and their way of life, but also preventing really rapid transformation of landscapes," Mordecai said. "That rapid transformation has huge-scale cultural and environmental consequences, but also disease-transmission consequences."

A large number of indigenous groups live in tropical forests - precisely the landscapes with the highest risk for new disease emergence, and also the places facing the highest rates of deforestation. Tropical deforestation is accelerating and accounts for about 90% of total deforestation worldwide. A 2020 study reported that at least 36% of the world's remaining intact forests - half of which are located in the tropics - fall within indigenous lands.

Of course, indigenous people are extremely diverse. Some live in cities, others in forests; some extract resources for profit, others use nature only for subsistence. In general, though, indigenous groups "are much more effective at protecting the forest and environment on their lands than most other users," said Mary Menton, a research fellow in environmental justice at the University of Sussex. In certain parts of Brazil, for example, indigenous protection is visible in satellite images from space.

"You can see exactly where the lines of indigenous territories are," Menton said. "Deforestation eats into forests around where indigenous areas are, and those areas really act as an effective barrier for expansion."

This is also supported by scientific evidence. A 2012 study comparing 40 protected areas and 33 community-managed forests revealed that the community-managed areas suffered less deforestation. "If we look across the tropics, indigenous people's lands, by and large, tend to be much better protected than other areas of the forest, even comparing community and indigenous lands to protected areas," Menton said.

Practically speaking, this is partly because indigenous people tend to live on large areas of land with relatively small populations. But even groups that live in smaller tracts of forest in north-east Brazil, for example, live more sustainably than much of the rest of humanity. "It's not just that they have lots of forest, it's the way they treat and see the forest, and interact with it," Menton said.

Many groups have been living in forested areas for generations and view the landscape as part of their community. Some also believe that their ancestors are part of the forest. Protecting nature, therefore, isn't just about ecology and biodiversity, Menton says, but also about preserving lives, history and culture.

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Indigenous people accomplish this through a variety of means that largely boil down to having a respect and awareness of the effect they have on the forest, Menton said. The Bribri, for example, divide their land into family and community areas, each of which have internal rules designed to promote sustainability. For example, members of the community can cut as many leaves as they want from local suita palms - used to make everything from houses to brooms - so long as they leave at least five leaves on each harvested plant so it can produce more leaves.

Many indigenous people also do not treat the forest as a means or impediment to getting rich. Romero, for his part, thinks that hyper-globalisation and consumerism are at the heart of many of the world's ills. "We need to rethink the model of development that's based on accumulating wealth while destroying resources," Romero said. "I see an economic model that is predatory to resources and to nature, that causes a lack of balance in the world."

However, profit-driven companies, governments and individuals often view indigenous people as standing in the way of economic growth. Around the world, indigenous land rights are under attack by agriculture, mining and other extractive industries. Between 2002 and 2017, Menton found that more than 1,500 environmental defenders were murdered in 50 countries, and that indigenous peoples died in higher numbers than any other group on the list. In 2015 and 2016, for example, indigenous people represented 40% of all murdered environmental defenders. A report published in April 2020 by the Pastoral Land Commission, a non-profit organisation in Brazil, likewise revealed that one-third of all families who faced land conflicts in rural Brazil in 2019 were indigenous.

Menton adds that indigenous people face additional threats because of racism and "perceptions that they're second-class citizens". Often, this is a problem promoted from the top down. Brazil's president, Jair Bolsonaro, recently said, for example, that " Indians are evolving " to become "increasingly human, like us". Indigenous people, in other words, are "facing threats both in terms of actual physical conflicts over land, but also cultural threats and attacks over their right to exist," Menton said.

Attacks on indigenous rights are not just attacks on individual cultures, Romero says, but on the health of the planet as a whole. "When we have rights over our forests and our lands, that means survival for us, for our families," he said. "But it also means we have a better probability of avoiding pandemics."

The Bribri, like much of the world, are now on lockdown. "The rhythm of our lives has been cut short," he said. Visits with elders are no longer permitted, sales of produce to the national market have dropped by around 90%, and the group's cultural and ecological tourism efforts - including guided trips to mountains and rivers, traditional food tours and home stays on family ranches - have stopped as well. "I could go on and on. There's a lot of impacts," Romero said.

Once the world does emerge from Covid-19, Romero hopes that there will be a silver lining to all of the suffering, loss and hardship that it has caused. He hopes that people will be more receptive to the knowledge that he and other indigenous leaders have to offer, and that humanity will begin to re-evaluate its relationship with nature.

"I think we have a long way to go, but after the coronavirus, I have faith that this will open up some space with governments," Romero said. "After this pandemic, governments should listen more."
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The indigenous communities that predicted Covid-19

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Inside the world's tropical forests, there are the agents of disease that have the power to bring our way of life to a halt. How we learn to live with these forests will determine our fate, hastening or slowing the onset of future pandemics and the climate crisis.

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One of the impediments to designing sustainable policy solutions to contain the damage from COVID has been the assumption that people have an accurate estimate of risk. Behavioral research has repeatedly illustrated how people generally miscalculate risks-especially when they are influenced by fear. This is why transparency, and the right incentives should form the core elements of any sustainable policy for the next phase of COVID response.

In late July, the U.S. Centers for Disease Control and Prevention (CDC) updated its mask guidance, recommending vaccinated people mask up indoors in areas with high infection transmission rates. This policy was a sharp reversal of its initial recommendation two months earlier. Masks remain an important tool in slowing down the spread of the coronavirus, especially during a surge in infections and in high-risk situations; however, having people look up the areas of transmission for making the decision is not a feasible solution for most. Masking guidelines have also been severely politicized, taking the attention away from a more urgent intervention: vaccines.

"Behavioral research has repeatedly illustrated how people generally miscalculate risks-especially when influenced by fear"

These unending debates on masks are distracting, and may lead to other long-term unanticipated problems, such as doubts about the effectiveness of vaccines. The reason for this is how people generally assess risk. The policy vacillations on the mask guidance could eliminate the incentives for some people to get a vaccine.

There are additional issues that could complicate the adoption of vaccines. First, there is a risk communication problem. When policymakers are constantly changing their stance on masks and other public health interventions, the messaging is muddled, and people receive no clear guidance on what to do. Additionally, vague guidance on masking-without specifying that high-filtration masks and high levels of compliance are required for effectiveness-is not actionable.

Second, there is a transparency problem. When the CDC announced the reversal on masking, there was no clear evidence at the time on why the risk assessment had changed. This created confusion and doubt. Eventually, internal CDC documents revealed that vaccinated people who were infected with the delta variant carried as much viral load as the delta-infected unvaccinated people. However, during those initial chaotic days, the message on what the COVID-19 vaccines can and cannot do was lost. In fact, the study that prompted the CDC to reverse its mask policy also reported that very few vaccinated people were hospitalized.

Lack of transparency on data and unclear communication has also led to significant erosion of trust in public health agencies, and the politicization of the response. In a recent poll, only 52 percent of Americans had "quite a lot" of trust in the recommendations from the CDC. The numbers were even lower for the National Institutes of Health (NIH) and the Food and Drug Administration (FDA), at 37 percent each. The same poll highlighted the sharp political polarization-with 76 percent of Democrats having a "great deal" of trust in the CDC, and only 27 percent Republicans sharing that view. While political intrusion at the CDC last year has played a significant role in this erosion of trust, the mixed messages from the agency have also contributed to these trends. The agency's initial guidance on masks in May and the reversal of the policy in July has further complicated the politics of the public health response, including vaccinations.

The situation doesn't need to be this way. Effective public health strategies are available-what we need are political will and thoughtful implementation.

COVID vaccinations need to be mandated. Unless there are legitimate exemptions, the benefits of the vaccine-at the individual and societal levels-far exceed the risks. The federal government, numerous private and educational organizations, and now the Pentagon have already adopted this policy. Although some resistance to this policy is expected, the U.S. Supreme Court recently rejected a request to block Indiana University's vaccine mandate. For the next phase in COVID response, these policies need to be expanded, especially in places where people assemble in large numbers. Some places in San Francisco have already done this. Private companies and state-level politicians should play a leadership role in implementing this policy. With the FDA granting full approval of the COVID vaccine (Pfizer), there is enough information and justification to address the concerns of those who have been reluctant until now.

"Effective public health strategies are available-what we need are political will and thoughtful implementation"

The recent FDA approval will also enhance the next strategy: greater investments in communicating the safety of vaccines. Policymakers should recognize that vaccine-hesitant people are not a monolith. Often what they want are more information and more assurance. Public health officials at all levels need to repeat and amplify the messaging around vaccines: they are highly effective and prevent severe disease, hospitalizations, and death. Policymakers can also take advantage of behavioral nudges to improve vaccine adoption. This can be done by making the path to getting vaccinated one of least resistance-by either making vaccinations a default option, or by asking people to get tested frequently for COVID.

At this point, the biggest barrier to combating COVID is psychological-understanding that while the pandemic will end, the coronavirus will likely become endemic. What this means is that, either from vaccinations or from infections, a sufficient number of people will develop levels of immunity such that there is reduced transmission, while the virus circulates. This will also require policymakers to clearly articulate that the "new normal" could be a life with the coronavirus, and accurately convey the risks.

With time, our understanding of the transmission dynamics of coronavirus and its variants will improve. This will necessitate changes in public health policy. Addressing the ongoing pandemic is a collective responsibility, with each person playing an active role. Policymakers should repeatedly, transparently, and clearly communicate this reality and develop structures that enable a safe transition to the next phase of COVID.

Junaid Nabi, MD, MPH, is a health-care researcher working at the intersection of health care reform and innovation. He is a New Voices senior fellow at the Aspen Institute and serves on the Working Group on Regulatory Considerations for Digital Health and Innovation at the World Health Organization.

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The Next Phase of COVID-19 Response | Think Global Health

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One of the impediments to designing sustainable policy solutions to contain the damage from COVID has been the assumption that people have an accurate estimate of risk. Behavioral research has repeatedly illustrated how people generally miscalculate risks-especially when they are influenced by fear.

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RECOVER: Researching COVID to Enhance Recovery

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Long COVID is real. Millions of people who had COVID-19 still have symptoms lasting weeks, months, or years.

We created RECOVER to understand, treat, and prevent Long COVID and help people who are suffering.

Learn more about Long COVID

The RECOVER Initiative

Millions of Americans suffer from Long COVID. This disease affects each person differently, so no single research study can provide all the answers to Long COVID for everyone. The National Institutes of Health (NIH) created the RECOVER Initiative to find answers across many different types of research studies.

RECOVER brings together clinicians, scientists, caregivers, patients, and community members to understand, treat, and prevent Long COVID. We've created one of the largest and most diverse groups of Long COVID study participants in the world.

We're learning about Long COVID and testing different treatments. We're sharing our research, quickly learning from it, adapting, and constantly refocusing our efforts to ease suffering for millions of people.

Together, we are working to understand, treat, and prevent Long COVID.

Explore RECOVER's progress and find out how to get involved:

Each RECOVER research team can use all RECOVER data and findings to inform and improve their study. This way, we can learn more quickly about this complex condition and better understand, treat, and prevent Long COVID.

Researchers study the health and symptoms of thousands of participants over several years. No treatments or medicines are provided.

Researchers study people who have died after having COVID, including people who did not have Long COVID.

Researchers study lab samples from people with and without Long COVID to understand how COVID affects different body systems.

Graphic showing the interaction of the RECOVER project's Research Components and Information Exchange.

All Data Shared

Four concepts interact to integrate the information gained from the groups into the overall RECOVER project.

Learning from People

This includes information from Tissue Pathology/Autopsy, as well as Cohort- and Community-based Study Groups.

Clinical Science

This includes information from Pathobiology.

Real World Data

This includes information from Electronic Health Records and the Digital Health Program.

Studying Treatments

This receives data and information from the other components and integrates that knowledge gained into Clinical Trials.

Researchers study millions of medical records, called EHR, to understand changes over time, learn who may have Long COVID, and learn how to treat or prevent it.

Researchers study possible treatments such as drugs, medical devices, or other approaches to learn how to treat Long COVID symptoms.

Each RECOVER research team can use all RECOVER data and findings to inform and improve their study. This way, we can learn more quickly about this complex condition and better understand, treat, and prevent Long COVID.

Researchers study the health and symptoms of thousands of participants over several years. No treatments or medicines are provided.

Researchers study people who have died after having COVID, including people who did not have Long COVID.

Researchers study lab samples from people with and without Long COVID to understand how COVID affects different body systems.

Researchers study millions of medical records, called EHR, to understand changes over time, learn who may have Long COVID, and learn how to treat or prevent it.

Researchers study possible treatments such as drugs, medical devices, or other approaches to learn how to treat Long COVID symptoms.

Data is shared between the different types of RECOVER research to inform clinical trials.

RECOVER Enrollment Summary

Enrollment in Cohort Studies

Adult Cohort Enrollment (non-Pregnant)

Pregnant Adult Enrollment

For People With and Without Long COVID

Participants in RECOVER observational cohort studies join for several years to help understand:

Who gets Long COVID and why

What symptoms people have

How Long COVID affects people's health over time

RECOVER cohort study participants are adults aged 26 or older, pregnant people, and children and young adults aged 25 or younger. These studies do not give treatments or medicine to participants.

Cohort Studies

Testing Treatments for Long COVID

RECOVER clinical trials test the safety and effectiveness of treatments for symptoms of Long COVID. These studies are informed by patient Representatives and the findings from other RECOVER studies.

The clinical trials will test multiple possible treatments for Long COVID symptoms. Treatments include drugs, biologics (medicines that come from blood or plasma), medical devices, and other therapies.

Clinical Trials

Explore COVID-19 Resources

Find information to help reach communities hit hardest by the pandemic.

Access NIH Long COVID resources, including interactive symptom information.

Find information to help treat patients.

Encuentre recursos en español, sobre el COVID-19.

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RECOVER: Researching COVID to Enhance Recovery

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Researching COVID to Enhance Recovery (RECOVER), a National Institutes of Health (NIH) research initiative, seeks to understand and prevent Long COVID.

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President Biden has said the government should help people who continue to experience symptoms long after a coronavirus infection. But qualifying remains a major hurdle.

Josie Taveras tested positive early in the pandemic and continued to have symptoms consistent with "long Covid." Credit... Sarah Blesener for The New York Times

Since she tested positive for the coronavirus in April 2020, Josie Cabrera Taveras has found herself sleeping for up to 15 hours a day, stopping in grocery store aisles to catch her breath, lapsing in and out of consciousness and unable to return to her job as a nanny.

She believes that she is one of thousands, possibly millions, of Americans who may have a condition known as "long Covid." The Biden administration has said people with the condition could qualify for federal disability protections and benefits, which can include health care, housing and unemployment benefits.

But like many others who may have long Covid, Ms. Taveras, 31, has had a hard time proving it.

Two brain M.R.I.s, several heart ultrasounds, dozens of lung X-rays, two stomach endoscopies, one colonoscopy and multiple CT scans have all provided the same results: Everything looks normal. "It's something doctors can't explain yet, what's happening to me," Ms. Taveras said.

With no direct medical evidence of her condition, she has been turned down for disability coverage twice. Even a note from a prestigious post-Covid clinic in the Mount Sinai hospital system, attesting that Ms. Taveras "continues to experience daily symptoms and is currently unable to work," was not enough.

In July, at a White House event celebrating the Americans with Disabilities Act, President Biden promised "to make sure Americans with long Covid who have a disability have access to the rights and resources that are due under the disability law."

But with no widely agreed-on method of diagnosing the ailment, those who believe they have long Covid are finding it difficult to qualify under a system that is unfamiliar and already tricky to navigate.

Studies have shown that a significant number of Covid-19 patients continue to seek treatment for a wide range of medical conditions many months after a diagnosis. The American Academy of Physical Medicine and Rehabilitation estimates that three million to 10 million Americans may have long Covid.

Yet many of those seeking benefits cannot produce a positive coronavirus test because tests were in short supply at the beginning of the pandemic. And lab results and scans often show nothing unusual for those continuing to experience symptoms.

"I expect the tests to come back normal," said Dr. Luis Tatem, an infectious-disease specialist who has been treating Ms. Taveras and other long Covid patients at the University Hospital of Brooklyn. He added: "We're used to having a laboratory to back us up. And for this, you don't."

Ms. Taveras with her children, Isabelle, 3, and Jhonatan, 7, at home in Brooklyn. Credit... Sarah Blesener for The New York Times

Since December 2020, the Social Security Administration has determined that about 16,000 applicants were able to provide medical evidence supporting Covid-19 as one of their impairments, according to Nicole Tiggemann, a spokeswoman for the agency, which was not flagging Covid cases before that.

But she would not say how many of those 16,000 applicants had been approved for benefits, or how many people claiming long Covid as a condition had been denied. Many cases are probably still pending; wait times for a determination can stretch for five months or more.

The pandemic forced the Social Security Administration to largely shut down in-person services, and some experts predict a flood of applicants with long Covid in the coming year, adding to the strained agency's workload.

"Addressing the disability backlog is one of our top priorities," Ms. Tiggemann said via email, acknowledging that the pandemic had increased wait times. Mr. Biden has called for an additional $1.3 billion for the agency's budget for the 2022 fiscal year, but his proposal is part of the current negotiations in Congress, and it is unclear whether it will pass.

About 8.1 million disabled workers and 1.4 million of their family members receive disability benefits, which average about $1,280 a month. To qualify, applicants must demonstrate a disability that substantially limits their ability to work and has lasted, or will last, for at least a year. Typically, the Social Security Administration uses medical assessments or health records to determine whether someone qualifies, and a vast majority of those approved for disability stay on it for life.

Getting approved can be difficult. Between 2009 and 2018, the Social Security Administration denied 66 percent of applications on average.

But some people with long Covid symptoms have had success - even without a positive coronavirus test - if they are able to demonstrate a substantial downturn in their health and ability to work.

Steven Trompeter, 49, was unable to perform his job as an industrial mechanic after getting sick with Covid symptoms, including cough, fever, muscle aches and loss of taste and smell, in February 2020. He applied for disability in December 2020 and was approved six months later.

Mr. Trompeter, a Navy veteran who lives in Idaho Falls, Idaho, said he believed that the extensive medical records documenting his past health and his repeated visits to a Veterans Affairs medical clinic in 2020 helped show how sick he had become, with ongoing "brain fog" and other difficulties.

"I've heard nightmares where you have to get denied three times and then get a lawyer to go before a judge, and I didn't have to do any of that," he said. "I just had to wait."

Ms. Tiggemann said a determination of whether people qualify for benefits has more to do with how their symptoms affect their ability to function than the exact diagnosis. So a positive Covid test, while helpful, might not be necessary if the other evidence clearly shows an inability to work, she said.

"No two cases are the same, each case is individual," she said. "We look at doctor's tests, medical records, past treatments and whether they have other conditions."

Long Covid has proved similar to other diseases that can be difficult to diagnose, including myalgic encephalomyelitis (also known as chronic fatigue syndrome), fibromyalgia, rheumatoid arthritis and post-treatment Lyme disease syndrome - conditions that can also cause fatigue, memory issues and joint pain.

Patients with these diseases often find it difficult to qualify for disability benefits and get accurate, timely medical diagnoses. Studies from the Centers for Disease Control and Prevention and organizations that represent people with those conditions have shown that some patients can spend years or even more than a decade trying to determine what causes their illnesses.

Many medical schools do not offer enough training on these types of diseases, and research for them is underfunded, said Linda Tannenbaum, chief executive of the Open Medicine Foundation, a nonprofit that funds research into chronic complex diseases like fibromyalgia and long Covid. "Most patients cannot get disability benefits," she said.

Dr. Stephen Martin,a physician and professor at the University of Massachusetts Medical School, said the complex nature of diagnosing long Covid required the coordination of various specialists who also have specific knowledge of the condition. Many are overbooked, he said, with wait lists of more than six months - especially for patients who do not have good health insurance.

"This really hits us in our Achilles' heel of health care," Dr. Martin said. "The American health care system really isn't set up to do this at scale."

Sandee Babb taking her blood pressure, which is now a daily ritual. Credit... Sylvia Jarrus for The New York Times

Sandee Babb, 54, of Grand Rapids, Mich., has seen nearly two dozen doctors over the past year trying to figure out what is causing a range of symptoms, including cardiac arrhythmia, a chronic cough, shortness of breath and joint pain, which have kept her from returning to her job as a teacher and librarian. She says she gets breathless just trying to put her socks on, and cannot walk up a flight of stairs without stopping to rest.

"The brain fog is crazy bad," Ms. Babb said. "I've been in the shower and stared at my shampoo bottle and couldn't figure out how to open it."

She could not get a coronavirus test when she first got sick in March 2020, early in the pandemic. But a September progress note from her doctor said her symptoms "could be consistent with long-haul type syndrome."

Since getting sick, Ms. Babb has lost her home and all of her retirement savings. She is working as a live-in caretaker for a quadriplegic friend in part to keep a roof over her head.

After months documenting her condition, she submitted her unemployment application in August and is not sure when she will get an answer. "If it doesn't come through, then I'm really stuck," she said. "Where do I go from here?"

Ms. Babb has struggled to walk upstairs without needing to rest to catch her breath. Credit... Sylvia Jarrus for The New York Times

# data[].attributes.attachment_link.title
Another Struggle for Long Covid Patients: Disability Benefits

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President Biden has said the government should help people who continue to experience symptoms long after a coronavirus infection. But qualifying remains a major hurdle. Since she tested positive for the coronavirus in April 2020, Josie Cabrera Taveras has found herself sleeping for up to 15 hours a day, stopping in grocery store aisles to catch her breath, lapsing in and out of consciousness and unable to return to her job as a nanny.

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PLoS One. 2021; 16(2): e0246317.

Steven Taylor, Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Visualization, Writing - original draft, Writing - review & editing 1,* and Gordon J. G. Asmundson, Funding acquisition, Investigation, Project administration, Supervision, Writing - review & editing ²

Abstract

This study reports a comprehensive empirical investigation of the nature and correlates of anti-mask attitudes during the COVID-19 pandemic. Accumulating evidence underscores the importance of facemasks, as worn by the general public, in limiting the spread of infection. Accordingly, mask wearing has become increasingly mandatory in public places such as stores and on public transit. Although the public has been generally adherent to mask wearing, a small but vocal group of individuals refuse to wear masks. Anti-mask protest rallies have occurred in many places throughout the world, sometimes erupting violently. Few empirical studies have examined the relationship between anti-mask attitudes and mask non-adherence and little is known about how such attitudes relate to one another or other factors (e.g., non-adherence to social distancing, anti-vaccination attitudes). To investigate these issues, the present study surveyed 2,078 adults from the US and Canada. Consistent with other surveys, we found that most (84%) people wore masks because of COVID-19. The 16% who did not wear masks scored higher on most measures of negative attitudes towards masks. Network analyses indicated that negative attitudes about masks formed an intercorrelated network, with the central nodes in the network being (a) beliefs that masks are ineffective in preventing COVID-19, and (b) psychological reactance (PR; i.e., an aversion to being forced to wear masks). These central nodes served as links, connecting the network of anti-masks attitudes to negative attitudes toward SARSCoV2 vaccination, beliefs that the threat of COVID-19 has been exaggerated, disregard for social distancing, and political conservatism. Findings regarding PR are important because, theoretically, PR is likely to strengthen other anti-masks attitudes (e.g., beliefs that masks are ineffective) because people with strong PR react with anger and counter-arguments when their beliefs are challenged, thereby leading to a strengthening of their anti-mask beliefs. Implications for improving mask adherence are discussed.

Introduction

Adherence and non-adherence to wearing facemasks

It has become increasingly apparent that behavioral science is vital for understanding how pandemics can be optimally managed, and for understanding and addressing pandemic-related socially disruptive phenomena such as the reluctance or frank refusal to follow health guidelines such as the wearing of face masks [ 1, 2]. Historically, protective facemasks have played an important role in limiting the spread of infection during pandemics [ 2]. Mask wearing has long been regarded as vital for healthcare workers and has been recommended for people in the community, although there have been inconsistent messages from health authorities about mask wearing for the general public during the COVID-19 pandemic [ 3- 5]. Early in the pandemic, some health authorities such as the World Health Organization (WHO) recommended that masks not be worn by the public and that masks should be reserved for health care workers and those infected with COVID-19 [ 5, 6]. At that time the WHO and other health authorities also averred that masks are ineffective for the general public, that masks provided a false sense of security, and that the wearing of masks would cause people to touch their faces, thereby increasing their chances of infection [ 5, 7]. Such concerns proved to be unfounded [ 7- 9] and evidence steadily emerged to support the wearing of masks by members of the general public [ 10, 11]. Health authorities such as the WHO subsequently reversed their position on facemasks and recommended that masks be worn by the public when they were in public places, especially when social distancing was not possible [ 6].

The prevalence of mask wearing in the community increased as COVID-19 spread globally [ 6, 12]. In the US and Canada, which were the counties in which the present research was focused, mask wearing in the community increased dramatically in the months following the formal declaration on March 11, 2020 that COVID-19 had become a pandemic [ 13- 16]. Surveys conducted from June to August, 2020 suggested that most (approximately 80-85%) of Canadian and American adults regularly wore masks [ 6, 14- 17]. The increase in mask wearing was likely due to several factors including (a) the increasing prevalence of COVID-19, (b) reversal by health authorities on their earlier position, from dissuading to encouraging the public to wear masks, and (c) mask wearing had become increasingly mandatory in stores and on public transport. In the months after the pandemic was declared, the policy of mandatory masks appeared to gain acceptance among the general public. Surveys in July, 2020 suggested that most respondents (74%) found that a policy of mandatory mask wearing was personally acceptable [ 14], which was an increase from 37% in May [ 13].

Despite the importance of masks, some people object to wearing them. During the so-called Spanish flu pandemic (1918-1920), for example, opposition to wearing masks occurred in San Francisco in 1919, when authorities attempted to make it mandatory to wear masks in public places. The Anti-Mask League was formed, which was a short-lived protest movement in which the proponents argued that masks were ineffective, inconvenient, and that mandatory mask wearing violated their civil liberties [ 18, 19]. These anti-maskers were a vocal but small group, so most people followed the recommendations to wear masks in public [ 18, 19].

A similar situation has arisen during the COVID-19 pandemic. Estimates suggest that at the time the present research was conducted (July-August, 2020), about 10-15% of adults in the US and Canada rarely or never wore masks in public [ 14, 16, 17]. During the COVID-19 pandemic, there have been numerous anti-mask protest rallies, primarily in the US, Canada, Europe, and Australia, with some rallies drawing thousands of people [ 20- 23]. Protest rallies have persisted despite high rates of infection and large numbers of deaths from COVID-19. Violence has erupted in some rallies as protesters clashed with counter-protesters or with police [ 21, 23- 26]. Just as in 1919, the COVID-19 anti-mask protests were spurred by government plans to make masks mandatory. Some rallies were protests against mandatory masks, while others were broader, protesting against masks, social distancing, lockdown, and vaccines [ 22, 23, 27]. Protesters at some anti-masks rallies were joined by people espousing conspiracy theories, such as the unfounded belief that the threat of COVID-19 has been exaggerated by the government in order to control the populace [ 28].

Unlike the 1919 anti-mask movement, which was short-lived and limited to a single city, the anti-mask rallies during COVID-19 have taken place in many cities, sporadically arising without any evidence (at the time of writing) of petering out. The recurrence of such rallies is likely fueled by social media and news media coverage combined with strongly engrained anti-mask attitudes held by at least a small proportion of the population.

Very little is known about the motivations for mask non-adherence. Public opinion polls suggest that people with conservative political affiliations (Republicans in the US or Conservatives in Canada) are less likely to wear masks than people with liberal affiliations (Democrats or Liberals) [ 6, 15, 17, 29]. This may be partly because Republican political leaders were initially reluctant to wear masks, even mocking those who wore masks [ 6, 17], and because people with politically conservative ideologies tend to resist government regulatory efforts [ 30], such as attempts to make masks mandatory.

Several opinion polls have assessed reasons for not wearing masks, although the polls were limited in the number of reasons assessed. The most common of the assessed reasons for not wearing masks were: Not believing that masks are effective, finding masks uncomfortable, difficulty establishing the habit of mask wearing, and lack of concern about COVID-19 [ 14, 15, 17, 31]. Newspaper reports of protest rallies offer additional, anecdotal information on anti-masks sentiments. Several reasons for not wearing masks were suggested by news reports of anti-mask protests: Beliefs that masks violate civil liberties, beliefs that masks are ineffective and possibly harmful because masks make breathing difficult, and beliefs that the threat of COVID-19 has been exaggerated [ 3, 20, 22, 23, 32- 38]. Despite the range of anti-mask attitudes, a common theme running through these reports is that protestors believe that mandatory masks are a violation of civil rights. In other words, anecdotal news reports suggest that the rallies are motivated, at least in part, by a phenomenon known as psychological reactance (PR).

Psychological reactance

People like to feel in control [ 39]. Relatedly, PR is a motivational response to rules, regulations, or attempts at persuasion that are perceived as threatening one's sense of control, autonomy, or freedom of choice [ 40, 41]. The perceived threat motivates the person to assert their freedom by rejecting attempts at persuasion, rules, regulation, and other means of control. Thus, when PR is evoked it is characterized by counter-arguments and anger [ 42]. This might involve denying the existence of a threat [ 40, 43]; for example, denying the need to wear masks by denying the seriousness of the pandemic. Thus, PR is expected to be correlated with a denial or disregard for the seriousness of the COVID-19 pandemic.

The tendency to experience PR is a personality trait [ 44], which is correlated with a range of phenomena including antisocial and narcissistic personality traits [ 45, 46] and with political conservatism [ 47, 48]. The latter finding is not surprising given that conservative ideology, as compared to liberal ideology, strongly favors limited government intervention [ 30], and so government policies that threaten to restrict freedoms are likely to elicit PR [ 47]. Mass communication messages that try to persuade people to adopt a given behavior, such as wearing masks, can elicit PR, thereby undermining the impact of the message [ 41, 49]. Given these considerations, it is important to investigate whether PR is implicated in mask non-adherence during the COVID-19 pandemic.

Aims of the present study

Although most people have been adherent to wearing masks during the COVID-19 pandemic, opinion polls suggest that a small but significant proportion of people (10-15%) object to wearing masks. News reports, although anecdotal, suggest that people who object to wearing masks are a vocal minority, engaging in protest rallies that sometimes erupt in violence. Accordingly, non-adherence to wearing masks is a socially important phenomenon as well as one that is relevant to managing the COVID-19 pandemic. To date, the study of mask non-adherence during the COVID-19 pandemic has been largely limited, with some exceptions discussed later [ 50, 51], to a small number of opinion polls, with a limited assessment of anti-masks attitudes. The present study had three primary aims.

The first aim was to conduct a broad examination of anti-mask attitudes, to determine which attitudes are related to masks non-adherence, and to investigate how anti-mask attitudes are related to one another. Previous research on PR suggests that mask-related PR (i.e., objecting to being forced to wear masks) should be related to other anti-mask attitudes, because when a person with a high degree of PR is challenged regarding a given attitude (e.g., the belief that masks are ineffective), then that person will resist the efforts at belief change by generating counter-arguments to support the attitudes (e.g., generating counter-arguments to support the belief that masks are ineffective).

The second aim was to investigate how anti-mask attitudes are related to political conservatism. Previous research, as discussed above, suggests that the general propensity to PR is related to conservatism; but, it has yet to be empirically established whether mask-related PR is related to political conservatism. The final aim was to investigate how anti-mask attitudes are related to attitudes and behaviors that are associated with non-adherence to other pandemic-control measures during the COVID-19 pandemic, such as disregard for social distancing and anti-vaccination attitudes. Recent research provides evidence for a COVID-19 disregard "syndrome" [ 52]. This is not a syndrome in the medical sense of the term, but rather a constellation of inter-related attitudes and beliefs. People with this syndrome tend to (a) believe that the COVID-19 pandemic has been exaggerated, (b) see themselves as physically robust to any illness they may experience as a result of being infected with SARSCoV2, and (c) tend to disregard social distancing because they see it as unnecessary [ 52]. This syndrome is also associated with negative attitudes toward a potential vaccine for SARSCoV2 (i.e., beliefs that a vaccine is unnecessary or that the benefits of such a vaccine are outweighed by the potential risks) [ 52].

The first aim of this study was addressed by simple t-tests comparing anti-mask attitudes of people who were adherent versus non-adherent to wearing masks. The remaining aims were address by network analyses, which are well-suited for gaining insights into the complex interplay among variables. Network analysis provides important information about relationships among elements (nodes) in a network (e.g., sets of attitudes or behaviors). Network analysis assumes that nodes are inter-related because they are, in some way, causally linked with one another. In network analysis, the links are known as "edges." The presence of statistically significant edges does not assume that nodes are influenced by some underlying factor such as a latent variable. Instead, network analysis assumes that nodes may directly influence one another [ 53]. In the present study, anti-mask attitudes were predicted to form a network of interconnected nodes. Given that PR theoretically amplifies the strength of other attitudes, mask-related PR was predicted to be one of the central nodes in the network of mask-related attitudes. Network analyses were also conducted to determine how the network of anti-mask attitudes is related to other variables: Political conservativism, the elements of the COVID-19 disregard syndrome, and SARSCoV2 anti-vaccination attitudes. If nodes causally influence one another, then changes in a central node are most likely to lead to changes in other nodes in the network through the spreading of activation. Central nodes, as compared to peripheral nodes, are defining features of a network. Identifying central nodes has the potential to inform which elements to target in interventions. As a caveat, note that network analyses in cross-sectional designs such as the present study are suggestive of, but do not establish causality. Significant edges might represent causal influences (either unidirectional or directional) but experimental designs are needed to establish causality. Accordingly, network analyses provide a source of hypotheses about causal links among variables in a network.

Method

Sample

The sample consisted of 2,078 adults (age ≥18 years) from the United States ( N = 1,036) and Canada ( N = 1,042). The mean age was 54 years (SD = 14 years, range 18-94 years). Most (93%) were employed full- or part-time, most (82%) had completed full or partial college, and 40% were female. Most (70%) were White, with the remainder being Asian (13%), African American/Black (8%), Latino/Hispanic (4%), or other (4%). Only 2% of the sample reported being diagnosed with COVID-19.

Data collection procedures

Data were collected from July 20 to August 7, 2020, using an internet-based self-report survey delivered in English by Qualtrics, a commercial survey sampling and administration company. Qualtrics solicited the present sample as part of our ongoing research program [ 54, 55]. Qualtrics maintains a pool of potential participants who have agreed to be contacted in order to respond to surveys. Qualtrics selected and contacted participants to meet sampling quotas based on age, gender, ethnicity, socioeconomic status, and geographic region within each country. All respondents provided written informed consent prior to completing the survey. The research described in this article was approved by the Research Ethics Board of the University of Regina (REB# 2020-043). Filters were used to eliminate data from careless responders. Embedded in the assessment battery were four attention-check items (e.g., "This is an attention check, please select Strongly Agree"; "For our research, it is really important that you paid attention while responding to our survey. How attentive were you when responding?": "Very Inattentive" to "Very Attentive"). Participants were included only if they provided correct responses to three or more of the four attention checks (e.g., "Strongly agree" or "Very attentive"), indicating that they were sufficiently attentive. In addition, at the end of the assessment battery, participants were asked to indicate whether, in their honest opinion, their data should be used. Those who responded "no" were excluded from data analysis, regardless of their score on the attention-check items.

Measures

Participants completed a battery of measures, including demographic questions. Adherence to wearing facemasks was assessed with a face-valid yes/no item: "Do you wear a facemask because of concerns about COVID-19?" Participants completed a 12-item scale, developed for the purpose of the present study, assessing negative attitudes about facemasks. The items, derived from previous descriptions of anti-mask attitudes [ 2, 14, 15, 17- 19, 31, 56], are listed in Table 1 . Each item was rated on a 7-point scale (1 = strongly disagree, 7 = strongly agree). Three scales, previously developed to assess the COVID Disregard Syndrome [ 52], were also administered: (a) Belief that the dangerousness of COVID-19 is exaggerated, (b) disregard for social distancing, and (c) belief that one has robust personal health against infection. Items on these scales were rated on a 5-point scale (0 = strongly disagree, 4 = strongly agree). These face-valid scales have good levels of reliability and validity [ 52]. Anti-vaccination attitudes toward a SARSCoV2 vaccine were measured using an adaptation of the Vaccination Attitudes Examination Scale [ 57], assessing vaccination attitudes specific to SARSCoV2 [ 58]. The items in this scale, each rated on a 6-point scale (0 = strongly disagree, 5 = strongly agree), assess mistrust of vaccine benefit, worries over unforeseen future effects of the vaccine, concerns about commercial profiteering from the vaccine, and preference for natural immunity. The scale has good levels of reliability and validity [ 57, 58]. Political conservatism was assessed with a single face-valid item: "In general, how would you describe your political views?" (1 = very liberal, 7 = very conservative).

Table 1

Fig 1 cluster

People who don't wear masks (N = 338)

People who wear masks (N = 1,740)

t(df = 2,026)

M (SD)

M (SD)

It is difficult to breathe when wearing a facemask.

E

4.5 (1.9)

4.3 (1.9)

1.70

Facemasks cause me to overheat.

E

4.3 (1.9)

4.2 (1.9)

1.39

Statistical procedures

For the network analyses, Glasso networks (regularized partial correlation networks) were computed using the R qgraph package [ 59]. Indices of centrality, also calculated with qgraph, were used to assess the relative importance of each node in the network [ 60]. Three indices of centrality were computed: Strength, betweenness, and closeness. Strength refers to how well a node is directly connected to other nodes in the network. Node strength is computed as the sum of the absolute values of edge weights (regularized partial correlations) that directly connect that node with other nodes. Closeness refers to how well a node is indirectly connected to other nodes in the network. Closeness is calculated by computing, for a given node, the inverse sum of edge weights for the shortest path between that node and each other node, and then summing the values for these paths. Betweenness refers to how important a given node is in the average path between two other nodes; that is, how often a given node is the most efficient (shortest) path between other nodes. This is an index of the importance of a given node in connecting nodes with one another. The stability (reliability) of the relative order of magnitude of edge weights and their strengths were tested by the correlation of stability coefficient, also calculated via bootnet [ 53]. Coefficients exceeding.50 suggest stable (reliable) results [ 53]. Due to the number of statistical tests conducted in this study, the α level was set at.01 instead of the conventional.05.

Results

The majority (84%) of respondents reported that they wore facemask because of personal concerns about COVID-19, which indicates a high degree of adherence to public health recommendations. Negative attitudes about masks were largely uncorrelated with demographic variables (see S1 Appendix). Wearing of masks because of concerns about COVID-19 was also largely unrelated to demographic variables (see S1 Appendix). That is, mask wearing (coded 1 = yes, 0 = no) was uncorrelated with age, gender, education level, and employment status ( rs ranged from -.03 to.02; see S1 Appendix). Mask wearing was significantly correlated with ethnic minority (non-White) status, but the correlation was very small ( r = .07, p < .001). Mask wearing also had a small but significant correlation with country (coded as 1 = Canada, 2 = US); r = .13, p < .001). That is, significantly more people from the US than Canada reported wearing masks (90% vs. 78%). This may have reflected the significantly higher per capita prevalence of COVID-19 disease and mortality in the US than Canada at the time the study was conducted (i.e., late July/early August, 2020). At that time, Canada was classified as a moderate mortality country and the US a high mortality country, with the estimated number of deaths per 100,000 people being 25 for Canada and 60 for the US [ 61].

Table 1 provides details about the degree of endorsement of negative attitudes about masks. People who did not wear masks because of COVID-19 tended to have more negative attitudes about masks as compared to people who wore masks. People who did not wear masks were most likely to report that they did not like being forced to wear a facemask (i.e., mask-related PR), believed that masks were ineffective and possibly harmful, believed that masks had adverse interpersonal effects, found masks to be esthetically unappealing, and found mask wearing to be an inconvenient habit to form (see Table 1 ).

Anti-mask attitudes were strongly correlated with one another, with rs ranging from.35 to.91 and a mean r of.55 ( ps < .001; see S1 Appendix). Figs ​Figs1 1 - 3 summarize the results of the network analyses. Fig 1 depicts the edges (regularized partial correlations) between nodes in the network of anti-mask attitudes. Edge values and their significance levels are shown in S1 Appendix. The Fig shows five sets of strongly clustered attitudinal variables, as indicated by the strongest edges (i.e., thickest of the green connecting lines) in Fig 1 : (A) Beliefs that masks are ineffective and possibly harmful, (B) beliefs that mask wearing is an inconvenient habit to form, (C) beliefs that masks are esthetically unappealing, (D) beliefs that masks have adverse interpersonal effects, and (E) beliefs about the physical inconvenience of masks (i.e., difficulty breathing and overheating). As shown in Table 1 , clusters A-D discriminated people who wore masks from those who did not. Fig 1 shows that at the center of the network was mask-related PR, which was connected to all clusters except cluster E. The coefficients of stability for the network shown in Fig 1 were.96 for edge weights and.75 for node strengths. These values exceed the cutoff of.50, suggesting stable (reliable) results.

Fig 2 shows the indices of centrality for the network in Fig 1 . Fig 2 shows that beliefs that masks are ineffective was the strongest node in the network in that it was the node that was most directly connected to other nodes in the network. Fig 2 further shows that PR had the highest values on the closeness and betweenness indices. In other words, PR was highly important in terms of connecting other nodes with one another. In summary, Figs ​Figs1 1 and ​and2 2 indicate that PR and beliefs that masks are ineffective were the most important nodes in the network of anti-mask attitudes.

Fig 3 shows how the network of anti-mask attitudes was linked to other variables. For this network the coefficient of stability was.93 for edge weights, suggesting that the estimation of these values was stable (reliable). The actual values of the edge weights and their significance levels appear in S1 Appendix. For the network in Fig 3 , centrality indices were not computed because they were not relevant to the aims of this analysis, which was to determine how the network of anti-mask attitudes was linked to other variables. The Fig shows that the network of anti-mask attitudes was linked to the other variables by means of the two most important nodes in the anti-mask network-PR and beliefs that masks are ineffective. Beliefs that masks are ineffective was also linked to the nodes comprising the COVID Disregard Syndrome, and to COVID-19 anti-vaccination attitudes. PR was linked to the COVID Disregard Syndrome and to political conservatism. PR was significantly correlated with political conservatism for samples from both the US ( r = .36, p < .001) and Canada ( r = .28, p < .001), with no significant difference between the two at the α level of.01 ( z = 1.98, p>.04).

Discussion

People who object to wearing masks are a small but highly vocal minority of individuals. The media attention that they have drawn may have given the misleading impression that the anti-mask sentiment is widespread. However, our findings, just like the findings from opinion surveys [ 6, 14- 17] show that the majority of people are willing to follow the advice of health authorities about wearing masks. Refusal to wear masks is associated with a range of anti-mask attitudes, at the center of which are PR and beliefs that masks are ineffective. The core reasons identified in the present study are remarkably similar to the reasons voiced in 1919 by the Anti-Mask League; that is, respondents in 2020, just like those in 1919, believed that masks were ineffective and violated their civil liberties. Fig 2 shows that the network of anti-mask attitudes is linked, via its central nodes (mask-related PR and beliefs that masks are ineffective), to other variables such disregard for social distancing and anti-vaccination attitudes. These findings underscore the importance of mask-related PR and beliefs that masks are ineffective.

A critical question for psychologists and those involved in public health messaging is, "What is the best way of encouraging people with anti-mask attitudes to wear masks?" It is important to consider the motivational roots of mask refusal. If a person refuses to wear a mask simply because he or she believes them to be ineffective, then it might be that targeted education may be sufficient. However, given that the belief that masks are ineffective is strongly correlated with mask-related PR ( r = .66, p < .001; see S1 Appendix), this approach may be insufficient in many or perhaps most other cases. People who believe masks are ineffective also tend to have high levels of PR. If one tries to persuade a person with high PR that masks are effective, this will elicit reactance in which that person generates further arguments against the effectiveness of masks. The same applies to other reasons for mask refusal (e.g., the belief that masks make people look suspicious). Attempts to counter the majority of reasons for mask refusal will also elicit reactance because mask-related PR lies at the heart of the network of anti-mask attitudes.

PR is strongly correlated ( r = .51) with psychopathic personality traits such as a tendency toward angry, impulsive behavior [ 46]. Accordingly, confronting people who refuse to wear masks could be hazardous. Indeed, there have been media reports of people reacting violently when confronted about not wearing masks. For example, on public transit or in stores in which mask wearing is mandatory, people who refuse to wear masks have verbally and physically assaulted people who have asked them to don a mask [ 62, 63]. Accordingly, the US Centers for Disease Control and Prevention has recommended against confronting non-mask-wearers [ 64].

Alternative strategies are required, particularly persuasion strategies that address PR. Targeting PR is important because reactance lies at the heart of anti-mask attitudes. If the links in Fig 1 have any causal status, then reducing PR should lead to a reduction in other anti-masks attitudes. Researchers in the field of mass communication have suggested several strategies for improving the persuasiveness of messages in situations in which PR might occur. Indirect or subtle types of messaging-known as "nudges" in behavioral economics [ 65]-could be used. A nudge is something that alters a person's behavior in a predictable way without forbidding any options or significantly changing their economic incentives. Mask-related nudges could consist of handing out free masks at the entrances to store or displaying brightly colored posters of happy cartoon characters wearing masks. It is unclear whether such nudges are effective when PR plays a role in mask refusal.

Other forms of messaging have been proposed as ways of specifically dealing with PR. A review of the research literature on mass communication [ 49] concluded that several messaging strategies could circumvent PR. These strategies could be adapted for mask-related PR, as follows:

1. Add postscripts to messages that emphasize freedom of choice (e.g., "Please do your part in managing the pandemic by wearing a mask. The choice is yours."). The postscript is intended to ameliorate PR.

2. Narratives that highlight personal choice (e.g., personal stories about why people who were initially reluctant to wear masks eventually chose to wear masks).

3. Messaging that emphasizes how an individual's choices impact others (e.g., "Choosing to wear a mask shows that you care about your community").

4. Messages that on the surface address one audience but are really targeted at a different audience who may be listening (e.g., "Thank you for choosing to wear masks. Wearing a mask might seem to be a small thing to it, but it is vitally important").

5. Messages that forewarn receivers about the potential of them experiencing reactance (e.g., "Some people think they're giving up freedom by wearing a mask. But that's not true. Wearing a mask is a way of freeing ourselves from the pandemic").

6. Using reactance to strengthen the message (e.g., "You have a right to wear a mask to stay safe. Don't let anyone take away your right"). This message could help mask-refusers to realize that wearing a mask is a right that they can choose to adopt.

No single type of message is effective under all circumstances, and pilot testing is required before messages are implemented in mass communication programs in order that they be fine-tuned and to avert any unintended adverse effects of messaging [ 2]. The efficacy of the above-mentioned messaging strategies for improving mask adherence largely remain to be investigated for improving mask adherence, although recent research supports the idea that emphasizing the importance of mask wearing for one's community (i.e., an appeal to altruism) can improve adherence to mask wearing [ 50].

Additional messaging strategies also merit investigation. The present study found that mask refusal was associated with affectively-toned reasons for not wearing masks (e.g., beliefs that masks are ugly or make people look silly) ( Table 1 ). Efforts at encouraging people to focus on the logical safety reasons for wearing masks may help people set aside their emotional or esthetic concerns about masks. Recent research supports this possibility, in which the intention to wear masks was facilitated by encouraging people to focus on the logical reasons rather than on their emotions [ 51].

The present study has various strengths and limitations. In terms of strengths, the sample was large and the present study was, to our knowledge, the first to use network analysis to understand the interrelationships among anti-mask attitudes and their relationships to other variables that have been shown to influence attitudes and behavior in the context of pandemics. A further strength of the present study was that, compared to previous surveys, the present study examined a larger number of different types of anti-mask attitudes as they related to mask wearing and other variables. A limitation is that not all possible anti-mask attitudes were assessed. Future research is needed to investigate anti-masks attitudes that were not investigated in the present study. For example, the present study did not assess the belief that mask wearing is a sign of weakness, which was an attitude voiced in an Ohio anti-mask rally [ 66] and identified as a reason for not wearing masks in research published after the present study had been completed [ 50]. The replicability of the findings across different countries and cultures also remains to be investigated in future research. A further limitation is that network analysis, as a statistical modeling method, is insufficient for determining the causal nature of the relationships between nodes. Nevertheless, the present findings provide a strong rationale for conducting future experimental studies on the causal status of mask-related PR and beliefs that masks are ineffective. The present study also underscores the importance of conducting future research to investigate the efficacy of messaging strategies that take PR into consideration as a means of addressing the problem of mask non-adherence.

Supporting information

S1 Appendix
Mask attitudes study.
(DOCX)

Acknowledgments

The authors thank Michelle M. Paluszek, Caeleigh A. Landry, and Geoffrey S. Rachor for their assistance in completing this study.

Funding Statement

This research was funded to G.J.G.A. and S.T. by the Canadian Institutes of Health Research (#439751) ( https://cihr-irsc.gc.ca/e/193.html) and to G.J.G.A. from the University of Regina ( https://www.uregina.ca/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References

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49. Staunton TV, Alvaro EM, Rosenberg BD. A case for directives: Strategies for enhancing clarity while mitigating reactance. Curr Psychol. 2020: 10.1007/s12144-019-00588-0 [[ CrossRef] Google Scholar]

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Articles from PLOS ONE are provided here courtesy of PLOS

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Negative attitudes about facemasks during the COVID-19 pandemic: The dual importance of perceived ineffectiveness and psychological reactance

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This study reports a comprehensive empirical investigation of the nature and correlates of anti-mask attitudes during the COVID-19 pandemic. Accumulating evidence underscores the importance of facemasks, as worn by the general public, in limiting the ...

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COVID is still crushing parts of the U.S. as the holiday season approaches

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The U.S. is entering an uneasy stretch of the pandemic. Despite progress, the delta surge is dragging on in certain regions. Can vaccines ward off a big surge over the holidays?

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Provides COVID-19 data comparisons that predict on-going infection and mortality trends across national, state and county-levels throughout the United States.

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In March, as claims about the dangers and ineffectiveness of coronavirus vaccines spun across social media and undermined attempts to stop the spread of the virus, some Facebook employees thought they had found a way to help.

By altering how posts about vaccines are ranked in people's newsfeeds, researchers at the company realized they could curtail the misleading information individuals saw about COVID-19 vaccines and offer users posts from legitimate sources like the World Health Organization.

"Given these results, I'm assuming we're hoping to launch ASAP," one Facebook employee wrote, responding to the internal memo about the study.

Instead, Facebook shelved some suggestions from the study. Other changes weren't made until April.

When another Facebook researcher suggested disabling comments on vaccine posts in March until the platform could do a better job of tackling anti-vaccine messages lurking in them, that proposal was ignored.

Critics say the reason Facebook was slow to take action on the ideas is simple: The tech giant worried it might impact the company's profits.

"Why would you not remove comments? Because engagement is the only thing that matters," said Imran Ahmed, the CEO of the Center for Countering Digital Hate, an internet watchdog group. "It drives attention and attention equals eyeballs and eyeballs equal ad revenue."

In an emailed statement, Facebook said it has made "considerable progress" this year with downgrading vaccine misinformation in users' feeds.

Facebook's internal discussions were revealed in disclosures made to the Securities and Exchange Commission and provided to Congress in redacted form by former Facebook employee-turned-whistleblower Frances Haugen's legal counsel. The redacted versions received by Congress were obtained by a consortium of news organizations, including The Associated Press.

The trove of documents shows that in the midst of the COVID-19 pandemic, Facebook carefully investigated how its platforms spread misinformation about life-saving vaccines. They also reveal rank-and-file employees regularly suggested solutions for countering anti-vaccine content on the site, to no avail. The Wall Street Journal reported on some of Facebook's efforts to deal with anti-vaccine comments last month.

Facebook's response raises questions about whether the company prioritized controversy and division over the health of its users.

"These people are selling fear and outrage," said Roger McNamee, a Silicon Valley venture capitalist and early investor in Facebook who is now a vocal critic. "It is not a fluke. It is a business model."

Typically, Facebook ranks posts by engagement - the total number of likes, dislikes, comments, and reshares. That ranking scheme may work well for innocuous subjects like recipes, dog photos, or the latest viral singalong. But Facebook's own documents show that when it comes to divisive public health issues like vaccines, engagement-based ranking only emphasizes polarization, disagreement, and doubt.

To study ways to reduce vaccine misinformation, Facebook researchers changed how posts are ranked for more than 6,000 users in the U.S., Mexico, Brazil, and the Philippines. Instead of seeing posts about vaccines that were chosen based on their popularity, these users saw posts selected for their trustworthiness.

The results were striking: a nearly 12% decrease in content that made claims debunked by fact-checkers and an 8% increase in content from authoritative public health organizations such as the WHO or U.S. Centers for Disease Control. Those users also had a 7% decrease in negative interactions on the site.

Employees at the company reacted to the study with exuberance, according to internal exchanges included in the whistleblower's documents.

"Is there any reason we wouldn't do this?" one Facebook employee wrote in response to an internal memo outlining how the platform could rein in anti-vaccine content.

Facebook said it did implement many of the study's findings - but not for another month, a delay that came at a pivotal stage of the global vaccine rollout.

In a statement, company spokeswoman Dani Lever said the internal documents "don't represent the considerable progress we have made since that time in promoting reliable information about COVID-19 and expanding our policies to remove more harmful COVID and vaccine misinformation."

The company also said it took time to consider and implement the changes.

Yet the need to act urgently couldn't have been clearer: At that time, states across the U.S. were rolling out vaccines to their most vulnerable - the elderly and sick. And public health officials were worried. Only 10% of the population had received their first dose of a COVID-19 vaccine. And a third of Americans were thinking about skipping the shot entirely, according to a poll from The Associated Press-NORC Center for Public Affairs Research.

Despite this, Facebook employees acknowledged they had "no idea" just how bad anti-vaccine sentiment was in the comments sections on Facebook posts. But company research in February found that as much as 60% of the comments on vaccine posts were anti-vaccine or vaccine reluctant.

"That's a huge problem and we need to fix it," the presentation on March 9 read.

Even worse, company employees admitted they didn't have a handle on catching those comments. And if they did, Facebook didn't have a policy in place to take the comments down. The free-for-all was allowing users to swarm vaccine posts from news outlets or humanitarian organizations with negative comments about vaccines.

"Our ability to detect (vaccine hesitancy) in comments is bad in English - and basically non-existent elsewhere," another internal memo posted on March 2 said.

Los Angeles resident Derek Beres, an author and fitness instructor, sees anti-vaccine content thrive in the comments every time he promotes immunizations on his accounts on Instagram, which is owned by Facebook. Last year, Beres began hosting a podcast with friends after they noticed conspiracy theories about COVID-19 and vaccines were swirling on the social media feeds of popular health and wellness influencers.

Earlier this year, when Beres posted a picture of himself receiving the COVID-19 shot, some on social media told him he would likely drop dead in six months' time.

"The comments section is a dumpster fire for so many people," Beres said.

Anti-vaccine comments on Facebook grew so bad that even as prominent public health agencies like UNICEF and the World Health Organization were urging people to take the vaccine, the organizations refused to use free advertising that Facebook had given them to promote inoculation, according to the documents.

Some Facebook employees had an idea. While the company worked to hammer out a plan to curb all the anti-vaccine sentiment in the comments, why not disable commenting on posts altogether?

"Very interested in your proposal to remove ALL in-line comments for vaccine posts as a stopgap solution until we can sufficiently detect vaccine hesitancy in comments to refine our removal," one Facebook employee wrote on March 2.

The suggestion went nowhere.

Instead, Facebook CEO Mark Zuckerberg announced on March 15 that the company would start labeling posts about vaccines that described them as safe.

The move allowed Facebook to continue to get high engagement - and ultimately profit - off anti-vaccine comments, said Ahmed of the Center for Countering Digital Hate.

"They were trying to find ways to not reduce engagement but at the same time make it look like they were trying to make some moves toward cleaning up the problems that they caused," he said.

It's unrealistic to expect a multi-billion-dollar company like Facebook to voluntarily change a system that has proven to be so lucrative, said Dan Brahmy, CEO of Cyabra, an Israeli tech firm that analyzes social media networks and disinformation. Brahmy said government regulations may be the only thing that could force Facebook to act.

"The reason they didn't do it is because they didn't have to," Brahmy said. "If it hurts the bottom line, it's undoable."

Bipartisan legislation in the U.S. Senate would require social media platforms to give users the option of turning off algorithms tech companies use to organize individuals' newsfeeds.

Sen. John Thune, R-South Dakota, a sponsor of the bill, asked Facebook whistleblower Haugen to describe the dangers of engagement-based ranking during her testimony before Congress earlier this month.

She said there are other ways of ranking content - for instance, by the quality of the source, or chronologically - that would serve users better. The reason Facebook won't consider them, she said, is that they would reduce engagement.

"Facebook knows that when they pick out the content ... we spend more time on their platform, they make more money," Haugen said.

Haugen's leaked documents also reveal that a relatively small number of Facebook's anti-vaccine users are rewarded with big pageviews under the tech platform's current ranking system.

Internal Facebook research presented on March 24 warned that most of the "problematic vaccine content" was coming from a handful of areas on the platform. In Facebook communities where vaccine distrust was highest, the report pegged 50% of anti-vaccine pageviews on just 111 - or .016% - of Facebook accounts.

"Top producers are mostly users serially posting (vaccine hesitancy) content to feed," the research found.

On that same day, the Center for Countering Digital Hate published an analysis of social media posts that estimated just a dozen Facebook users were responsible for 73% of anti-vaccine posts on the site between February and March. It was a study that Facebook's leaders in August told the public was "faulty," despite the internal research published months before that confirmed a small number of accounts drive anti-vaccine sentiment.

Earlier this month, an AP-NORC poll found that most Americans blame social media companies, like Facebook, and their users for misinformation.

But Ahmed said Facebook shouldn't just shoulder blame for that problem. "Facebook has taken decisions which have led to people receiving misinformation which caused them to die," Ahmed said. "At this point, there should be a murder investigation."
Seitz reported from Columbus, Ohio.

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Documents Show Facebook Froze As Anti-Vaccine Comments Gained Momentum

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In March, as claims about the dangers and ineffectiveness of coronavirus vaccines spun across social media and undermined attempts to stop the spread of the virus, some Facebook employees thought they had found a way to help.

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"Surveying victim service professionals offers a unique frontline perspective of the impact this pandemic has had on firearm violence or abuse and allows for the opportunity to examine the critical issue of safety planning surrounding firearms during a time of particular risk for victims who might be isolated at home with an abuser with direct access to firearms," Lynch said.

Lynch collaborated on the study with TK Logan, a professor in the Center for Research on Drugs and Alcohol at the University of Kentucky's Department of Behavioral Science. Their report, titled "Always Know Where the Gun Is: Service Providers Perceptions of Firearm Access, Violence, and Safety Planning During the COVID-19 Pandemic," was published in the Journal of Interpersonal Violence.

The researchers focused on the increased firearm accessibility of abusers during the pandemic and increased risk for firearm abuse/violence.

The study documented the impact of the pandemic on firearm access and violence as well as the advice given through the perspective of victim service providers across the U.S. about safety planning surrounding firearms and firearm-related abuse tactics.

The data included responses from victim-service professionals from both rural and urban/suburban areas who worked with victims of gender-based violence.

Gender-based violence is a general term used to refer to any type of violence between genders based on unequal power relationships. Gender-based violence can impact anyone, and can include intimate partner and family violence, elder abuse, sexual violence, stalking and human trafficking.

The research team also addressed the fact that procedures, such as shelter-in-place and school closures, which are designed to help protect the community from the spread of COVID-19, further isolate victims and hinder the help-seeking process.

"There is great value in examining patterns of official crime records over the course of the pandemic," Lynch explained, "but official data capture only a fraction of the issue of violence and abuse occurring among victims who are isolated at home with their abusers."

The researchers also studied firearm access related to gender-based violence during this time of uncertainty and unrest. The U.S. observed a "boom" in firearm sales in the early stages of the pandemic and records show the FBI performed nearly 40 million background checks on firearm sales in 2020 -an increase of more than 10 million compared to the number of background checks in 2019, and a record high for the country.

"Moving forward, it is important to keep in mind the potential impact of increased firearm sales and/or stockpiles in firearm supplies during the pandemic," Lynch said. "About one in five participants reported that threatening to shoot others in public increased during the pandemic."

The researchers also addressed the common themes related to safety planning with firearms. The themes included advising the victim to contact the system for help, assessing the location of firearms, and removing the firearms or ammunition.

"It is critical to recognize the overlap of domestic abuse and gun violence and do a better job of assessing and managing these threats to mitigate the potential risk of devastating homicides," Lynch said.

The researchers concluded that the results offer an initial exploratory investigation on the increase in violence that can be built upon with future work. Ideally, a longitudinal study could examine if and how firearm-related issues change as the pandemic continues and society moves toward whatever the new normal will look like.

"The results stress the importance of ensuring that firearms are included in safety planning and risk assessment, while also highlighting the need for evidence-based information about best strategies in cases where an abuser has access to a firearm," Lynch concluded.

UTSA is an urban serving research university that is committed to tackling society's grand challenges. Its academic and research specialties include health, cybersecurity, fundamental futures and social-economic transformation.

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Criminology professor addresses impact of COVID on firearm-related abuse

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"Surveying victim service professionals offers a unique frontline perspective of the impact this pandemic has had on firearm violence or abuse and allows for the opportunity to examine the critical issue of safety planning surrounding firearms during a time of particular risk for victims who might be isolated at home with an abuser with direct access to firearms," Lynch said.

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HLRP: Health Literacy Research and Practice

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Introduction

Increasingly, scientists are encouraged to translate scientific concepts and research findings into plain language for the lay public and people without a scientific research background. This trend is particularly prominent in medical research, reflecting a growing focus on patient-centeredness and on the ethical responsibility to report findings to the public ( European Commission, 2014; World Medical Association, 2013). The call for user-friendly presentations of research findings is also pragmatic: to put evidence into practice, health professionals as well as the public need to understand key messages of research findings ( Buljan et al., 2018).

Evidence summaries can help communicate key messages effectively and efficiently to readers ( Alderdice et al., 2016). However, scientists struggle to communicate research concepts and findings in accessible ways ( Gagliardi et al., 2016; Kurtzman & Greene, 2016; Maguire & Clarke, 2014). A plain language summary of a research study is a concise synthesis of the study written in a way that the lay public would understand ( Whiting et al., 2018). Best practices for summarizing research in plain language include reducing jargon and defining technical terms; using short sentences and unifying points within a paragraph; testing with intended audiences for intended comprehension; and asssessing reading level, usually via a metric that considers the number of syllables per word and number of words per sentence ( Centers for Disease Control and Prevention, 2015; Centers for Medicare & Medicaid Services, 2012; Office of Disease Prevention and Health Promotion, 2016).

Biomedical journals increasingly have committed to presenting findings for lay audiences. For example, PLOS Medicine author summaries feature short statements for non-expert readers about why the study was done, what the researchers did and found, and what the findings mean ( PLOS Medicine, 2019). Other journals capture and highlight specific information in accessible formats. The British Medical Journal, for example, includes a summary box providing a "thumbnail sketch" of what an article adds to the literature ( BMJ, 2019). In addition, perhaps the most well-studied plain language summaries are from the Cochrane Collaboration's systematic reviews ( Alderdice et al., 2016, Buljan et al., 2018; Maguire & Clarke, 2014; Whiting et al., 2018). These short summaries present findings from systematic reviews of 40 or more pages on a wide range of clinical topics. The format of Cochrane's plain language summary has evolved over time with the goals of improving clarity and usefulness for the public, for example by adding information about the benefits and harms of interventions and the quality or strength of evidence ( Santesso et al., 2015).

Over the past several years, the Patient-Centered Outcomes Research Institute (PCORI) has undertaken a substantial new effort to translate research findings into plain language summaries for the lay public. PCORI's effort derives from its commitment to transparency-the presentation of all results, regardless of the outcome of the study-and from its charge to make findings available in a manner that is comprehensible and useful in informing health care decisions. Although some aspects of PCORI's plain language summaries are specific to the organization's mission and mandate, many elements of the summary translation and publication process may be useful to health communication professionals and other organizations or publishers contemplating similar efforts to make scientific research results more accessible. To inform these efforts, this article summarizes lessoned learned from PCORI's efforts to develop plain language summaries.

Overview of PCORI and its Public Reporting Efforts

Authorized by the United States Congress in 2010, PCORI is an independent, nongovernmental organization that funds research to help patients and those who care for them-along with clinicians, purchasers, and policy makers-make better-informed decisions about the health care choices they face. PCORI funds patient-centered comparative effectiveness research on a wide range of topics, requiring that researchers engage patients and other health care stakeholders throughout the research process to better enable studies to address their concerns ( Patient-Centered Outcomes Research Institute, 2017).

PCORI's authorizing legislation requires that the institute make research findings available to the public quickly and in a way that is useful to patients, clinicians, and the public. In addition, these materials must discuss considerations specific to certain subpopulations, risk factors, and comorbidities; describe research limitations; and identify what future research may be needed, as appropriate ( Patient Protection and Affordable Care Act, 2010).

To fulfill this statutory mandate, PCORI's Board of Governors adopted a process for releasing research findings. Within 90 days of PCORI's mandated peer review of study findings and formal acceptance of the final research report ( Broitman et al., 2019), PCORI posts two summaries of the study's results to its website: one for patients and the public, with readability at a sixth to eighth grade level, and one for professionals. The summaries are kept short to promote readability and to ensure that they will not include so much detail as to interfere with publication opportunities. All summaries must be tested for comprehensibility with intended audiences. After 1 year, PCORI posts the entire final research report on its website.

Implementation

PCORI's translation efforts are supported by its PCOR Translation Center (hereafter, the Translation Center). Building on best practices for plain language, the Translation Center developed an approach for creating plain language summaries of all completed research studies, in satisfaction of PCORI's legislative requirements. This approach included: developing, testing, and finalizing a template for the plain language summaries; establishing a workflow that is efficient, incorporates all required expertise, and accords with all legislative requirements; and implementing the translation process and modifying based on lessons learned.

Template Development

A main initial challenge for translation of PCORI's research findings was to provide a consistent approach for presenting individual comparative effectiveness research studies that have different designs, focus on different health care topics, and employ different research methods. Applying best practices for plain language and building on previous research exploring the public's views on medical evidence ( Carman et al., 2010, 2016), we developed templates that identified what information should be included in summaries and how it should be presented. To engage readers in the content, templates use a question-and-answer format, with sections on the rationale, methods, results, limitations, and how the research will help inform decisions. The template headings refer to high-level elements that are common across individual studies, using wording general enough to apply across content areas.

We tested the templates with their intended audiences-primarily members of the public (called consumers for the purposes of this article), but also clinicians and others who would be in a position to use plain language summaries in their work with patients and others. After receiving Institutional Review Board approval from the American Institutes for Research, we conducted six focus groups in English and Spanish with 52 consumers representing three geographic regions and a range of race, ethnicity, age, gender, and educational attainment ( Table 1). We also conducted 1-hour phone interviews with 10 doctors and 2 nurse practitioners, and 15 stakeholders representing 3 patient and consumer advocacy organizations, 4 professional societies, 2 health systems, and 2 payer and employer organizations. In addition, four members of the PCORI Board of Governors participated in the interviews.

Characteristic

Location (N = 52)

NC (n = 18)

MD (n = 16)

CA (n = 18)a

(%)

Using a purposeful sampling approach, we used market research firms to recruit consumers and clinicians. For consumer focus groups, the firms recruited adults who represented diversity in gender, race, and ethnicity and who had obtained an educational level of some college or less. Consumers were excluded if they worked in a clinical setting or took part in a research study in the past 6 months. For clinician interviews, the firm recruited practicing clinicians from specialties relevant to PCORI research (i.e., primary care, oncology, cardiology, neurology, psychiatry). For stakeholder interviews, we worked with PCORI's Engagement Department to create a list of 29 PCORI stakeholders who had previously partnered with PCORI and had used, or were likely to use, the summaries posted on PCORI's website and conducted interviews with those who responded and agreed to participate.

Interviews and focus groups concentrated on what information participants expected or wanted to know about research findings from a specific single study, information sources for research, and participants' overall reactions to the proposed formats. During the interviews and focus groups, moderators and interviewers who had experience in qualitative research and cognitive testing used semi-structured interview protocols. Opening questions focused on what information participants expected or wanted to know about research findings from specific single study. Then, we presented an example summary using the template and asked participants about their overall reactions, feedback on the wording and order of the headings, and the usefulness of the information. We used two existing PCORI projects as examples to assess whether problems arose from the content of the research study or the template itself and changed the order in which the example projects were presented by group or interview. Participants were compensated for their time.

We audio-recorded and had all focus groups and interviews professionally transcribed. A certified Spanish language transcriptionist translated and transcribed recordings into English for analysis. We uploaded transcripts into the NVivo 11.0 qualitative research software (QSR International) for review and coding. A team of four analysts read and applied a priori codes based on the main topic areas of the interview protocol (e.g., expectations, reactions to headings, usefulness of information). One analyst coded and summarized findings for each audience: English-speaking consumers, Spanish-speaking consumers, clinicians, and stakeholders. Then, the lead researcher (M.M.) and team of analysts summarized findings across audiences and made recommendations for revising the templates. The four analysts met weekly to discuss reactions and emerging ideas and ensured codes were applied consistently.

A Technical Expert Panel also provided input on the templates. Its 15 members included patients, practicing clinicians, and experts in health communication, health literacy, and evidence review.

Developing a Workflow

Drawing on Lean Six Sigma quality and process improvement tools, we developed work processes to efficiently manage and organize the workflow for activities and reviews from the beginning to end of plain language translation. The processes account for the volume of production, the expertise required for each abstract, and the timing of all steps in the process, highlighting places where flexibility in timing can be accommodated. Over the course of the project, the translation process has been modified to improve efficiency while maintaining quality. Below, we describe the current process.

Writers develop the summary based on a draft report submitted to peer review with input from health communication and subject matter experts. Communication experts work closely with writers to identify key messages from the report and translate these into plain language. Subject matter experts assess scientific accuracy and ensure that the translations maintain fidelity to the report. Then, the summaries undergo cognitive testing with four to six individuals drawn from a pool of panelists who provide feedback on the overall clarity and quality of each section and reactions to specific content related to medical or methodology terms that may be unfamiliar, such as cardiac tamponade, transforming variables, or sleep impairment. Currently the panel includes about 175 individuals, including patients, caregivers, clinicians, researchers, and representatives of advocacy organizations, health systems, and payers. Panelists are compensated for their review. An analyst summarizes the findings from testing to highlight areas requiring revision.

Once PCORI's peer review team accepts the awardee's research report as final, the writer revises the summary based on any changes made in response to peer review comments, and also incorporates feedback from the testing. Then, PCORI's Program Officer and the Principal Investigator review for accuracy. Final summaries undergo copy-edit and approval before being posted on PCORI's website within the 90-day period.

Finally, the Translation Center produces an audio file of the English summary and a Spanish version of the summary available for download as a PDF file. Audio recording experts review the summaries and suggest edits to make the summaries more comprehensible when read out loud in English. Then a voice-over professional records the summaries. For Spanish translations, a certified translator translates the abstract from English to Spanish. A native speaker then reviews the translation for accuracy and plain language; the translator and native speaker then meet to resolve discrepancies.

Length of Time for Implementation

Between February 2017 and March 2020, we completed 272 plain language summaries of PCORI-funded studies, covering topics including cardiovascular disease, obesity, cancer, mental health, asthma, HIV/AIDS, and comparative effectiveness research methods.

Final Template

Final template designs for plain language summaries reflect input from the technical expert panel and from testing. The final template consists of six sections that provide context for the research, report the results, and describe the study:

What was the research about?

What were the results?

Who was in the study?

What did the research team do?

What were the limits of the study?

How can people use the results?

Below, we summarize findings from audience testing that influenced decisions made for the content and organization of the final plain language template. Overall, reactions to the template were consistent across testing participant type.

Heading wording and order. Participants confirmed that the question-and-answer format was straightforward and easy to understand. The headings were "precise and to the point," answering questions that people wanted to know. A clinician commented, "They're focusing on what's most important to patients." When testing alternate wording of templates, most consumer participants indicated a preference for simple wording, for example preferring "What were the results" to "What did the research team learn."

In contrast to the order of a traditional research abstract, the template emphasizes results before methods. Consumer participants preferred to read the results and conclusions drawn from the study right away-before deciding to read other information, like the study's methods.

Establishing relevance. Consumer participants wanted to be able to evaluate easily whether the study and its results were of interest and applied to them personally. In response to these preferences, we include in the summary title, whenever possible, details about the health condition, interventions, outcomes assessed, and relevant demographics of study participants. Summary text also includes race, ethnicity, age, gender, geographic location, and other participant demographic characteristics.

Conveying impartiality and limitations. Consumer participants wanted to know if the funder or investigators had a vested interest in the outcomes. As one put it, it is important to know if the research studies are "independent research versus [the] Lipton Tea Company that conducted it to tell you that coffee was bad for you." We highlight patients' and patient organizations' participation on the research team in the "what did the research team do" section to emphasize their interest in the study, and to allay concerns about motivations for study design. As one participant said, "I think you've got to play up that this wasn't some researcher in a white lab coat in some ivory tower who's decided this." PCORI also discloses researchers' conflicts of interest on the summary webpage.

Consumers appreciated that the summary included a limitations section, describing it as "honest." As one consumer summarized, "Transparency. It's a synonym of honesty. They don't just tell you about the good things [translated from Spanish]."

Implementation Lessons Learned

The experience gained through writing these summaries brought to light additional lessons learned that may be relevant for those producing plain language summaries.

Supporting consistency across individual summaries. To support consistency in preparing individual summaries and to assure that each summary meets the mandated requirements for PCORI summaries, such as length and grade level, the Translation Center developed guidance for writers and reviewers. This guidance included the content to include in each section of the template, how to present specific concepts, and how to address new issues as they emerge. The Translation Center also created and continues to update a common lexicon for terms related to health (e.g., specific health conditions), interventions (e.g., decision aids, community health workers), methods (e.g., randomization), and study-related situations or limitations (e.g., implications of different study designs, generalizability).

Prioritizing content. Given the word limits PCORI prescribes for its summaries, writers learned to prioritize what content to include while still telling a coherent story. Summaries usually report only on the study's comparative aim and prioritize results, details about the interventions, participant demographics, future research needs, and limitations. Information to provide context is also important but must be conveyed in one or two sentences.

Although best practices for plain language health materials suggest specifying an action for a reader to take, writers must be cautious about using any language that would recommend treatments or a course of action from a single study. Ultimately, clinical decisions need to be considered within the limitations of the study and the larger body of evidence around a topic, as well as patients' values and preferences.

Balancing plain language and precision. The plain language summaries for completed projects have an average reading level of 8.1, with a range of 6.8 to 8.5, using the Flesch-Kincaid assessment tool in Microsoft Word. A challenge in writing plain language summaries is to avoid oversimplifying terms or concepts, which can lead to content that is misleading or inaccurate, or that obscures what happened during research. For this reason, summaries may include technical terms, even though they can increase reading level. A technical term may be acceptable, for example, if health care providers often use it and patients are familiar with it. In these cases, we define the technical term on first use. For example, chemotherapy is defined on first use but then used throughout a summary to distinguish it from other types of cancer treatment.

Results

This section describes findings from audience testing that influenced template development as well as other lessons learned from implementation.

Implications

Publishers, health research funders, and researchers themselves have demonstrated an increasing commitment to making available plain language summaries of research studies that are readily understandable by patients, caregivers, and other stakeholders. Making research results accessible has the potential to help patients and the lay public understand the role of research in health care and improves transparency and accountability.

Although the goal is simple, the process of creating plain language summaries is not. Writing in plain language requires a specific skillset that scientists may or may not have. Further, scientists may be too close to their topic to write a concise summary ( Denegri & Faure, 2013). Consistency of summaries across different studies or systematic reviews may also be a challenge. For example, none of the Cochrane plain language summaries, as written by the authors of the systematic reviews, adhered to the Cochrane's standards ( Jelicic Kadic et al., 2016); they varied in structure, length, details included, and use of jargon. Employing independent writers, as PCORI does, may help improve readability and consistency of plain language summaries ( Kirkpatrick et al., 2017).

Producing consistent plain language summaries requires a commitment of resources. PCORI's investment has included developing a standard approach for all funded research projects and includes resources for writing, reviewing, developing audio files, and translation into Spanish plus project management and quality control. Costs per summary have decreased over time as standard language for common terms and situations have been developed.

PCORI's commitment to plain language presentation of research findings stems from the high priority the organization places on transparency in service to-and as part of its responsibility to-patients and the public. An equivalent level of investment may not be possible for all organizations; publishers and research funders will need to weigh the benefits of readability and consistency with the expense ( Denegri & Faure, 2013). To the extent that other organizations can leverage PCORI's investments, we may be able to improve the feasibility of plain language translation of research findings going forward.

A range of resources, including frameworks and descriptions of best practices, currently informs the translation of findings from health care research into language accessible to patients and others. However, further research could support improvements in this field. For example, research could investigate how different audiences read and use plain language summaries for single studies and whether alternate formats or displays, such as infographics, can effectively convey study information. Google analytics on PCORI's posted summaries-nearly 29,000 views in the final quarter of 2019-demonstrate interest; studies could also document the ways in which actual and intended audiences use these summaries.

Ultimately, creating a structure and process for research summary development requires balancing precision with simplicity, completeness with brevity, and what the research team knows to be true with what the audience finds important to know. PCORI's transparency efforts reflects the complexity of producing clear summaries and the evolving understanding by researchers, funders, and publishers of how best to meet public needs.

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Lessons Learned from Developing Plain Language Summaries of Research Studies | HLRP: Health Literacy Research and Practice

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Increasingly, scientists are encouraged to translate scientific concepts and research findings into plain language for the lay public and people without a scientific research background. This trend is particularly prominent in medical research, reflecting a growing focus on patient-centeredness and on the ethical responsibility to report findings to the public ( European Commission, 2014; World Medical Association, 2013).

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA)

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Highlights

*

SARS-CoV-2 is the retrovirus responsible for the COVID-19.

*

Virions can spread to various organs including the reproductive system.

*

Infection has potential to disrupt ANG-II/AT ₁ R axis and redox/cytokine homeostasis.

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Orchitis, low sperm quality, and oligozoospermia are reported in some cases.

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Miscarriage, preterm delivery, and prolonged cycle are evident in SARS-CoV-2 infected women.

Abstract

COVID-19 is the ongoing health emergency affecting individuals of all ages around the globe. Initially, the infection was reported to affect pulmonary structures. However, recent studies have delineated the impacts of COVID-19 on the reproductive system of both men and women. Hence, the present review aims to shed light on the distribution of SARS-CoV-2 entry factors in various reproductive organs. In addition, impacts of COVID-19 mediators like disrupted renin angiotensin system, oxidative stress, cytokine storm, fever, and the mental stress on reproductive physiology have also been discussed. For the present study, various keywords were used to search literature on PubMed, ScienceDirect, and Google Scholar databases. Articles were screened for relevancy and were studied in detail for qualitative synthesis of the review. Through our literature review, we found a multitude of effects of COVID-19 mediators on reproductive systems. Studies reported expression of receptors like ACE-2, TMPRSS2, and CD147 in the testes, epididymis, prostrate, seminal vesicles, and ovarian follicles. These proteins are known to serve as major SARS-CoV-2 entry factors. The expression of lysosomal cathepsins (CTSB/CTSL) and/ neuropilin-1 (NRP-1) are also evident in the testes, epididymis, seminal vesicles, fallopian tube, cervix, and endometrium. The binding of viral spike protein with ACE-2 was found to alter the renin-angiotensin cascade, which could invite additional infertility problems. Furthermore, COVID-19 mediated cytokine storm, oxidative stress, and elevated body temperature could be detrimental to gametogenesis, steroidogenesis, and reproductive cycles in patients. Finally, social isolation, confinement, and job insecurities have fueled mental stress and frustration that might promote glucocorticoid-mediated subnormal sperm quality in men and higher risk of miscarriage in women. Hence, the influence of COVID-19 on the alteration of reproductive health and fertility is quite apparent.

View Abstract

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Understanding the cross-talk between mediators of infertility and COVID-19

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SARS-CoV-2 is the retrovirus responsible for the COVID-19. * Virions can spread to various organs including the reproductive system. * Infection has potential to disrupt ANG-II/AT 1 R axis and redox/cytokine homeostasis. * Orchitis, low sperm quality, and oligozoospermia are reported in some cases.

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During the long, divisive, and seemingly endless war against COVID-19, there was a constant whisper. Would our battle have been more successful if someone-anyone-had really been in charge?

The Centers for Disease Control and Prevention had its share of the skirmishes. Then there was the National Institutes of Health and the Food and Drug Administration. Most of the 50 states had governors speaking loudly, but out of very different megaphones. Then there was the public health apparatus, sometimes in state hands but mostly led by counties-except when municipalities took the lead.

As Brian Castrucci, head of the de Beaumont Foundation, put it, "If you believe in a 'U.S. public health system,' you probably also believe in unicorns because neither exists." That non-system imposed enormous costs on the American economy. Economists David M. Cutler and Lawrence H. Summers called COVID-19 the "$16 trillion virus," based on estimates of the amount the disease cost Americans in terms of premature deaths, other health issues, and lost gross domestic product. That's four times the impact of the Great Recession, the damages of 50 years of climate change, and twice the expenditures for all of the military actions in which America has fought since the September 11 terrorist attacks.

Surely, putting a single entity in charge would have saved us from this fate, it might seem. But as we've argued in our new report from the IBM Center for the Business of Government, Managing the Next Crisis: Twelve Principles for Dealing with Viral Uncertainty, that is a pipe dream. Given the vast complexity of the nation-and of the health authorities who try to keep its citizens safe-it would have been unwise to impose a one-size-fits-all strategy on regions as different as South Dakota's Black Hills and New York's Times Square. And given the political tensions woven throughout the COVID-19 response, it would have been impossible.

That's a frightening prospect. Another pandemic is inevitable at some point in our future. And a wrenching national crisis is certain, much sooner. Stanford economist Paul Romer famously said in 2002 that "a crisis is a terrible thing to waste." Without thinking carefully about the lessons we need to learn from COVID-19, as well as ensuring we don't try to do what can't or shouldn't be done, we're likely to fall right into Romer's trap.

What can-and should-the federal government do when faced with the viral uncertainty that comes with a crisis like COVID-19? Here are three steps to begin.

First, local governments will inevitably wage the front-line campaign against future crises, but the feds can-and must-play a crucial role in coordinating the national response. If there's anything we've learned, it's that no community can insulate itself from fast-spreading problems. A major crisis in any community can be a major threat to all.

The novel coronavirus taught us the hard way just how fast a pandemic can spread, whether in its initial outbreak or in the rampage of virus variants and how a problem anywhere can quickly become a problem everywhere. It's been a struggle to create a common interest to join Americans in pursuit of such a common enemy. We've learned that fighting any future crisis will require a robust role for national leaders to frame a shared vision to the problems at hand.

Second, the federal government can never run the national response, except in wartime, but it can play a central role in getting buy-in from the major players-in the public, private, and nonprofit sectors-and weaving together the pieces connecting them. There can't be coordination without a coordinator. There can't be a coordinator that tries to impose its will on everyone. A smart coordinator can play the most effective role by helping to define the way everyone looks at a problem and what roads are likely to be most successful. The kinds of networks we need are never self-creating or self-directing.

The twin efforts of Operation Warp Speed, to produce stunningly successful vaccines in record time, and the vaccine rollout, which put shots in the arms of more than half of all Americans in far less time than anyone imagined possible, provide great examples of how the feds can weave important pieces together. Even a devolved system needs someone at the tiller.

Third, this coordination requires creating a common language that can connect all the players. An enormous problem during the pandemic has been that there was no shared way of comparing "cases," "deaths," and other key issues in the campaign. Without the data collected and shared by the Johns Hopkins Coronavirus Resource Center, it would have been tremendously more complicated to have a national conversation about the virus.

Data is the key to understanding a problem well enough to develop a solution. Everyone involved in combating big problems needs to be able to communicate with each other, both to get a grasp on the problems and to share the strategies for crisis-fighting. The federal government doesn't need to force everyone into a common strategy, but without a national lead in establishing the common language, the country could find itself repeatedly stumbling into variations of the Tower of Babel.

There are many other takeaways that we can spin from our painful battle against COVID-19. But these three lessons could frame the federal response to the inevitable crises we'll face in the future. This is one crisis we can't afford to waste.
Correction: The initial version of this piece misspelled Brian Castrucci's name.

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Three Pandemic Lessons for the Next Crisis

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During the long, divisive, and seemingly endless war against COVID-19, there was a constant whisper. Would our battle have been more successful if someone-anyone-had really been in charge? The Centers for Disease Control and Prevention had its share of the skirmishes. Then there was the National Institutes of Health and the Food and Drug Administration.

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Equity in Health Data: COVID 19 as a Case Study

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'We Are Not Guinea Pigs': The Effects of Negative News on Vaccine Compliance

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In 1996, following an epidemic, Pfizer tested a new drug on 200 children in Muslim Nigeria. 11 children died and multiple were disabled. We study the effects of negative news on vaccine compliance using evidence from the 2000 disclosure of deaths of Muslim children in the Pfizer trials.

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In more specific there are three lessons we should understand from this coronavirus pandemic regarding public health:

Science does matter

The public needs to be educated

Public health should be always in the spotlight

In this episode, we are talking about these lessons and how we can take action with the knowledge we learn from this latest pandemic.

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Coronavirus - Three Lessons We Learn about Public Health

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In more specific there are three lessons we should understand from this coronavirus pandemic regarding public health: Science does matter The public needs to be educated Public health should be always in the spotlight In this episode, we are talking about these lessons and how we can take action with the knowledge we learn from this latest pandemic.

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With a theme of 'Stay Clean, Stay Strong' and a palette of soft colours, the four artworks are to help companies maintain good hygiene in and around the workplace. It comes after many workers return to their offices after a long period of homeworking due to the Covid-19 outbreak.

Each poster touches on a different workplace theme, echoing advice laid out by the Chinese government and the World Health Organisation. The first reads, "Make it a team effort! Covid-19 Stay Clean, Stay Strong" - encouraging everyone to take individual action to stop the spread of germs and demonstrates that "every little helps" in the fight against infection.

Another says, "Get a handle on virus prevention. Covid-19 Stay Clean, Stay Strong", a reminder to wash your hands after touching well-handled objects. The third urges people to have better habits of hygiene in shared workspaces and offers suggestions of things that can protect against infection. While the final poster reads, "Your hands are your first line of defence. COVID-19 Stay Clean, Stay Strong" - telling us to sing Happy Birthday twice when washing our hands thoroughly.

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Shanghai studio JWDK creates posters to help fight against coronavirus, inspired by vintage Chinese public health notices

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With a theme of 'Stay Clean, Stay Strong' and a palette of soft colours, the four artworks are to help companies maintain good hygiene in and around the workplace. It comes after many workers return to their offices after a long period of homeworking due to the Covid-19 outbreak.

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Browse free resources for K-12 and college classrooms | Econ Lowdown

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Browse Econ Lowdown’s award-winning economics and personal finance resources for K-12 and college classrooms.

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EBI Public Lecture 2021 - Development of the Oxford AstraZeneca COVID-19 vaccine, Dame Sarah Gilbert

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In July, local health official Faisal Khan attended a county council meeting to do his job - talk about COVID-19 data and offer guidance on the best ways to save lives and contain the spread of the virus. He left the meeting needing security detail for his entire family.

"I was prepared for a discussion, even skepticism," said Khan, MPH, MBBS, director of the St. Louis County Department of Public Health in Missouri. "But in 25 years of public health service, I have never faced this sort of situation."

That night at the council meeting, Khan explained why he and fellow county officials had decided to reinstate a mask requirement against a backdrop of surging infections, lagging vaccination rates and rising hospitalizations. Khan's talk was met with jeers, taunts and verbal abuse. One council member pointed out that Khan was not born in the U.S.

As Khan left the meeting, an angry crowd hurled racial slurs and physically assaulted him, Khan later wrote in a letter to the council chair. The situation "saddens me beyond comprehension," he told The Nation's Health.

"Politicizing a public health crisis is never a good idea - it backfires spectacularly," said Khan, an APHA member. "Our response should be a united front and we have failed miserably on that count."

Usually known for working quietly behind the scenes with little fanfare, local health officials such as Khan have become targets for people's frustrations with the COVID-19 pandemic, as well as verbal punching bags for bad-faith lawmakers and purveyors of disinformation. As a result, reports of public health officials being harassed and threatened have become all too common, from death threats and armed protests to online stalking and emails filled with racist and sexist abuse.

In June, a study published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report found that nearly 24% of more than 26,100 state, tribal, local and territorial public health workers surveyed this spring were feeling bullied, threatened or harassed due to work. Almost 12% had received job-related threats.

The problem not only endangers the safety and mental well-being of public health workers; it is pushing out leaders when public health needs them most. It could also make it harder to recruit new workers into governmental public health. According to an analysis from Kaiser Health News and The Associated Press, published in December, at least 181 state and local public health leaders in 38 states had resigned, retired or been fired since April 1.

In August 2020, Joshua Sharfstein, MD, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health, coauthored an article in the Journal of the American Medical Association highlighting attacks on public health workers. He urged local officials to step up protections, including investigating credible threats, providing security detail when needed and prosecuting those who break the law. A year later, the backlash against local health officials seems to be getting worse, he said, egged on by legislative attempts in more than a dozen states to restrict and undermine the authority of health agencies to act in emergencies.

Sharfstein said many of the factors contributing to the backlash were entrenched well before COVID-19, such as political polarization and social media sites that make it easy to spread misinformation and extremist views. But he said elected officials and community leaders can help by speaking up in support of public health authorities and making sure workers are protected from threats.

"I think the next couple years will be critical (for public health)," said Sharfstein, an APHA member. "We really have to be prepared to explain to people how great public health is and why it's so important."

Georges Benjamin, MD, executive director of APHA, also urged elected officials to speak out in support of local health authorities and condemn harassment. A former health official in Maryland and Washington, D.C., Benjamin said he has spoken at contentious public hearings during his career, but never experienced the "vitriol and anger" public health workers are now facing.

"People forget that when you run out your local epidemiologist because you're mad about masking advice, you're also running out the person protecting you from all kinds of other diseases," he said. "Elected officials need to control these public meetings and be clear that attacks on public health officials will be prosecuted."

Many states already have criminal statutes on the books that could be used to protect public health workers, such as laws against obstructing government operations and harassing public officials, according to Brooke Torton, JD, senior staff attorney for the Network for Public Health Law-Eastern Region. Torton, an APHA member, conducted a 50-state survey about existing legal protections, which the network shared this year in response to growing questions and concerns.

However, laws are only as effective as their enforcement, Torton said. Long-term campaigns are needed to help people better understand what public health does and why it matters, she said.

"These officials have already been worked to the bone dealing with the pandemic and don't have the time to pursue their own protection," Torton, who is also deputy director of the Legal Resource Center for Public Health Policy at the University of Maryland, told The Nation's Health. "When the pandemic is more livable, I think some of this (harassment) will scale back. But the next time there's a public health crisis, it'll be like reopening a wound."

Some lawmakers are stepping up. In Colorado in May, Gov. Jared Polis signed a bill making it a misdemeanor to maliciously publish the private information of workers at public health departments, a practice known as doxxing. It also gave workers the option of removing their personal information from public records. State Rep. Yadira Caraveo, MD, who co-sponsored the bill, said she spoke with health officials around Colorado who were facing threats, from harassing phone calls and angry picketing outside their homes to one whose dog was poisoned.

Caraveo, a pediatrician in the city of Thornton who was busy treating a spike in kids with COVID-19 only a few months after the bill was signed, said she is especially worried that continued threats will add to a recent wave of health officials resigning across Colorado.

"People are really dismayed that they're doing their best to do their jobs and still getting personal threats because of it."
- Yadira Caraveo

"It's already pushing people out," she told The Nation's Health. "People are really dismayed that they're doing their best to do their jobs and still getting personal threats because of it."

In Oxford, North Carolina, Lisa Macon Harrison, MPH, health director at Granville Vance Public Health, said residents of the two rural counties the health department serves have been fairly supportive of its COVID-19 response. But staff has sometimes encountered anger, frustration and confusion, especially when following up with people about quarantining and isolation.

Harrison, an APHA member, said she is worried about the mental toll such backlash is taking on already-exhausted health department workers.

"It would be nice if the public health workforce was respected the same way the military was for preserving life and liberty," Harrison told The Nation's Health. "Right now, the opposite is taking place, but I hope we'll get there."

For more on protecting public health workers, visit www.networkforphl.org.

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Threatened, harassed, doxxed: Public health workers forge on - Security teams protecting health officers

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In July, local health official Faisal Khan attended a county council meeting to do his job - talk about COVID-19 data and offer guidance on the best ways to save lives and contain the spread of the virus. He left the meeting needing security detail for his entire family.

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Delivering COVID-19 vaccines to people equitably requires leaders to plan and upgrade their delivery strategies regularly. We built the Vaccine Equity Planner to help public health officials, providers, employers, researchers and others assess various scenarios to support equitable access.

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In a sense, COVID-19 could be the perfect story to automate. As the virus spread across the world at the beginning of 2020, governments and health authorities made a considerable amount of open-source data available to the public, such as the number of deaths, patients in intensive care units, and seven-day incidence rates.

This type of well-arranged data, which can fit into narratives that can be created in advance, lays the groundwork for a recent journalistic development known as "automated journalism," a computational process that creates automated pieces of news without any human intervention, except for the initial programming.

Automated journalism generally implies the use of algorithms that fetch information on external or internal datasets, and then fill in the blanks left on templates that have been prewritten. This process, which can be compared to the word game Mad Libs, constitutes a basic application of Natural Language Generation, a computer technique that has been around for several decades in domains such as weather forecasts, sports and financial results.

NLG made a leap into journalism and was more widely discussed in the first half of the 2010s as The Los Angeles Times used automated text to report on homicides and earthquake alerts, while The Associated Press partnered with the firm Automated Insights to automate stories on corporate earning. Numerous media organizations have subsequently adopted or experimented with automated journalism, including major ones like Le Monde, The Washington Post and the BBC.

Proponents of automated journalism typically develop their technology in-house, outsource it to an external content provider such as Syllabs in France and Narrativa in Spain and in the United States, or use third-party solutions so that journalists can design their own automated news, as it is made possible through Automated Insights' Wordsmith and Arria NLG Studio.

Automated news can then be published simultaneously at massive scale or used as first drafts to assist journalists with their own writing.

In my report for the Tow Center, I documented the experiences of nine media organizations that have used automated news for reporting on COVID-19. I found that most organizations used them to provide a statistical overview of the spread of the virus, through user-facing interfaces and new media products.

For instance, Swiss media company Tamedia and The Times (United Kingdom) featured national and international dashboards that summarized the latest COVID-19 data with automated text, along with a great many automated or semi-automated graphics.

I also found that some organizations deployed new forms of newsroom workflows, where journalists contributed to the creation of automated news or worked directly with them.

At the British news agency RADAR, a new form of workflow where journalists are involved all the way into the process of setting up automated news - from finding storylines in newly published datasets to authoring templates using a third-party tool - demonstrated to be robust enough to handle the data deluge that followed the spread of the virus.

At the Finnish newspaper Helsingin Sanomat, an algorithm set up by the data team fetched new COVID-19 numbers on a governmental API, so as to generate short pieces of text that were sent to Slack to inform reporters. They could then decide to publish these as-is or tweak them before publication.

In my report, I also illustrated some of the challenges that newsrooms faced when using automated news to cover COVID-19. Overall, these demonstrated the difficulties associated with having to rely on external datasets.

This was most notably the case with newsrooms trying to get data from several levels of government.

In Canada, a journalist-developer at the Canadian Press said that it was hard to get COVID-19 data from multiple governments: "They all put it up in a different fashion, they put it up at different times," he said.

In the United Kingdom, The Times grappled with the same lack of cohesive efforts: "England, Scotland, Wales, and Northern Ireland all publish it in different ways," said a data and interactive journalist at the newspaper, adding that this made comparisons between regions even more difficult.

In Norway, the news agency NTB faced an even bigger challenge: "Every Norwegian municipality has a different way of providing the data on their own pages. So it's like 356 municipalities, and they have 356 different ways of sharing the data," said a chief development officer at NTB.

Another challenge of relying on external datasets to automate COVID-19 stories had to do with erroneous data and sudden changes of format.

First, data published by health and governmental bodies could prove to be inaccurate. "Sometimes the data has been wrong and they're not corrected," said an editor at NTB. This could be even more problematic when it concerned the number of patients who have died from the virus.

Second, sudden changes of format were also considered to be a major obstacle in automating the coverage of the virus. For instance, the data team at Helsingin Sanomat experienced difficulties with some data being released in an HTML table format. A data journalist explained that the table's structure kept changing all the time, for instance when the number of patients hospitalized was being moved from one column to another, making it very hard to use for automated news.

Finally, releasing data too soon or too late also came into consideration when working with external datasets to generate automated news on the spread of the disease.

Some media organizations occasionally reported a lag in releasing data on the pandemic, resulting in numbers accumulating over a few days before being published all at once with more up-to-date data. "In today's numbers, they might publish some deaths for a week ago," said an editor at RADAR, who cautioned that reporters then needed to be extra careful when reporting differences between each of these dates.

On the other side of the coin, news organizations could also get the latest COVID-19 numbers before any official announcement, while connecting to an API service set up by governments or health authorities. "Sometimes we have actually managed to kind of beat, so to speak, the local health sources on their own news," said a managing editor at Omni, a Swedish news service that used an automated dashboard connected to these kinds of sources.

To overcome the challenges of having to rely on external datasets to cover COVID-19 with automated news, media practitioners with a strong computing background at some of the organizations that I've studied developed ad hoc solutions to work around those.

To deal with data being released in various time zones, the Canadian Press set up an advanced shared spreadsheet system that involved the participation of journalists in all Canadian provinces and territories, while The Times and Helsingin Sanomat developed an alert system to work around tight deadlines and sudden changes of format.

All in all, these ad hoc solutions demonstrate the importance for media practitioners to be able to solve problems through applying computing skills, a form of knowledge commonly known as computational thinking or computational journalism in a newsroom setting.

This type of mindset has given journalists a considerable edge in deploying automated news quickly and efficiently in the midst of a global pandemic, but may also fuel ideas for the next iteration of these products.

Although the template-based approaches are sometimes criticized for being too formulaic and less enjoyable to read than human-written news, they can at least be tweaked to achieve editorial goals. The more media practitioners engage with this tinkering of automated news systems, the more they develop their programmatic skills and thus reinforce their ability to exert control and have a say over the computational turn that journalism is taking.
This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 765140.

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How news organizations used automated news to cover COVID-19 - Poynter

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In a sense, COVID-19 could be the perfect story to automate. As the virus spread across the world at the beginning of 2020, governments and health authorities made a considerable amount of open-source data available to the public, such as the number of deaths, patients in intensive care units, and seven-day incidence rates.

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA)

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The Gesundheit II booth is used to capture exhaled breath of COVID-19 patients. SARS-CoV-2 is evolving toward more efficient aerosol generation, and loose-fitting masks provide significant but only modest source control. Until vaccination rates are very high, continued layered controls, including improved ventilation, increased filtration, UV air sanitation, and tight-fitting masks are critical to protect people in public-facing jobs and indoor spaces.

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COVID-19 Virus is Evolving to Get Better at Becoming Airborne, new study shows

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Results of a new study led by the University of Maryland School of Public Health show that people infected with the virus that causes COVID-19 exhale infectious virus in their breath - and those infected with the Alpha variant (the dominant strain circulating at the time this study was conducted) put 43 to 100 times more virus into the air than people infected with the original strains of the virus.

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Washington University School of Medicine in St. Louis

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Major study details numerous long-term effects of COVID-19, pointing to massive health burden
Sara Moser
As the COVID-19 pandemic has progressed, it has become clear that many survivors - even those who had mild cases - continue to manage a variety of health problems long after the initial infection should have resolved. In what is believed to be the largest comprehensive study of long COVID-19 to date, researchers at Washington University School of Medicine in St. Louis showed that COVID-19 survivors - including those not sick enough to be hospitalized - have an increased risk of death in the six months following diagnosis with the virus.

The researchers also have catalogued the numerous diseases associated with COVID-19, providing a big-picture overview of the long-term complications of COVID-19 and revealing the massive burden this disease is likely to place on the world's population in the coming years.

The study, involving more than 87,000 COVID-19 patients and nearly 5 million control patients in a federal database, appears online April 22 in the journal Nature.

"Our study demonstrates that up to six months after diagnosis, the risk of death following even a mild case of COVID-19 is not trivial and increases with disease severity," said senior author Ziyad Al-Aly, MD, an assistant professor of medicine. "It is not an exaggeration to say that long COVID-19 - the long-term health consequences of COVID-19 - is America's next big health crisis. Given that more than 30 million Americans have been infected with this virus, and given that the burden of long COVID-19 is substantial, the lingering effects of this disease will reverberate for many years and even decades. Physicians must be vigilant in evaluating people who have had COVID-19. These patients will need integrated, multidisciplinary care."

In the new study, the researchers were able to calculate the potential scale of the problems first glimpsed from anecdotal accounts and smaller studies that hinted at the wide-ranging side effects of surviving COVID-19, from breathing problems and irregular heart rhythms to mental health issues and hair loss.

"This study differs from others that have looked at long COVID-19 because, rather than focusing on just the neurologic or cardiovascular complications, for example, we took a broad view and used the vast databases of the Veterans Health Administration (VHA) to comprehensively catalog all diseases that may be attributable to COVID-19," said Al-Aly, also director of the Clinical Epidemiology Center and chief of the Research and Education Service at the Veterans Affairs St. Louis Health Care System.

The investigators showed that, after surviving the initial infection (beyond the first 30 days of illness), COVID-19 survivors had an almost 60% increased risk of death over the following six months compared with the general population. At the six-month mark, excess deaths among all COVID-19 survivors were estimated at eight people per 1,000 patients. Among patients who were ill enough to be hospitalized with COVID-19 and who survived beyond the first 30 days of illness, there were 29 excess deaths per 1,000 patients over the following six months.

"These later deaths due to long-term complications of the infection are not necessarily recorded as deaths due to COVID-19," Al-Aly said. "As far as total pandemic death toll, these numbers suggest that the deaths we're counting due to the immediate viral infection are only the tip of the iceberg."

The researchers analyzed data from the national health-care databases of the U.S. Department of Veterans Affairs. The dataset included 73,435 VHA patients with confirmed COVID-19 but who were not hospitalized and, for comparison, almost 5 million VHA patients who did not have a COVID-19 diagnosis and were not hospitalized during this time frame. The veterans in the study were primarily men (almost 88%), but the large sample size meant that the study still included 8,880 women with confirmed cases.

To help understand the long-term effects of more severe COVID-19, the researchers harnessed VHA data to conduct a separate analysis of 13,654 patients hospitalized with COVID-19 compared with 13,997 patients hospitalized with seasonal flu. All patients survived at least 30 days after hospital admission, and the analysis included six months of follow-up data.

The researchers confirmed that, despite being initially a respiratory virus, long COVID-19 can affect nearly every organ system in the body. Evaluating 379 diagnoses of diseases possibly related to COVID-19, 380 classes of medications prescribed and 62 laboratory tests administered, the researchers identified newly diagnosed major health issues that persisted in COVID-19 patients over at least six months and that affected nearly every organ and regulatory system in the body, including:

Respiratory system: persistent cough, shortness of breath and low oxygen levels in the blood.

Nervous system: stroke, headaches, memory problems and problems with senses of taste and smell.

Mental health: anxiety, depression, sleep problems and substance abuse.

Metabolism: new onset of diabetes, obesity and high cholesterol.

Cardiovascular system: acute coronary disease, heart failure, heart palpitations and irregular heart rhythms.

Gastrointestinal system: constipation, diarrhea and acid reflux.

Kidney: acute kidney injury and chronic kidney disease that can, in severe cases, require dialysis.

Coagulation regulation: blood clots in the legs and lungs.

Skin: rash and hair loss.

Musculoskeletal system: joint pain and muscle weakness.

General health: malaise, fatigue and anemia.

While no survivor suffered from all of these problems, many developed a cluster of several issues that have a significant impact on health and quality of life.

Among hospitalized patients, those who had COVID-19 fared considerably worse than those who had influenza, according to the analysis. COVID-19 survivors had a 50% increased risk of death compared with flu survivors, with about 29 excess deaths per 1,000 patients at six months. Survivors of COVID-19 also had a substantially higher risk of long-term medical problems.

"Compared with flu, COVID-19 showed remarkably higher burden of disease, both in the magnitude of risk and the breadth of organ system involvement," Al-Aly said. "Long COVID-19 is more than a typical postviral syndrome. The size of the risk of disease and death and the extent of organ system involvement is far higher than what we see with other respiratory viruses, such as influenza."

In addition, the researchers found that the health risks from surviving COVID-19 increased with the severity of disease, with hospitalized patients who required intensive care being at highest risk of long COVID-19 complications and death.

"Some of these problems may improve with time - for example, shortness of breath and cough may get better - and some problems may get worse," Al-Aly added. "We will continue following these patients to help us understand the ongoing impacts of the virus beyond the first six months after infection. We're only a little over a year into this pandemic, so there may be consequences of long COVID-19 that are not yet visible."

In future analyses of these same datasets, Al-Aly and his colleagues also plan to look at whether patients fared differently based on age, race and gender to gain a deeper understanding of the risk of death in people with long COVID-19. Sara Moser

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Among COVID-19 survivors, an increased risk of death, serious illness | Washington University School of Medicine in St. Louis

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Visit the News Hub Major study details numerous long-term effects of COVID-19, pointing to massive health burden Sara Moser As the COVID-19 pandemic has progressed, it has become clear that many survivors - even those who had mild cases - continue to manage a variety of health problems long after the initial infection should have resolved.

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The first study of its kind has revealed how much a COVID-19 patient's risk of requiring hospitalization or developing serious symptoms increases when four key risk factors are combined.

Those factors are being 65 or older, male, obese, or having type 2 diabetes.

A research team from Kitasato University analyzed the electronic medical records of about 28,000 patients who were infected with the new coronavirus between January and November 2020 in the United States.

The study analyzed patients that had overlapping risk factors and found the more that patients had, the more likely they needed to be hospitalized.

The rate of COVID-19 patients exhibiting just one of the risk factors who required hospitalization tripled compared to people who had none. The rate of patients with all four risk factors who were hospitalized was about 19 times higher than those with none.

The rate of patients with one risk factor who developed serious symptoms and needed to be treated in intensive care units increased threefold. The rate of patients with two risk factors was 15 times higher, three risk factors was 38 times higher, and all four of the risk factors was a staggering 56 times higher.

The researchers hope their findings will lead to better prediction and prevention of the development of serious symptoms.

The study defined obesity as having a BMI (body-mass index) 30 or higher, using the same standard that the United States adopts.

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Mix of 4 factors increases chance of COVID-19 hospitalization | The Asahi Shimbun: Breaking News, Japan News and Analysis

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The first study of its kind has revealed how much a COVID-19 patient's risk of requiring hospitalization or developing serious symptoms increases when four key risk factors are combined. Those factors are being 65 or older, male, obese, or having type 2 diabetes.

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From a political and legal standpoint, the battle over whether mask wearing should be enforced in schools is still raging. But from a scientific standpoint, there's little debate: Masks really do help curb the spread of the coronavirus in school.

While there are still some non-believers ...

This week, a spokesperson for Florida Gov. Ron DeSantis was asked to comment on a lawsuit challenging Florida's ban on mask mandates in school. The spokesperson told NPR, "The assertion that forced-masking all children ages 2 and up has any impact on school safety vis-a-vis COVID-19 is not data-driven and is not reflective of a scientific consensus." Montana Gov. Greg Gianforte expressed similar doubt last week. He called existing research "inconclusive" and announced a new rule that encourages schools to give parents the final word on whether their kids don masks.

... the research is conclusive

Several studies over the past year have shown that widespread masking can significantly curb transmission from student to student.

For example, one study in Wood County, Wisconsin, last fall found that schools that required masking had a whopping 37 percent lower incidence of COVID-19 than the surrounding community. Another study, conducted in Salt Lake County, Utah, last winter, found that high levels of mask wearing among students helped keep the rate of in-school spread of the coronavirus to under 1% - even as COVID-19 cases were surging in the wider community.

Now, in all those examples, schools were also using other protective strategies that experts strongly recommend layering on - like physical distancing and opening windows.

But studies show that even in situations where these other measures aren't being used, masking makes a big difference in keeping the virus from spreading. That was one conclusion of the ABC Science Collaborative, a major research initiative involving nearly 1 million students from 100 school districts and 14 charter school in North Carolina. It found that universal masking policies helped keep transmission rates of the coronavirus within schools to under 1% last fall and spring.

"The science clearly shows us that masking is an effective strategy to prevent within-school transmission when COVID-19 is circulating and when vaccination is not yet available for all children," Dr. Kanecia Zimmerman, co-chair of the ABC Science Collaborative, said in a statement reviewing those findings.

Even with the delta variant, within-school spread is low

Now, most of those studies were conducted before the highly contagious delta variant began its current sweep across the U.S. But unpublished data, gathered during this past summer school session in North Carolina, shows that transmission was indeed a bit higher as delta spread in the surrounding communities. But even then, thanks to universal masking and other mitigation strategies, the rate of within-school spread was under 3%, says Dr. Ibukun Kalu, a pediatric infectious disease specialist at Duke and also a member of the ABC Science Collaborative research team.

But, again, proper masking is key

Not masking could be disastrous for schools, says Julie Swann, a department head and professor at North Carolina State University who leads a COVID-19 forecasting team funded by the Centers for Disease Control and Prevention.

According to a recent modeling study from Swann's lab, without masking policies or other interventions in place, within the first three months of school, the delta variant could infect more than 75 percent of susceptible kids - those who aren't vaccinated and haven't previously had a bout of COVID-19.

"It's shocking, right?" Swann says. "And I'm the parent of two school-age [children]."

Swann says her model's projection represents "pretty close to a worst-case scenario" - a situation where kids are wearing ill-fitting masks that don't filter well, and mask wearing isn't reliably enforced. But, it doesn't have to be that way.

With proper masking and other interventions in place, she says, schools may still see some outbreaks because of delta's highly infectious nature, but far fewer than they would otherwise.

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Yes, Gov. DeSantis, Studies Do Show Masks Curb Covid-19 In Schools

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From a political and legal standpoint, the battle over whether mask wearing should be enforced in schools is still raging. But from a scientific standpoint, there's little debate: Masks really do help curb the spread of the coronavirus in school. This week, a spokesperson for Florida Gov.

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MULLINS, S.C. - When the last mourners departed and funeral director Shawn Troy was left among the headstones, he wept alone.

For five decades, the closing words at countless funerals in this town of 4,400 had been delivered by his father, William Penn Troy Sr. Now the elder Troy was gone, one of many Black morticians claimed by a pandemic that has taken an outsized toll on African Americans, after months of burying its victims.

And as Shawn Troy stepped forward to speak in place of a man well known beyond his trade - for his work in county politics and advocacy of its Black citizens - the emptiness felt overwhelming. Not just his family, but his community, had lost an anchor.

"I walked over to his grave and I could hear him talking to me," Shawn Troy said, his own voice breaking as he recalled kneeling beside the plot last September, on a low rise near two palmetto trees. "And he said, 'You got it. You can do it. This is what you were built for.' He passed the baton on to me, so I've got to get running."

He is hardly alone. Since the start of the pandemic, about 130 Black morticians have died from COVID-19, according to the association that represents them.

Deaths of funeral workers are not closely tracked. But the National Funeral Directors Association, which represents the broader industry, said it has not seen a corresponding rise in COVID deaths among its members.

The deaths of Black morticians are particularly notable because of the prominent role they have long played in many communities. Often admired for their success in business, a number have been elected to political office, served as local power brokers, and helped fund civil rights efforts.

At the same time, the "homegoing" services they arrange have frequently served as communal touchstones, events as much about life as death, that draw mourners together with pageantry, preaching and song.

Black funerals are "more celebration, and that's no disrespect to my colleagues across the country. We're more, I should say, intimate," said Hari P. Close, president of the National Funeral Directors & Morticians Association and the operator of a Baltimore funeral home. The association represents Black morticians.

When the pandemic hit, the very closeness and celebration that distinguish Black funerals put morticians at risk, Close said.

Their deaths have left some successors struggling to fill their role.

"It has really had an impact ... particularly in African American funeral homes," he said.

The deaths have come despite concerted efforts by morticians to protect themselves from the virus and limits imposed on the size and scope of burial gatherings to keep it from spreading.

"This year was unlike any other year I've ever lived through in the funeral service," said Edith Churchman, the fourth-generation owner of a mortuary in Newark, N.J. that serves a largely Black clientele.

Dealing with an onslaught of COVID deaths, at first with limited personal protective equipment, and later with shortages of caskets and prepared burial plots, put pressure on funeral directors that far exceeded the demands at the peak of the AIDS epidemic, she said.

"We were getting bombarded with COVID bodies," said Dr. Mary Gaffney, who stepped in to run her brother, Jeremiah's, funeral home in Inwood, New York after he died of the virus last May.

At least 95,000 Black Americans have died of COVID, according to an AP analysis of data from the National Center for Health Statistics, perishing at the highest rate of any racial group in the U.S.

Adjusting the figures to account for age differences shows that Blacks, Latinos and Native Americans are two to three times more likely to die of the virus than white people, according to the Centers for Disease Control and Prevention.

"Of course ... you feared for your own safety," Churchman said. "You're kind of dangling on that precipice, saying what if?"

In Mississippi, Luzern "Sonny" Dillon and employees at his two funeral homes worked for months to fulfill COVID safety protocols, restricting gatherings. But Dillon, a widely known former councilman, continued his routine of spending time in the community, engaging people in conversation.

"People would be like, 'You know, Mr. Sonny,' and they'd just begin to talk and share things with him. It was just like a given," his wife, Georgia Dillon, said.

In one of those conversations, early this year, a restaurant manager confided to Dillon that he'd lost three family members to COVID in a matter of weeks. The mortician extended his condolences, reassuring the man that, contrary to what some people said, the pandemic was very real. Those words proved prescient.

A few weeks later, a funeral home employee tested positive, followed soon after by both of the Dillons.

"Just in case I don't make it out of here, this is what I want you all to do," Sonny Dillon told his wife from a hospital bed in March. He died weeks later at 72.

Georgia Dillon, a nurse, had long helped keep financial ledgers for the business. But her husband was the unquestioned consoler-in-chief and she and other family members scrambled to keep the funeral homes, in McComb and Tylertown, running in his absence.

But there was little filling the role that Sonny Dillon occupied beyond the mortuary. In his 20s, he had been one of the first Black candidates elected to local political office. Later, he worked with the daughter of Martin Luther King Jr. to rename a boulevard for the slain civil rights leader. He pushed to get more Black citizens to vote.

Dillon's civic role fit a pattern common in many African American communities, where morticians have long been prominent, said Suzanne E. Smith, a professor at George Mason University who authored a book about the Black funeral business.

The best known include the Ford family of Memphis, Tennessee, funeral home operators who sent a father and son to Congress. In Detroit, funeral director Charles Diggs Sr. was a state legislator before his son won a seat in Washington and helped found the Congressional Black Caucus.

In cities throughout the South, funeral directors often supplied the limousines for visiting civil rights leaders when they came to rally supporters.

"There's all this stuff going on in (Black) funeral homes that is not about burying the dead, but servicing the living," Smith said.

By late this summer, Georgia Dillon was preparing to turn over the business to her daughter and son-in-law. Working together with employees at the funeral homes, the family is determined to maintain the business as Sonny Dillon would have run it.

"We talk and we cry and we try to build each other up. We tell each other we've got to keep his legacy going," she said.

In New York, Gaffney is trying to do much the same, but after years away from the funeral business.

During the first months of the pandemic, Gaffney said she warned her brother, who had some chronic health issues, to isolate himself and let employees at the funeral home care for the bodies of the dead. But that was not his character.

The funeral home, started by the Gaffneys' parents in the early 1970s, had long served mostly African American families in the city neighborhoods and suburban towns near John F. Kennedy International Airport.

But after the gregarious Jeremiah took over from his father, a staid retired Army officer, he worked to broaden the clientele, speaking French to some families and hiring staff who spoke Spanish and African languages to others.

"In the mortuary business you've got to really be in the community," Mary Gaffney said. "That was his thing. He was grass roots. He never met a stranger."

While Jeremiah Gaffney ran the family business, Mary Gaffney studied medicine, setting up a practice in Charlotte, North Carolina. After her brother fell ill over the Easter weekend of 2020 and then was diagnosed with COVID, she tried to ensure his care. But his death weeks later, at 65, confronted Mary Gaffney with responsibilities well beyond her expertise.

With deaths soaring, she rented a refrigerated trailer to handle the overload. In the New York City neighborhood a few blocks from the funeral home, COVID has killed more than 500 people, double the citywide average.

"I don't think it slowed. I think I just sped up," said Gaffney, who hired a second funeral director, supplementing one already working in New York, to help her coordinate operations from Charlotte. Every other week, Gaffney drove between the cities to take on the responsibilities her brother had left behind.

But she declined offers to sell, feeling that would betray the legacy of her parents and the grandparents who funded its founding. And she has embraced the role her brother once filled as the face of the business, taking calls from grieving families at all hours. Just getting through a year without her brother to tell her what to do feels like crossing a finish line, she said.

"We're going to see what the future holds," said Gaffney, who hopes younger family members might eventually seek a place in the business. "Needless to say, it's been an emotional journey."

South Carolina's Troy has faced somewhat different challenges, taking over the mortuary business founded by his father in 1973 after years of working alongside him.

"The thing about me and my dad was, we woke up together, we came to work together and then went home and ate together and talked late at night," he said.

The Troys had agreed that Shawn would take over the business during the next few years. But he had expected to do so with his father's counsel. The void left by the senior Troy's death extends well beyond the chapel.

Over the years, the elder Troy, known as Penn, had served as a county commissioner, local school board member and church treasurer. But those were just his official duties.

"If my mother didn't have enough to feed us, he'd help us out. When you're talking about Mr. Penn, he was the community," said Jessica Godbolt, a former neighbor whose family gathered recently for the funeral of her uncle.

Penn Troy used jokes and small talk to win people over and get things done, said Cynthia Leggette, a school board member and longtime friend.

When officials voted to close a school because of declining enrollment, Troy pushed to turn it into a science and technology academy that quickly drew more students, she said. Noting that a citizens committee lobbying for school improvements was overwhelmingly white, Troy made calls that brought Black parents into the fold.

"Growing up in the 60s, Penn knew what struggle was," Legette said. "He would tell me, 'Cynthia, we have been blessed ... so it's up to us to lift the torch and light the way for our children'."

In recognition, officials gathered recently under a tent at Mullins' edge to name a stretch of U.S. 76 the William Penn Troy Highway. Directly across the road, a digital sign flashed a welcome to motorists: "For Your Safety and Ours, Please Wear a Mask."

Last summer, both Troys were diagnosed and hospitalized with COVID. The elder Troy never returned home. And two weeks after his father's burial, Shawn Troy presided over the first funeral without him.

The early months were the hardest. Penn Troy's charisma gave life to the business of death. Shawn Troy had mostly worked behind the scenes. He recently declined an invitation to get involved in civic affairs, at least for now, preferring to focus on his new role.

Standing in the chapel recently on the evening before a funeral, he greeted mourners by name, placing his arm around several shoulders.

"You doing all right?" he asked from behind his mask. "I haven't seen you in a while."

But returning again and again to run funerals at the cemetery where his father is buried is a constant reminder that he is doing so alone.

Near sunset recently, Troy paced down a row of headstones, planting tiny flags at an empty plot to mark it for a burial the following morning. Not 50 feet away, lengthening shadows stretched across his father's grave.

"I don't think I'll ever get over it," he said. "But I'll get through it."

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The Coronavirus Claims Black Morticians, Leaving Holes In Communities

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MULLINS, S.C. - When the last mourners departed and funeral director Shawn Troy was left among the headstones, he wept alone. For five decades, the closing words at countless funerals in this town of 4,400 had been delivered by his father, William Penn Troy Sr.

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As COVID-19 restrictions loosen and the country settles into a new normal, disability advocates have mixed feelings about the future of the workplace and public health in the U.S.

Marcie Roth, executive director and chief executive officer of the World Institute on Disability, hopes the accommodations that have been made for all workers during the pandemic continue as the world goes back to normal.

"For lots of people with disabilities, returning to normal horrifies us," Roth said. "Returning to normal means exclusion, inaccessibility, rigidity, a lack of imagination. Rather than the notion that we would be building back better ... we would really like to be building forward better."

Some accommodations have become commonplace during the pandemic -- like equipment requests, modifications to work environments and new schedules and responsibilities. Advocates are demanding that these adaptations are not only kept in place, but embraced by workplaces across industries.

Adjusting to a new normal
At work, his laptop's screen reader had helped him read the text displayed on the computer and he had co-workers to help him around the office.

But once the Centers for Disease Control and Prevention recommended social isolation and Catherine was forced to stay at home, the new computer software for remote work wasn't immediately compatible with his screen reader.

However, after a few lessons on app workarounds and accessibility updates, Catherine was able to comfortably and efficiently work from home.

"We often talk about how resilient people with disabilities are, that they're problem solvers," Catherine said. "The pandemic was a great example of that."

Catherine, the associate director of special projects at the National Organization on Disability, is one of about 61 million disabled Americans who had to adjust to a world with COVID-19, according to numbers from the Department of Labor.

Catherine was lucky enough to have employers who are knowledgeable about accessibility needs, so adjustments were almost immediate.

Now, he hopes all employers can see the value in disabled workers and create safe spaces for them.
A growing disabled workforce
People with disabilities are joining the workforce in increasing numbers -- rising above pre-pandemic levels.

The disabled labor force participation rate grew to 35.4% in June, according to a report from the Kessler Foundation, a research group focused on people with disabilities, the highest participation rate for this group since July 2009.

"This has been a bright spot during the Covid-19 pandemic, as people with disabilities, perhaps out of economic necessity, remained engaged in the labor market," John O'Neill, the Kessler Foundation's director of the Center for Employment and Disability Research, said in a press release.

Roth said that when the pandemic hit, the requests disabled workers had long been fighting for became a reality once the non-disabled population was also threatened by the virus.

"We have a saying in the disability community: 'Nothing about us without us,'" Roth said. "Employers, schools, community leaders, elected officials, can't be planning for us. We need to be at the table."
COVID-19 fears remain
As coronavirus cases rise again in the U.S., disability rights activists, like Roth and Charis Hill, are asking employers to understand workers' fears concerning the ongoing pandemic.

"My life is still threatened, more so now that people are partying and pretending that there's no danger," Hill, a writer and advocate, said. "A lot of that has to do with them not even realizing the vaccines are less effective with people like me."

The delta variant of the novel coronavirus continues to ravage countries across the globe. Last week marked the fourth in a row that the number of new COVID-19 cases increased internationally, according to the World Health Organization.

Activists would like to remind others that the pandemic isn't over yet, especially for immunocompromised people.

"Everyone now knows what it's like to live with the threat of severe health issues and we've been doing that for our whole lives," Hill said. "Policywise, as we move forward, having disabled people at every table where public health decisions are made is vital for the health and safety of the world."

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Return to the workplace highlights accessibility concerns for disabled employees

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As COVID-19 restrictions loosen and the country settles into a new normal, disability advocates have mixed feelings about the future of the workplace and public health in the U.S. Marcie Roth, executive director and chief executive officer of the World Institute on Disability, hopes the accommodations that have been made for all workers during the pandemic continue as the world goes back to normal.

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There was a point a couple of weeks ago when every patient Dr. Oni Blackstock saw - back to back to back - said they didn't want the coronavirus vaccine.

"Why are you people always pushing this?" one woman snapped at her the second she brought it up.

Deflated, Blackstock, a primary care and HIV physician in New York who serves primarily people of color, considered the growing complexity of the task ahead of her: The people who have not yet received the vaccine are dug in; if they're holding out, it's for a reason.

"People have just been so traumatized and so terrorized by this society to the point where people have so many concerns and worries and doubts about this being something safe," Blackstock said. "To then believe that a system that has worked against them is now trying to help them? For me, it's just really devastating."

As the vaccination effort becomes more individualized, the frustration, exhaustion and pressure is weighing heavily on people on the front lines, who have already suffered a year of immeasurable pain and loss, but who also feel a deep responsibility to do the work it'll take to reach the remaining 40 percent of the population that is eligible for a jab.

The vast majority of that labor - so much of it invisible - is now resting on the shoulders of women, especially women of color, and other marginalized people, experts say.

People of color have been disproportionately impacted by the pandemic in every arena, from health outcomes to economic ones.Black and Native American people have died from COVID-19 at 1.4 times the rate of White people, according to the most recent data, through early March, from the COVID Tracking Project. Nearly a year and a half out from the start of the pandemic, women of color continue to have the highest unemployment rates of any group: 7.6 percent for Black women and 6.7 percent for Latinas, while White women's rate is 4.5 percent. And LGBTQ+ people, who are more vulnerable to complications from coronavirus because of underlying health issues and more likely to live in poverty, are among the groups contending with a potential wave of evictions once a moratorium expires in October that could put their livelihoods and health at risk.

Now, stopping additional devastation is up to the same people who have experienced the trauma of the pandemic. They're rising up across the country to try to inch the vaccination effort forward where national campaigns, advertisements and even workplace incentives have fallen short.

It's doctors like Blackstock, who are attempting to gain trust from communities who lost it long ago. It's the caretakers, the ones who do it professionally and in their families, who have lived the losses caused by coronavirus first hand. It's the mothers ravaged by the nation's first women's recession, who can't see a return to any version of normal if they don't have school or child care for their kids. And it's the organizers, who are taking on this new dimension to their work because they know what it takes to meet people where they are.

"In our community, Black women are seen as a trusted voice because of our role leading families and leading movements," Blackstock said. "We feel a responsibility to our communities to do this... we feel like a lot of this work is our life's purpose."

"It's almost like we have this burden," she added, "of having to address and mitigate the mistrust that we did not create."

That burden is deeply personal for people like Autumn Phair, a 25-year-old master's student in Seattle who is her mother's primary caregiver.

Last year, her mom, Michelle Phair, spent a month in the hospital, some of that in the intensive care unit, when she contracted COVID-19. They spent Christmas apart. Like today, hospitals were overwhelmed, and days would go by before she got a call about her mother's condition.

When Michelle survived, Phair thought surely her mother would want to get vaccinated as soon as the option was available to her.

But Michelle, a Black woman, pointed to how 600 low-income Black men were used in the Tuskegee Syphilis Study run by the U.S. Public Health Service from 1932 to 1972 to test how the disease progressed - but were never told they had it and weren't treated for it. She talked about how Black people have felt tricked and bamboozled and led astray before. And after a life that has involved many hospitalizations and many treatments by specialists for various health issues, Phair fears her mother has developed a phobia around the vulnerability of that situation - of trusting her life to any one person. Or any one vaccine.

The vaccine, her mother told her, "is not going to save you. We are all going to die."

Phair said that comment shook her. After all they had gone through, it had not been enough.

It's almost like we have this burden of having to address and mitigate the mistrust that we did not create.
Dr. Oni Blackstock, physician who serves primarily people of color

But one day a few weeks ago, while on a routine pharmacy trip to Walmart, Phair's mother suddenly said she would get vaccinated. The news of the Delta variant had started to rattle her. Right then and there, she got her first dose of the Moderna vaccine.

Regret set in quickly, and it set in deeply. "I don't know if I should have done that," Michelle told her daughter. Now, past due to get her second shot, Michelle is firmly back in the "no" camp. She won't go in for it.

"I tried," Phair wrote in an email to The 19th this week.

Phair feels a mix of resignation and anger. She's considered life insurance and what kind of funeral service her mother would like. She now knows Michelle would prefer cremation. It's the first time she's ever planned for that loss.

Eve Rodsky, who has spent the past decade researching and writing about the invisible labor women take on, said the work that is taking place in homes like Phair's and in workplaces across the nation has always been gendered. In her book, "Fair Play: A Game-Changing Solution for When You Have Too Much to Do (and More Life to Live)," she writes that women and marginalized people are the ones most often taking on what she calls "the civic engagement and social enrichment card."

It was women of color who helped register voters at historic levels to flip states during the 2020 election and women who were the majority of those who stepped up to get vaccinated first in every state. The vaccination effort is a continuation of that work.

Some of it is existential. For the hundreds of thousands of moms who lost work and put their careers on hold because of the pandemic, vaccinations are a path toward returning to regular school and child care hours. They're also doing that work in a micro sense, setting up coronavirus testing appointments when a school or kid's soccer team requires it.

In the thousands of interviews she's conducted with people for her book, Rodsky said that more often than not, women are the ones who take on the work when things fall apart. And they're burning out because of it.

"We find that women take on the cards that you can't control. So it's very disruptive to mental health and cortisol levels and stress because we are dealing with unpredictable things," Rodsky said. "That's all COVID has been: unpredictable things they can't do on their own timetable. The nature of invisible work has just exploded."

Even outside the home, work being done by community organizations hasn't always been paid. In Colorado, Out Boulder County, an LGBTQ+ advocacy organization, has been working all year to set up clinics with the county's public health department to vaccinate members of the queer community. The group has also provided pronoun training and guidance on updating forms to be more inclusive. About 7,000 people came through the equity clinics they set up for the vaccine, many of those events run by volunteers who showed up to help encourage other LGBTQ+ people to get the vaccine.

In the first months of the year, "there were promises that we would be paid for our time, and it was taking a ton of time," said Mardi Moore, the organization's executive director. Instead of the public health department paying for the events, it was ultimately later funded by another organization, the Community Foundation of Boulder County. "You do the work because it's the right thing to do, but I don't get paid overtime," she said.

As the months have dragged on, that labor has only become more challenging. Out Boulder County is now working with smaller LGBTQ+ organizations in areas around Boulder to help fund vaccination events, food for volunteers and other needs in order to reach people in outlying areas.

"What is so difficult is the fight to get people vaccinated. We are always noodling on what approach will work," said Moore, who had just jumped off a call on how motivational interviewing - a technique used in the medical field to help patients who may be hesitant - might be one way to reach those who are still holding out. They'll try that next, but, she conceded, "I think we are all tired."

Some who are still trying consider it work that will serve future generations. That's how LaTanja Silvester and Allie Young, who both lead organized vaccination efforts in their communities, talk about the mission behind the effort now.

Silvester is the Louisiana director for Resilience Force, a workforce development program that employed hospitality workers who lost their jobs during the pandemic and trained them to be community health workers. In New Orleans, their teams work to meet people who have not yet received the vaccine with information and an open mind. They've set up at grocery stores, beauty salons and parks. And they've seen success by reaching people directly, in their language, and by also offering referrals for other services, like help with unemployment insurance.

It's about building trust and it's also about the larger picture, Silvester said. The virus has devastated people's lives in every sense, and she wants people to know that they understand that, too.

"This is about the future - their future, for their lives to go back to normal, but also the future of our kids who are now being thrown into the hospital system," she said.

Young, a member of the Diné, or Navajo Nation, founded a nonprofit in the wake of the pandemic called Protect the Sacred that also builds on the idea that the vaccination effort is not just important now, but will also help preserve the valuable knowledge of elders and ensure cultures are preserved.

Young's grandparents, who are in their 80s, were part of the inspiration for her push for vaccinations. Her grandmother had a hand in raising her, and her grandfather is a medicine man who is still passing along his traditional wisdom. Young's mother works at Indian Health Services in Shiprock, New Mexico, and is among the many health care workers who have shown up to help run vaccination events in Navajo Nation after the virus drove some of the highest death tolls in Native communities this past year.

"When you think about the mutual aid efforts that popped up across the Navajo Nation very early on, they were all led by women. It's very hard work. You put yourself out there and you are vulnerable and you put yourself in a situation where you may be attacked online. Just the emotional labor," Young said. "That's what it comes down to: Native women - we are all about community."

They've been successful: Navajo Nation, once the epicenter of the pandemic, now has about a 70 percent vaccination rate. But Young said she is focusing her remaining energy on the next 30 percent. What has resonated with many people is that they have seen the devastation first hand.

"We don't know one person who hasn't been affected and lost a loved one," Young said. "Our community is so close and family-oriented and community-oriented."

At the individual level, the recent spike in cases due to the Delta variant has been a motivator for many people to restart conversations around the vaccine they had tabled earlier in the year with reluctant loved ones.

Cass Casarez, a coffee shop worker in St. Paul, Minnesota, said as they've felt the tangible and growing fear of watching more and more customers come in their shop without masks, working to get their mom vaccinated felt like one of the few things they could control.

Casarez's mother has been skeptical of the vaccine's efficacy, particularly after her sister experienced longer-term symptoms after receiving a dose. It's a personal decision, and Casarez wants to respect that, but as someone who works face to face with customers every day, they know those decisions can put others in harm's way.

"It's frustrating that her decision impacts so many people and we see the stories about the family members, or the people who are on their deathbed with COVID, they say they wish they got the vaccine earlier," Casarez said earlier this month. "I am just scared that's going to be my mom."

As a nonbinary transgender person, Casarez also knows they are personally more at risk for complications from the virus, even though they are vaccinated.

For weeks, the anxiety has built up. Then last week a text came in from their mom: "Well I have been mandated to get the vaccine, spiked a fever with both. The second shot had me down 4 days grr and still have to wear a mask. Not happy about that at all."

Shocked, Casarez told their mom how glad they were: "I hope you know you getting vaccinated will help things get back to normal.... I know you had to do it, but thank you for getting it."

The relief they felt is the reason so many have taken on this work, even when it feels like there isn't much left to give after 17 months that have taken so much.

It was the lifting of the heaviest burden, Casarez said, "like serenity for me."

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Women of color and LGBTQ+ people are taking on the invisible work of the vaccination effort

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There was a point a couple of weeks ago when every patient Dr. Oni Blackstock saw - back to back to back - said they didn't want the coronavirus vaccine. "Why are you people always pushing this?" one woman snapped at her the second she brought it up.

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The roots of U.S. vaccine mandates predate both the U.S. and vaccines.

A group of people observing a doctor as he vaccinates a man in an 1870s illustration called "Vaccinating the Poor," by Solomon Eytinge Jr. Credit... via National Library of Medicine

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As disease and death reigned around them, some Americans declared that they would never get vaccinated and raged at government efforts to compel them. Anti-vaccination groups spread propaganda about terrible side effects and corrupt doctors. State officials tried to ban mandates, and people made fake vaccination certificates to evade inoculation rules already in place.

The years were 1898 to 1903, and the disease was smallpox. News articles and health board reports describe crowds of parents marching to schoolhouses to demand that their unvaccinated children be allowed in, said Michael Willrich, a professor of history at Brandeis University, with some even burning their own arms with nitric acid to mimic the characteristic scar left by the smallpox vaccine.

"People went to some pretty extraordinary lengths not to comply," said Professor Willrich, who wrote "Pox: An American History," a book about the civil liberties battles prompted by the epidemic.

If it all sounds familiar, well, there is nothing new under the sun: not years that feel like centuries, not the wailing and gnashing of teeth over masks, and not vaccine mandates either.

As the coronavirus overwhelms hospitals across the South and more than 650,000 Americans - an increasing number of them children - lie dead, the same pattern is emerging. On Thursday, President Biden announced that he would move to require most federal workers and contractors to be vaccinated and, more sweepingly, that all employers with 100 or more employees would have to mandate vaccines or weekly testing. Colleges, businesses and local governments have enacted mandates at a steady pace, and conservative anger has built accordingly.

On Monday, Representative Jim Jordan, Republican of Ohio, tweeted that vaccine mandates were "un-American." In reality, they are a time-honored American tradition.

But to be fair, so is public fury over them.

"We're really seeing a lot of echoes of the smallpox era," said Elena Conis, an associate professor and historian of medicine at the University of California, Berkeley. "Mandates elicit resistance. They always have."

The roots of U.S. vaccine mandates predate both the U.S. and vaccines. The colonies sought to prevent disease outbreaks by quarantining ships from Europe and sometimes, in the case of smallpox, requiring inoculations: a crude and much riskier predecessor to vaccinations in which doctors rubbed live smallpox virus into broken skin to induce a relatively mild infection that would guard against severe infection later. They were a source of enormous fear and anger.

In January 1777, George Washington mandated inoculations for the soldiers under his command in the Continental Army, writing that if smallpox were to break out, "we should have more to dread from it, than from the Sword of the Enemy." Notably, it was in large part the soldiers' desires that overcame his resistance to a mandate.

"They were the ones calling for it," said Andrew Wehrman, an associate professor of history at Central Michigan University who studies the politics of medicine in the colonial and revolutionary eras. "There's no record that I have seen - and I've looked - of any soldier turning it down, protesting it."

Buoyed by the success of the mandate, Washington wrote to his brother in June 1777 that he was upset by a Virginia law restricting inoculations. "I would rather move for a Law to compell the Masters of Families to inoculate every Child born within a certain limitted time under severe Penalties," he wrote.

Over the next century, many local governments did exactly that. Professor Wehrman this week tweeted an example of what, in an interview, he said was a "ubiquitous" phenomenon: The health board in Urbana, Ohio, Jordan's hometown, enacted a requirement in 1867 that in any futureepidemic, "the heads of families must see that all the members of their families have been vaccinated."

But by the end of the 1800s, opposition was louder and more widespread. Some states, particularly in the West, introduced laws prohibiting vaccine mandates. Others narrowly passed mandates after intense debate.

The reasons for resistance were myriad: Some Americans opposed mandates on the grounds of personal liberty; some because they believed lawmakers were in cahoots with vaccine makers; and some because of safety concerns that were, to be fair, more grounded in reality than the modern equivalent. Vaccines then were not regulated the way they are now, and there were documented cases of doses contaminated with tetanus.

The government's response resembled what, today, are wild conspiracy theories. Contrary to the assertions of some on the far right, the Biden administration has never suggested going door to door to force people to take coronavirus vaccines. But in the 1890s and 1900s, that actually happened: Squads of men would enter people's homes in the middle of the night, breaking down doors if necessary, to inject people with smallpox vaccines.

Legally speaking, the Supreme Court resolved the issue of mandatory vaccinations in 1905, ruling 7-2 in Jacobson v. Massachusetts that they were constitutional.

The Constitution "does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint," Justice John Marshall Harlan, known for defending civil liberties, wrote. "Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others."

Understand Vaccine and Mask Mandates in the U.S.

Vaccine rules.On Aug. 23, the Food and Drug Administration granted full approval to Pfizer-BioNTech's coronavirus vaccine for people 16 and up, paving the way for an increase in mandates in both the public and private sectors. Private companies have been increasingly mandating vaccines for employees. Such mandates are legally allowed and have been upheld in court challenges.

Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.

College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.

Schools. Both California and New York City have introduced vaccine mandates for education staff. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.

Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.

New York City. Proof of vaccination is required of workers and customers for indoor dining, gyms, performances and other indoor situations, although enforcement does not begin until Sept. 13. Teachers and other education workers in the city's vast school system will need to have at least one vaccine dose by Sept. 27, without the option of weekly testing. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.

At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country's 1.3 million active-duty troops "no later" than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.

In the court of public opinion, there was no such resolution.

The polio vaccine was less controversial, mainly because it wasn't initially mandated and because it had been funded by a widely respected nonprofit: the National Foundation for Infantile Paralysis, now called the March of Dimes. This reduced opposition based on mistrust of pharmaceutical companies, and most parents willingly got their children vaccinated. The measles vaccine, too, was not particularly controversial because mandates were not initially enforced.

"Nobody was enforcing vaccination, and so it simply didn't elicit that mistrust," Professor Conis said. In the smallpox era, by contrast, "skeptical people said, 'Well, why are we doing this? It just benefits the companies making the vaccine and the doctors administering the vaccine, and why should we trust any of them?'"

But the fear and anger came roaring back with the introduction of childhood vaccination mandates in the 1970s. By 1980, all 50 states required schoolchildren to be vaccinated against an array of diseases.

None of it is new, but one thing distinguishes today's anti-vaccination protesters from those of the past. The opposition was always political. It wasn't always partisan.

"There are plenty of echoes today: There are liberty claims, there are strong sentiments about parental rights, there are concerns about the science, there are concerns about the profit involved," Professor Willrich said. "But this party divide in terms of who is most likely to be hesitant or refuse a vaccine mandate is really, I think, something of our own 21st-century moment."

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Vaccination Mandates Are an American Tradition. So Is the Backlash.

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The roots of U.S. vaccine mandates predate both the U.S. and vaccines. Sign up here to get On Politics in your inbox every weekday. As disease and death reigned around them, some Americans declared that they would never get vaccinated and raged at government efforts to compel them.

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Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.
It appears that the U.S. Food and Drug Administration will beat its goal of giving the first COVID-19 vaccine full approval by Labor Day. The agency is preparing to declare the Pfizer vaccine safe and effective and remove it from being administered under an emergency approval order.

The approval may arrive today or in the next few days as the agency works through a mountain of data from hundreds of millions of vaccines delivered.

The status removes one more barrier that vaccine skeptics have to taking the vaccine. A recent poll by the Kaiser Family Foundation found the lack of full FDA approval is a key reason that people who are unvaccinated give for not taking the shot. The newest polling shows:

Three in ten of the unvaccinated ( 31%) report that they would be more likely to get vaccinated if the FDA moved vaccines from emergency use to full approval. That's because many unvaccinated people worry that the vaccines are experimental and fears about the safety of the vaccine are a major reason some groups are hesitant to get vaccinated. FDA approval offers an opportunity to aggressively address safety and efficacy concerns. Lack of FDA approval has allowed the idea that the vaccines are unsafe or ineffective to fester.

More than half of the unvaccinated are also unsure what the status of FDA approval is. Approval also offers an opportunity to clear up substantial public confusion.

Some employers who have imposed vaccine mandates, including hospitals, have faced blowback from some employees. Approval will provide justification and cover for them.

And most important of all, it can boost vaccinations by emboldening more local governments and employers to move ahead with passports and mandates. Education Secretary Cardona underscored the point in a recent Washington Post interview: "I would favor the vaccine being required but ... having the FDA do the final approval on it would make some who don't feel comfortable feel comfortable."

Once the FDA gives approval, you can count on government- and employer-sponsored campaigns that stress the full approval as a new reason to get vaccinated.

The committee that will consider full FDA approval is the Vaccines and Related Biological Products Advisory Committee. The committee posts research materials and live feeds of meetings to this FDA website. These are the committee members. Check the list because they are from all over the country and might be near you.

Let's get you caught up on the terminology you will hear a lot in the next couple of days. Pfizer applied for a Biologics License Application, or BLA - which would mean full approval. When the company applied for full approval, BioNTech CEO Dr. Uğur Şahin said, "Following the successful delivery of more than 170 million doses to the U.S. population in just a few months, the BLA submission is an important cornerstone of achieving long-term herd immunity and containing COVID-19 in the future."

A year ago, Pfizer and Moderna collected data from tens of thousands of volunteers, half of whom took the vaccine and half of whom got placebos. The Pfizer trial involved 43,000 participants, while 30,400 people took part in the Moderna trial.

Emergency use approval required the drug companies to follow the volunteers for two months after vaccination. Experts say two months is usually enough to know what reactions we can expect from a vaccine.

But full approval requires at least six months of data. Massive amounts of evidence are collected that can lead the FDA to issue warnings for possible side effects, as it has done with the Johnson & Johnson vaccine. The FDA once required the drug companies to complete their data collection and submit it, but now the FDA has a "Fast Track" system that allows companies to collect and submit data on a rolling basis to speed the time it takes to get medicines and treatments to market faster.

FDA approval does not change who should take the vaccine. It still will not likely be approved for younger children since those drug trials are still underway.

But full approval would also allow Pfizer to directly market the vaccine to the public. For example, all of those pharmaceuticals that you see in TV commercials required that the FDA fully approved those drugs first.

Full approval also pretty much closes the door on any other companies who come up with new vaccines and want fast approval. The FDA's rules spell out that emergency approval is only given when "there is no adequate, approved, and available alternative." And full approval allows the Pfizer vaccine to remain available even when the official "emergency" ends.

Don't read more into this than we know, but the Centers for Disease Control and Prevention advisory board that looks at vaccines had planned to meet Tuesday to consider approving COVID-19 booster shots for everyone who has been vaccinated. Now that meeting has been delayed for a week.

You knew that, as soon as the Biden administration announced last week that it would ask the FDA and CDC to approve COVID-19 booster shots eight months after people were vaccinated, some people would try to jump the line and grab their third shot ahead of everyone else.

But Dr. Anthony Fauci said people would be wise to wait the full eight months to give their immune systems a chance to "mature" before getting a booster.

NBC News points out:

Deepta Bhattacharya, professor of immunobiology at the University of Arizona, echoed Fauci's comments, telling NBC News that getting a booster soon after a second shot "raises the possibility that it won't work that well."

He explained that third doses will likely work much better after fully vaccinated people lose some of the antibodies in their systems. He was quick to add that people will need to balance that likelihood "against the risk that your protection is reduced during the interval between shots."

By the way, CDC Director Dr. Rochelle Walensky said, at this time, she does not think you will be getting annual COVID-19 shots. But, she said, "This virus has been humbling, so I don't want to say never, but we are not necessarily anticipating that you will need this annually."

I had to dig around a little to understand this one. The city of Orlando asked people to cut back on their water use to help hospitals treat COVID-19 patients.

Linda Ferrone of the Orlando Utilities Commission and Orlando Mayor Buddy Dyer told people in Orlando that the city uses liquid oxygen to purify water, but right now that oxygen is needed to treat COVID-19 patients in hospitals.

The city is asking people not to water their lawns or wash their cars for a couple of weeks.

Mayor Dyer said nationally the demand for liquid oxygen is high and supplies are tight. He said the city is not in an oxygen emergency yet but didn't want to wait until there was a critical shortage.

Orlando is far from alone in this situation. Other places that have been overrun with new cases, like Alabama, have run short of liquid oxygen, too.

Those of us who grew up around Kentucky horse farms know the drug ivermectin as a horse dewormer medication. Whoever started the rumor that that drug could fight COVID-19 is now responsible for a spike of poisonings.

In fact, the Mississippi State Department of Health sent out a warning saying, "The Mississippi Poison Control Center has received an increasing number of calls from individuals with potential ivermectin exposure taken to treat or prevent COVID-19 infection. At least 70% of the recent calls have been related to ingestion of livestock or animal formulations of ivermectin purchased at livestock supply centers. 85% of the callers had mild symptoms, but one individual was instructed to seek further evaluation due to the amount of ivermectin reportedly ingested."

Let's be clear, livestock drugs are made for livestock. They are highly concentrated and can be really dangerous to humans.

When the school district in Paris, Texas, wanted to require students to wear masks, it found itself in a showdown with the governor who, despite testing positive himself recently, opposes mask mandates. So the school district changed its dress code.

Dennis Eichelbaum, Paris Independent School District general counsel, said it is not a loophole. He said, "Mandating masks is really no different than mandating shoes or other protective gear that we require."

By the way, Gov. Greg Abbott said over the weekend that he has tested "negative" for the virus and credits the vaccine for the brevity of his illness.

It seems that most places that are imposing COVID-19 vaccine mandates leave open a small window for people who have religious or health exemptions that prevent them from taking the vaccine. But now, several Catholic archdioceses are refusing to issue such exemptions for parishioners who ask. Axios says:

Though the Vatican says getting the vaccine is " morally acceptable," some bishops have argued that vaccination is not a moral obligation and must be voluntary.

At least five other diocese - including San Diego, New York, Los Angeles, Honolulu and Camden, N.J. - have issued similar guidance, while other bishops and Catholic organizations have publicly backed parishioners seeking exemptions for reasons of conscience.

In Lexington, Ky., employees at the Catholic Center of the Catholic Diocese of Lexington will be required to be vaccinated against COVID-19, Bishop John Stowe announced this week.

Just as the cruise industry was starting to get its sea legs back, the CDC issued new warnings to older adults, pregnant people and people with certain medical conditions.

Until now, the CDC's guidance was mostly aimed at unvaccinated people. The new guidance says COVID-19 can spread easily between people in close quarters on ships, and the chance of getting the virus on cruise ships is "high." Here is CDC's newest alert:

Key Information for Cruise Ship Travelers

The virus that causes COVID-19 spreads easily between people in close quarters aboard ships, and the chance of getting COVID-19 on cruise ships is high. Outbreaks of COVID-19 have been reported on cruise ships.

CDC recommends that people who are not fully vaccinated avoid travel on cruise ships, including river cruises, worldwide.

People with an increased risk of severe illness should also avoid travel on cruise ships, including river cruises, regardless of vaccination status.

People who decide to go on a cruise should get tested 1-3 days before their trip and 3-5 days after their trip, regardless of vaccination status.

Along with testing, passengers who are not fully vaccinated should self-quarantine for 7 days after cruise travel, even if they test negative. If they do not get tested, they should self-quarantine for 10 days after cruise travel.

People on cruise ships should wear a mask to keep their nose and mouth covered when in shared spaces. While CDC's Mask Order is not being enforced on cruise ships, individual cruise lines may require travelers (passengers and crew) to wear masks indoors on board the ship.

USA Today reports:

COVID-19 outbreaks have been reported on cruise ships in recent months, despite various testing and vaccination requirements among cruise lines.

In July, four vaccinated adults and two unvaccinated children tested positive for COVID-19 on a Royal Caribbean ship that had required passengers 16 and older to be fully vaccinated against COVID-19 and all passengers to receive a negative test before boarding. Last week, 27 people - 26 of whom were crew members - tested positive for COVID-19 on Carnival Cruise Line's Carnival Vista ship. More than 99% of crew members were vaccinated on the ship and 96.5% of passengers were vaccinated, according to the Belize Tourism Board.

The New York Times gives us a look at why it is good for patients that hospitals are required to publish their prices for common treatments and procedures. Hospitals fought that rule, which took effect today. Some make it difficult to find the prices. But, when you do, you find what the Times found: "In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all."

The Times points out, "This secrecy has allowed hospitals to tell patients that they are getting "steep" discounts, while still charging them many times what a public program like Medicare is willing to pay. And it has left insurers with little incentive to negotiate well. The peculiar economics of health insurance also help keep prices high."

If Congress wants to investigate something useful that affects everyone - including you, me and our employers - this is a good place to spend some time and energy.

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You saw that sentence in the cutline, right? First class airline passengers, who I assume are less rowdy, still get drinks.
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I now have a collection of drink tickets from airlines that do not serve alcohol but plan to next year. I don't drink, but I certainly understand why a person might these days.

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Why the FDA's full approval of COVID vaccines matters - Poynter

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Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning. It appears that the U.S.

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The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can find all of the stories here.
As an emergency medicine and critical care doctor at the University of Washington School of Medicine in Seattle, I've lost count of the number of COVID-19 surges since the U.S. pandemic began in Seattle in February 2020. But this one feels different. The patients are younger. They have fewer preexisting medical conditions. And at my hospital, over 95% of these hospitalized patients share one common feature: They're unvaccinated.

While I'm grateful to see news of the FDA's recent full approval of one of the COVID-19 mRNA vaccines, the science has been clear in my mind for quite some time. mRNA vaccines, first developed over nearly 50 years, are nothing short of a miracle of science designed for situations just like a respiratory virus pandemic. The vaccines are the most effective tool we have to prevent severe illness and hospitalization and protect our precious health care resources. Some of my colleagues just published a study showing exactly this.

Of course, every medical treatment has risks and potential side effects, but we've witnessed the world's largest vaccine trial, with more than 200 million people in the U.S. receiving at least one dose. Doctors can confidently say that vaccine side effects are rare and generally mild, and rumors about vaccines altering DNA or causing infertility are completely unfounded, with no scientific basis.

But I also have sympathy for those who fell victim to disinformation. Too many times I've been asked by a family member of a dying patient with COVID-19 if it was too late for the vaccine. Too many times, I've had to say yes. The next question is often, "Is there anything else that can be done?" Too often, the answer is no.

Having this conversation over and over again, often over teleconferencing software or the phone, is exhausting and profoundly sad, especially knowing that, in the case of unvaccinated patients, it likely could have been prevented.

I realize that not everybody sees what I see every day. While stories about vaccine reactions abound, few hear about the realities of severe COVID-19 infection. However, when I close my eyes at night, I see the healthy 27-year-old man who died after four weeks hooked up to machines that tried to keep him alive, and the young family he left behind. I see the 41-year-old woman now weak and permanently disabled after a long hospital stay. I see the 53-year-old farmworker who now requires dialysis after developing renal failure, a common complication of severe COVID-19. And countless more.

I often hear claims of " 99% survival" from COVID-19 with or without the vaccine, but in reality, the facts are much more staggering. Nearly 1 in 500 Americans has died from this disease, and for those who survive, the devastation is like nothing I've ever seen. Holes in lungs, muscle wasted, organs failing one by one - millions of people will suffer physical, psychological and financial consequences that will last months or years, a toll difficult to quantify.

The impact on our health care system is also difficult to quantify. Staffing, even more than beds or ventilators, is critically low. In Washington state, Texas and across the country, experienced health care workers are leaving the profession in droves, exasperated by the continuous onslaught of sick COVID-19 patients and a demanding work environment. People - nurses, respiratory therapists, doctors, physical therapists, sanitation workers - do the work in hospitals; a hospital bed is worthless without staff to provide care.

Because of these staffing shortages, hospitals are closing, and the inequities and weaknesses in an already-stretched health care system are being exposed. Revered as "health care heroes" just a year ago, doctors are being heckled and even assaulted after speaking out about science at school board meetings.

I'm frustrated that more Americans have not chosen to get vaccinated, to wear masks, to take this pandemic seriously. I often wonder what 2021 would look like if they had. For example, we've worn masks in the hospital for years for procedures and to protect us from other respiratory viruses. We know that the SARS-CoV-2 virus can be spread by aerosols that remain suspended in the air, and that some masks can't entirely block these droplets. But we also know that COVID-19 and most other respiratory viruses also spread from coughing and sneezing via larger respiratory droplets, which most masks do block. Masks are not perfect, but there is strong evidence that they reduce transmission.

With many hospitals at capacity, there have been questions in the media and elsewhere about whether hospitals or health care workers should prioritize the care of the vaccinated, or even refuse to care for unvaccinated individuals who develop severe COVID-19, but that's not how we think. In medicine, especially in emergency and critical care medicine, we often care for people who make poor choices about their health. We counsel, we provide information, we hope and we press on, providing the exact same care regardless of choices or beliefs.

Although stretched thin and imperfect, we do our best for everyone who needs us. But many places have reached a point at which the demand for health care has outstripped the ability to provide it. And we need help.

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At my hospital, over 95% of COVID-19 patients share one thing in common: They're unvaccinated

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The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can find all of the stories here. As an emergency medicine and critical care doctor at the University of Washington School of Medicine in Seattle, I've lost count of the number of COVID-19 surges since the U.S.

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Curious Kids is a series for children of all ages. If you have a question you'd like an expert to answer, send it to curiouskidsus@theconversation.com.
How does a COVID-19 vaccine work in the body? - Wixy, age 12, New York

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has changed the way people live around the world. As of late August 2021, more than 630,000 people have died in the United States alone. Health experts agree that COVID-19 vaccines are one important way to help bring an end to the pandemic.

But getting a vaccine can be scary for both kids and adults. Plus, there is lot of information about how the COVID-19 vaccines work, but some of it can be hard to understand.

As a pediatrician, infectious disease doctor and scientist who studies germs like bacteria and viruses, I have devoted close attention to the pandemic and the development of the COVID-19 vaccines.

Vaccines are made to resemble invaders

The most important thing to understand about vaccines is that they teach your body how to gear up to fight an infection, without your body having to deal with the infection itself. In this way, vaccines help your body be prepared for invasions by germs that could otherwise make you very sick.

All three of the COVID-19 vaccines available in the U.S. focus on what is called the spike protein of the SARS-CoV-2 virus, or coronavirus. SARS-CoV-2 is a round virus, with bumps all over it - sort of like a baseball covered in golf tees. The bumps are the spike proteins.

On an actual coronavirus, spike proteins allow the COVID-19 virus to get into cells so the virus can make more copies of itself. It does this by sticking to certain kinds of proteins, called receptors, on human cells - particularly lung cells. In this way, the virus can break into healthy cells and infect them.

The Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines all work similarly by giving the body's cells the instructions to make the spike protein. The Pfizer and Moderna vaccines carry these instructions on a molecule called mRNA. This single-stranded molecule looks like a long piece of tape with the instructions to make a protein coded on one side.

The Johnson & Johnson vaccine, on the other hand, passes the instructions to cells through DNA molecules. It uses a virus called an adenovirus, which cannot make copies of itself, to carry the spike proteins' DNA into human cells. This DNA gets copied into mRNA, which then translates the instructions into proteins - in this case, the spike protein of the coronavirus.

Trinset/iStock via Getty Images Plus

So the main difference between the three vaccines is that the Pfizer and Moderna shots give your body instructions for the spike protein through mRNA, while the Johnson & Johnson shot directs it via DNA. After that, all three vaccines work the same way.

What happens when the vaccine enters your body?

Once a COVID-19 vaccine is injected, the mRNA or DNA gets swallowed up by tissue cells and special immune cells that live in muscles, skin and organs called dendritic cells. Dendritic cells keep watch over all parts of the body like sentinels, searching for signs of invading germs - like the coronavirus.

As soon as the DNA or mRNA is inside the dendritic or tissue cells, the cells use the instructions to create spike proteins. This process usually takes less than 12 hours. After the spike proteins are made and ready to "show" to the immune system, the mRNA or DNA is broken down by the cell and eliminated.

It's important to know that even though your cells have made their own spike proteins, they don't have enough information to make copies of the full virus. But the spike proteins can trigger the body's immune system to amp up its defense so it is ready if the whole coronavirus invades.

When the tissue cells and dendritic cells recognize the spike proteins as unwelcome visitors, the cells place sections of the spike proteins on their exterior for other cells to see. The dendritic cells also release "danger" signals at the same time to let other cells know that the spike protein presents a threat. The danger signals are like flashing neon yellow signs pointing to the displayed spike protein piece saying, "This does not belong!"

These warning signals then fire up your body's immune response.

What happens once the immune system gets revved up?

Thanks to that process, the body is now on high alert and ready to learn to fight invaders - in this case, the spike proteins made after injection with the COVID-19 vaccine.

Immune cells in the body, called B-cells and T-cells, recognize the warning signs of an outside invader. Thousands of these cells rush to the area to learn about this new threat so they can help provide protection.

B-cells are specialists at building "traps," called antibodies, that will take down any invading spike proteins. Different B-cells make lots of specialized antibodies that recognize different parts of a virus or bacteria. And B-cells will act like a factory, continuing to make antibodies against the perceived threat even after it's gone in order to protect the body for a long time to come.

Christoph Burgstedt/Science Photo Library via Getty Images

One type of T-cell, called helper T-cells, assist the B-cells in making antibodies when danger signals are present. Another kind of T-cell is there to check if other cells in the body are infected by the virus. If that type of T-cell spots an infected cell, it removes the infected cell so it cannot create more copies and pass on the infection to other cells.

Why is my arm sore?

As all of these important processes are happening inside your body, you might see some physical signs that there's a struggle going on underneath the skin. If your arm gets sore after you get the shot, it's because immune cells like the dendritic cells, T-cells and B-cells are racing to the arm to inspect the threat.

You might also experience a fever or other signs of sickness. All of these mean that your body is doing exactly what it's supposed to. This is a safe and natural process that happens when the body is learning how to fight the spike proteins. That way, if you do come into contact with the real coronavirus, your body has learned how to protect you from it.
Hello, curious kids! Do you have a question you'd like an expert to answer? Ask an adult to send your question to CuriousKidsUS@theconversation.com. Please tell us your name, age and the city where you live. And since curiosity has no age limit - adults, let us know what you're wondering, too. We won't be able to answer every question, but we will do our best.

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What happens when the COVID-19 vaccines enter the body - a road map for kids and grown-ups

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Curious Kids is a series for children of all ages. If you have a question you'd like an expert to answer, send it to curiouskidsus@theconversation.com. How does a COVID-19 vaccine work in the body? - Wixy, age 12, New York The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has changed the way people live around the world.

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About 18 months into the coronavirus pandemic, roughly 61% of all Americans have gotten at least one dose of a COVID-19 vaccine. In some states, however, the share of vaccinated people is as low as 43.6%. There are many counties where numbers are even lower than that, leaving them especially vulnerable to surges in coronavirus infections, hospitalizations and deaths. Here, four public health and communications experts from Michigan, Indiana, Mississippi and South Carolina explain how they are teaming up with nonprofits and other partners to encourage more people in their states and local communities to get these potentially lifesaving shots.
1. Closing the racial gap in Michigan's COVID-19 vaccination
Debra Furr-Holden, professor of public health, Michigan State University
Initially, Michigan was one of many states with tremendous racial disparities in COVID-19 cases and deaths. As a result, the state tried to make it easier for Blacks and other people of color to get tested, acquire personal protective equipment and, once vaccines became available, get vaccines.

About 13% of Michigan residents are Black, and yet 10% of the people in the state who had gotten at least one dose of a vaccine by Aug. 16, 2021 were Black, according to the Kaiser Foundation.

This imbalance is one reason why I helped launch the National Network to Innovate for COVID-19 and Adult Vaccine Equity, funded with a $6 million grant from the Centers for Disease Control and Prevention. One overarching goal of this project is to close the racial disparities gap in COVID-19 and other adult vaccinations, such as the flu and shingles.

The project is a partnership between Michigan State University, Michigan Public Health Institute, the Community Foundation of Greater Flint and Community Campus Partnerships for Health. It also partners with organizations committed to reducing African American health disparities, including the NAACP, the Rainbow PUSH Coalition and the National Medical Association.

2. Outreach to Latinos and members of the Haitian community in Indiana

Omolola Adeoye-Olatunde, assistant professor of pharmacy practice, Purdue University

Marion County, which includes Indianapolis, is racially and ethnically diverse, with nearly half the population identifying as people of color. Even before the COVID-19 pandemic, it had Indiana's highest level of food insecurity. As of mid-August, Black and Latino residents were underrepresented among people in Indiana who had gotten at least one COVID-19 vaccine dose. Roughly half of all people in Marion County had gotten at least one dose by late August 2021.

The Purdue University Center for Health Equity and Innovation, or CHEqI, where I work, partnered with the Gleaners Food Bank of Indiana and Walgreens to design and pilot an initiative that gave COVID-19 vaccines to people arriving for drive-thru food distribution.

Across the pilot's first six vaccination events occurring between June and August 2021, 2,787 families got food and 2,465 of the food bank's clients were asked about their vaccination status and interest by student pharmacists. About 60% said they'd already been vaccinated; 229 of them got vaccines by Walgreens pharmacy staff, with 14% being second-dose vaccinations.

Nearly 60% of the people who got the pilot's vaccines and reported their ethnicity self-identified as Hispanic or Latino.

Numbers of vaccinations have declined since the first events in June, but student volunteers and Walgreens staff have observed that several clients who received vaccines were previously reluctant to get them. For example, one food bank client indicated they had recently canceled a scheduled vaccine appointment due to hesitancy. Upon talking to student pharmacists and Walgreens pharmacy staff for 10 minutes, and having all of their concerns addressed, they decided to get the vaccine at a Gleaners vaccine event.

We will expand this model to another central Indiana location in late August 2021. There, we should be able to serve not just more Latinos, but many members of the Haitian immigrant community and other food-insecure people. Later, we plan to try integrating access to donated food with other public health initiatives.

I believe that this collaborative model, built on longstanding trust between Gleaners and its clients, serves as a promising avenue to simultaneously address food insecurity, decrease vaccine hesitancy, increase access to COVID-19 vaccines and promote health equity in central Indiana.

3. Navigating the Mississippi RIVER
David Buys, associate professor of health, Mississippi State University
The new Mississippi RIVER project - RIVER stands for Recognizing Important Vaccine and Education Resources - includes more than 20 students and others who are paid vaccination ambassadors. During the 2021-2022 school year, they are educating their classmates, answering frequently asked questions and encouraging their peers to visit pop-up clinics.

This partnership is funded by the Health Resources and Services Administration, a federal agency. In turn, it is funding incentives for Mississippi State students to get their shots, such as $250 in bookstore coupons or a chance to win a $9,000 tuition discount through a raffle.

Additionally, through this partnership, my university's extension service, where I do most of my work for the state, is leveraging our reach across Mississippi, including through one-on-one conversations with community members at local workplaces, festivals and other events.

4. Identifying barriers through focus groups in South Carolina

Brooke W. McKeever, associate professor of communication, University of South Carolina

Together, we are working to learn what barriers still exist, what misinformation may be spreading in various communities, how we can increase trust and convince those who have not been vaccinated to get their shots amid an alarming outbreak.

Based on what we learn through focus groups, we will work with community health workers to address misinformation and communicate with those who still have concerns that are keeping them from getting vaccinated. If there are other barriers, such as access to vaccines, we will address those, too.

Our Prevention Research Center is one of many throughout the U.S. that have been funded by the Centers for Disease Control and Prevention as part of its COVID-19 Vaccinate with Confidence Strategy program. We hope our work with the CDC, state agencies and local nonprofits will get more South Carolina residents vaccinated, which will help protect us all moving forward.

[ Research into coronavirus and other news from science Subscribe to The Conversation's new science newsletter.]

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How public health partnerships are encouraging COVID-19 vaccination in Mississippi, Michigan, Indiana and South Carolina

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About 18 months into the coronavirus pandemic, roughly 61% of all Americans have gotten at least one dose of a COVID-19 vaccine. In some states, however, the share of vaccinated people is as low as 43.6%. There are many counties where numbers are even lower than that, leaving them especially vulnerable to surges in coronavirus infections, hospitalizations and deaths.

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The resurgence of COVID-19 this summer and the national debate over vaccine requirements have created a fraught situation for the nation's first responders, who are dying in larger numbers but pushing back against mandates.

It's a stark contrast from the beginning of the vaccine rollout when first responders were prioritized for shots.

The mandates affect tens of thousands of police officers, firefighters and others on the front lines across the country, many of whom are spurning the vaccine. That is happening despite mandates' consequences that range from weekly testing to suspension to termination - even though the virus is now the leading cause of U.S. law enforcement line-of-duty deaths.
READ MORE: 4 takeaways about Americans' COVID views at summer's end
According to the Officer Down Memorial Page, 132 members of law enforcement agencies are known to have died of COVID-19 in 2021. In Florida alone last month, six people affiliated with law enforcement died over a 10-day period.

Despite the deaths, police officers and other first responders are among those most hesitant to get the vaccine and their cases continue to grow. No national statistics show the vaccination rate for America's entire population of first responders but individual police and fire departments across the country report figures far below the national rate of 74% of adults who have had at least one dose.

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More U.S. first responders are dying of COVID-19

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The resurgence of COVID-19 this summer and the national debate over vaccine requirements have created a fraught situation for the nation's first responders, who are dying in larger numbers but pushing back against mandates. It's a stark contrast from the beginning of the vaccine rollout when first responders were prioritized for shots.

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We've spent the past year trying to analyze, dissect and intellectualize all the ways that our world has changed. But sometimes the best way to understand our circumstances isn't through data and reports - it's through art and poetry. So this week, we're hearing from some of the country's most critical observers: poets.

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Spit A Verse, Drop Some Knowledge : Code Switch

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We've spent the past year trying to analyze, dissect and intellectualize all the ways that our world has changed. But sometimes the best way to understand our circumstances isn't through data and reports - it's through art and poetry. So this week, we're hearing from some of the country's most critical observers: poets.

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Filipinos make up a small fraction of the nurses in the United States, but almost a third of the nurses who have died of COVID-19 in the U.S. have been of Filipino descent. So what exactly is going on? Our friends over at The Atlantic and WNYC tried to understand more about this troubling statistic by telling the story of one woman: Rosary Castro-Olega.

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Filipinos make up a small fraction of the nurses in the United States, but almost a third of the nurses who have died of COVID-19 in the U.S. have been of Filipino descent. So what exactly is going on?

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Aug. 31, 2021 -- As the pandemic raged last year, Ilish Pérez, a contact tracer and case interviewer for the Los Angeles County Department of Public Health, would often reach out to more than 100 people a day. She would talk to people about their positive COVID test result and tell others that they had been exposed to COVID.

"Our shifts were generally 8 hours," says Pérez, an experienced health educator who worked in HIV and other sexually transmitted diseases before being transferred to the COVID-19 effort. But "sometimes we would do overtime. At the end of the day, I was exhausted not only physically, but mentally as well. All the emotions you go through with each different call can be quite exhausting. And during the peak, there was no downtime between calls to reset your mind."

Once the vaccines became available, and new cases slowed, her call list grew shorter. Just a few months ago, she sometimes had as few as 10 contacts a day to reach.

But now, with the Delta variant triggering a dramatic uptick in cases, Pérez and other public health workers and officials nationwide involved in contact tracing have geared back up.

While contact tracing -- the process of identifying people potentially exposed to someone infected and advising them to quarantine and test -- has taken a back seat in recent months to pandemic control plans, experts say it's time to ramp it up again.

It's also time, some say, to do contact tracing smarter. That means merging it with testing and vaccination efforts.

The public perception of contact tracing may need to change, too.

"Contact tracing is so much more than getting ahold of someone and telling them to quarantine," says True Beck, a COVID-19 response manager for the Los Angeles County Department of Public Health. Ideally, she says, it begins with a call from a compassionate person who is able to personalize the advice.

"Anyone can Google 'What to do if I am COVID-positive,'" Beck says. An effective contact tracer will go much beyond that. For instance, she says, "Our contact tracers will ask, 'Do you live in a one-bedroom apartment?'" If so, they give advice about how to isolate or, if needed, help people find a hotel. They also connect people to services. And now, of course, contact tracers should help people get vaccinated, she says.

Contact Tracing, Done Right

Many other countries have the U.S. beat at contact tracing of infectious diseases, says K.J. Seung, MD, a senior health and policy adviser for Partners in Health, a global nonprofit health organization involved with COVID-19 efforts.

That's partly because those countries have more practice, he says, as they frequently trace tuberculosis and Ebola, for instance. Even so, the contact tracing protocol common in the U.S. is outdated, he says.

"It's clear we are going to have contact tracing going forward," he says. "But we have to do it smarter than we were doing it before," says Seung, also an assistant professor of global health and social medicine at Harvard Medical School.

One way is to stop "siloing" testing, tracing, and vaccination as three separate measures and instead integrate them, as Seung and Natalie Dean, PhD, an assistant professor of biostatistics and bioinformatics at Emory University in Atlanta, wrote recently in Stat News.

While the call from a contact tracer covers a lot of ground, such as if and when people should get tested or quarantine, it is also a perfect opportunity to suggest getting vaccinated right away, Seung and Dean contend. "Linking testing and tracing to vaccination might seem obvious," the two write, "but the reality is that it is not happening nationally."

In an interview with WebMD, Seung says public health officials should consider another approach to contact tracing recognized by the CDC. It's known as source investigation, and it involves looking back at patient movements 14 days before symptoms started and identifying interactions with people, places, and events that might have been the source of the infection.

"Instead of trying to figure out who [the infected person] may have infected in the last 48 hours," he says, the question is "Where do you think you got infected? Camp? Day care? A bar?"

Benjamin J. Ryan, PhD, an environmental health specialist and clinical associate professor of environmental health science at Baylor University in Waco, TX, knows contact tracing is important. But, he says, it can be a particular challenge to identify everyone who may have been exposed.

One solution, he suggests, is to use Bluetooth devices and advanced data analytics. Participants would wear the device as a condition of entry to an event or facility. It would identify others who come within 6 feet of another person for a cumulative 15 minutes of contact. The device would deactivate once people left the venue. Then, if participants later tested positive, the venue could give public health officials a limited list of close contacts, rather than the list of the thousands who attended.

Understanding Culture, Language Differences

"Contact tracing is fundamentally an exercise in trust building," says Emily Henke, executive director of the Oregon Public Health Institute (OPHI). She's also director of the local office of Tracing Health, a partnership between OPHI and the Public Health Institute that focuses on advancing health equity.

It's difficult to build that trust if the contact tracer doesn't understand the language or the culture of the person they are calling.

The Tracing Health approach, Henke says, is to match its 293 contact tracers, culturally and linguistically, with the people they call.

"We are also looking at this as an investment in economic recovery of communities of color," she says, with 72% of its workforce Black, Indigenous, or people of color. Its team members speak 52 languages.

"When you speak the same language as someone else and you share their culture, you are better able to meet their needs," says Vadim Gaynaliy, a Tracing Health contact tracer fluent in Russian and English.

Without the need for an interpreter, he gains the trust of the people he calls more easily, he says.

Efforts to Ramp Up Contact Tracing

Approaches to contact tracing vary among states. Some states have their own employees doing it, others contract it out, and some states partner with other organizations.

With the surge of the Delta variant, many states are increasing efforts.

In Arkansas, where the 7-day average cases rose from 173 at the end of May to more than 2,000 by the end of August, contact tracing is also on the rise.

"When case volume was lower, staffing was also modified to match the lower workload," says Danyelle McNeill, a spokesperson for the state Department of Health. "Now that the case volume has escalated, the vendors [that the state contracts with] are adding staff to meet the growing caseload."

With funding an issue for many public health efforts, partnering with universities can be one solution, says Ryan, the environmental health specialist. "Tap into universities and have universities do the contact tracing in partnership with the county," he says.

How Much Can Contact Tracing Help?

"Any amount of contact tracing can help to interrupt the chains of transmission," says Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

No expert would argue with that, but the lack of funding is an ongoing obstacle, he says. "Public health infrastructure is something that has been under-resourced and undervalued for decades," he says, so it is a surprise many are having a hard time now.

Adalja bemoans the lack of cooperation early on, when many phone calls from contact tracers went unanswered.

"This was likely the result of politics and conspiracy theories about privacy issues being injected into the response from the very start," he says.

Even though the Delta variant is more than twice as contagious as previous variants, according to the CDC, contact tracing can help reduce transmission, Ryan says.

Research on prior variants found that good contact tracing could lead to a reduction in the virus's "reproductive number," or the number of secondary infections that occur, by 3 to 4 times, Ryan says. So he would expect the same reduction for Delta, but of course the overall transmission reduction would not be as great.

"Remember we are not going for [a goal of] zero COVID. We are trying to suppress the level among the unvaccinated."

Enough Exhaustion to Go Around

Contact tracers aren't the only ones who are exhausted, Henke says. Many of the people her contact tracers call are, too.

"They are exhausted and over it," she says. "That definitely affects the mood they bring into these phone calls."

Even so, Henke says, "What makes a good contact tracer is someone who can be there for that person and move the conversation forward, to help them understand there are supports out there to help them."

Pérez, the L.A. County contact tracer, notices some progress, compared to last year.

"I feel people are more willing to help," she says

That's a welcome relief from her experience last year, when family members sometimes urged COVID-positive patients to hang up and stop giving her requested information. She also senses less stigma.

"They are more comfortable telling their contacts themselves," she says.

Sources

Ilish Pérez, health educator, Los Angeles County Department of Public Health.

True Beck, COVID-19 response manager, Los Angeles County Department of Public Health.

K.J. Seung, MD, senior health and policy adviser, Partners in Health; assistant professor of global health and social medicine, Harvard Medical School.

Danyelle McNeill, spokesperson, Arkansas Department of Health, Little Rock.

Benjamin J. Ryan, PhD, environmental health specialist; clinical associate professor of environmental health science, Baylor University, Waco, TX.

Emily Henke, executive director, Oregon Public Health Institute; director of Tracing Health, Pacific Northwest.

Disaster Medicine Public Health Preparedness: "COVID-19 Contact Tracing Solutions for Mass Gatherings."

CDC: "COVID-19 Source Investigation."

Stat News: "To vaccinate more Americans, lean into outbreaks."

National Academy of State Health Policy: "State Approaches to Contact Tracing During the COVID-19 Pandemic."

The New York Times: Coronavirus Tracker.

CDC: "Delta Variant: What We Know about the Science."

YouTube: "Vadim Gaynaliy, Bilingual Contact Tracer: Filling In The Dialect Gaps Of Interpreter Services," Tracing Health.

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As Delta Surges, Contact Tracing Re-Takes COVID Center Stage

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Aug. 31, 2021 -- As the pandemic raged last year, Ilish Pérez, a contact tracer and case interviewer for the Los Angeles County Department of Public Health, would often reach out to more than 100 people a day. She would talk to people about their positive COVID test result and tell others that they had been exposed to COVID.

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Editor's note: A photo in this story contains language that some may find offensive.

Months after Kyle Dixon died, his old house in Lanse, Pa., is still full of reminders of a life cut short.

His tent and hiking boots sit on the porch where he last put them.

The grass that he used to mow has grown tall in his absence.

And on the kitchen counter, there are still bottles of the over-the-counter cough medicine he took to try to ease his symptoms at home as COVID-19 began to destroy his lungs.

Dixon was a guard at a nearby state prison here in rural, conservative Clearfield County, Pa. He died of the virus Jan. 20 at age 27.

His older sister Stephanie Rimel is overwhelmed with emotion as she walks through Dixon's home and talks about him.

"I'll never get to be at his wedding," Rimel says. "I'll never see him old. Like, that was the last birthday in September we got to celebrate with him."

Her grief, however, quickly turns to anger. Rimel recalls some of the misinformation that proliferated last year: Masks don't work. The virus is a Democratic hoax to win the election. Only old people or people who are already sick are at risk.

Rimel says her brother believed some of that. He heard it from other prison guards, from family and friends on Facebook, she says, and from the former president, whom he voted for twice.

These falsehoods and conspiracies fostered a dismissive attitude about the coronavirus among many rural Pennsylvanians, here where she and her siblings grew up. Because of the misinformation, Dixon didn't always wear a mask or practice physical distancing, Rimel says.

Some of those beliefs were even expressed by members of their family - making Rimel's grief more painful and isolating.

Rimel recalls a particularly tough time right after her brother had to be hospitalized. Even then, family members were repeating conspiracy theories on social media and bragging about not wearing masks, Rimel says.

Some of the same people who attended Dixon's funeral are still sharing misinformation related to COVID-19 online, says another sister, Jennifer Dixon.

"They're back to posting their same stuff," she says. " 'It's a hoax' - that sort of stuff."

Jennifer Dixon wishes those people could understand what her brother endured while hospitalized.

"I wish that they could have been there his last days and watched him suffer," she says. "Watch his heart still be able to beat. His kidneys still producing urine because [they were] so strong. His liver still working. Everything. It was his lungs that were gone. His lungs. And that was only due to COVID."

Both sisters wanted their brother's death notice to be unambiguous about what had killed him. It reads, "Kyle had so much more of life to live and COVID-19 stopped his bright future."

The notice also included a warning that the virus is real and can kill.

While these sisters have chosen to be outspoken about what happened, other families have opted to keep quiet about deaths from COVID-19, according to Mike Kuhn, a funeral director in Reading, Pa.

Kuhn's business did not handle Kyle Dixon's funeral, but over the course of the pandemic his chain of three funeral homes has helped bury hundreds of people who died from the coronavirus. He says about half of those families asked that COVID-19 not be mentioned in obituaries or death notices.

"You know, I've had people say, 'My mother or my father was going to die, probably in the next year or two anyway, and they were in a nursing home, and then they got COVID, and you know, I don't really want to give a lot of credence to COVID,' " Kuhn says.

Some families wanted to have their loved one's official death certificate changed so that COVID-19 was not listed as the cause of death, Kuhn adds. Death certificates are official state documents, so Kuhn couldn't make that change even if he wanted to so. But the request shows how badly some people want to minimize the role of the virus in a loved one's death.

Refusing to face the truth about what killed a family or community member can make the grieving process much harder, according to Ken Doka, who works for the Hospice Foundation of America and has written books about aging, dying, grief and end-of-life care.

When a person dies from something controversial, Doka says, that's called a "disenfranchising death." The term refers to a death that people don't feel comfortable talking openly about due to social norms.

Doka pioneered the concept in the 1980s, along with a related concept: "disenfranchised grief." This occurs when mourners feel they don't have the right to express their loss openly or fully because of the cultural stigma about how the person died. For example, deaths from drug overdoses or suicide are frequently viewed as stemming from a supposed "moral" failure, and those who are left behind to mourn often fear others are judging them or the dead person's choices and behaviors, Doka says.

"So for instance, if I say my brother died of lung cancer, what's the first question you're going to ask - was he a smoker?" Doka says. "And somehow, if he was a smoker, he's responsible."

Doka says he saw this dynamic a lot when the AIDS crisis first began in the 1980s. At conferences, doctors often called children with AIDS "innocent victims." Doka hated the term because it implied that the adults, in contrast, were somehow to blame and deserved to have the disease. "To me, anybody who had it was an innocent victim," he says.

These days, Doka predicts, Americans who have lost loved ones to COVID-19 in communities where the virus isn't taken seriously may also encounter similar efforts to shift responsibility - from the virus to the person who died.

Dixon's sisters have experienced that firsthand: When they tell people their brother died of COVID-19, they're often asked whether he had preexisting conditions or if he was overweight - as if he were to blame for his own death.

Countering such attitudes is difficult, Doka says, because people who believe falsehoods about the virus will continue to seek out information that confirms their beliefs. They will work hard to reject or dismiss any information that opposes those beliefs.

Those who criticize or dismiss victims of the pandemic are unlikely to change their minds easily, says Holly Prigerson, a sociologist specializing in grief. She says those judgmental comments stem from a psychological concept known as cognitive dissonance.

If people believe the pandemic is a hoax, or that the dangers of the virus are overblown, then "anything, including the death of a loved one from this disease ... they compartmentalize it," Prigerson says. "They're not going to process it. It gives them too much of a headache to try to reconcile."

Prigerson says trying to fight someone's cognitive dissonance rarely works. People double down on their beliefs when they are challenged, a concept known as the "backfire effect."

She advises that people whose families or friends aren't willing to acknowledge the reality of COVID-19 might have to set new boundaries for those relationships.

Prigerson says she had to cut ties with some of her relatives after her mother died of COVID-19.

As Rimel continues to mourn her brother's death, she has found relief by joining bereavement support groups with others grieving who agree on the facts about COVID-19. In August, she and her mother attended a remembrance march for COVID-19 victims in downtown Pittsburgh, organized by the group COVID Survivors for Change.

And in June, a headstone was placed on Dixon's grave.

The epitaph says "beloved son, brother & uncle" over the dates of birth and death and an engraved portrait of Dixon. Near the bottom, chiseled in the same formal font as everything else, is a blunt message for the public, and for posterity: F**k COVID-19.

The family's motivation for carving that into the headstone? It's simple, Rimel says: Long after they are gone, they want the truth to endure.

"We want to make sure that people know Kyle's story, and that he passed away from the virus."
This story comes from NPR's health reporting partnership with and Kaiser Health News (KHN).

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When COVID Deaths Are Dismissed Or Stigmatized, Grief Is Mixed With Shame And Anger

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Editor's note: A photo in this story contains language that some may find offensive. Months after Kyle Dixon died, his old house in Lanse, Pa., is still full of reminders of a life cut short. His tent and hiking boots sit on the porch where he last put them.

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Good afternoon. I'm Cait Ellis, Program Manager at the National Institute for Health Care Management Foundation. On behalf of NIHCM, thank you for joining us today. Our goal today is to share information on the impact of the COVID-19 pandemic on people with disabilities, and to discuss actionable strategies to address challenges and barriers to care, including vaccine access.

According to the CDC, one in four adults in the United States has a disability. People with disabilities are a diverse group with wide ranging needs. There are many types of disabilities such as those that affect vision, movement, cognition, and hearing, where people with disabilities barriers around communication, physical access, attitudes and social determinants of health can have a tremendous impact on their health and well being and their ability to access critical care and services. This expert panel will provide insights into how the pandemic exacerbated existing challenges and how this community was uniquely impacted. And they'll outline some lessons learned and best practices that can advance health equity, and help support individuals with disabilities going forward.

Before we hear from them, I'd like to thank NIHCM's President and CEO, Nancy Chockley and the NIHCM team who helped to convene this event. You can find biographical information for all of our speakers on our website, along with today's agenda and copies of slides. Additionally, please use the Q&A tab to submit any questions during the webinar and we'll return to those after we hear from our three panelists. I'm now pleased to introduce our first speaker, Dr. Bonnielin Swenor. Dr. Swenor is an Epidemiologist and Associate Professor at the Johns Hopkins Wilmer Eye Institute, and the Epidemiology Department at The Johns Hopkins Bloomberg School of Public Health.

She's the Founder and Director of The Johns Hopkins Disability Health Research Center, which addresses health inequities for people with disabilities, and aims to shift the paradigm from living with a disability to thriving with a disability. We're pleased to have Dr. Swenor with us today to share her work and expertise. Dr. Swenor?
Bonnielin Swenor - Director, Johns Hopkins Disability Health Research Center
Thank you so much. I'm really grateful for the opportunity to be a part of this esteemed panel and talk about COVID-19 and the impact it's had on the disability community. Thank you so much for that wonderful introduction, what I'm showing on this slide is some of my contact information and I'll go back over it at the end in case anyone in the audience wants to connect.

So my interest in the impact of COVID-19 on the disability community really started early in the pandemic and it stems quite honestly directly from my personal experience, in March 2020, I began feeling unwell after being exposed to two people who were confirmed positive COVID-19. And when I called my provider to get information on how I could get a COVID-19 test, I was told to go to a drive through testing site that had been propped up near my home. But as a person with a visual disability myself, I have a degenerative retinal disease that's led me to lose my vision over the past 15 years and I no longer drive. That suggestion honestly was laughable, drive through test site is completely inaccessible to me.

So what I'm showing on this slide is an image of an article that I wrote for STAT news about that experience and the ways in which that personal experience early on in the pandemic made me think about my work and pivot really towards the unique ways that the disability community was being impacted by the pandemic.

So, as I steered my Disability Health Research Center towards looking at the implications of the pandemic on the disability community, it became really clear early that one of the main ways the community was being impacted was around gaps in accessibility.

There were clear gaps in access to critical public health information early on, which included lack of ASL interpreters during public health press conferences or not including alternative text images or descriptions of figures and images, including those pandemic curves which held really valuable information, those gaps in information, access created inequities for the disability community which quite honestly persisted throughout the pandemic and are persisting today. Additionally, there are in many ways still remain barriers to accessing COVID-19 tests and vaccines for people with many types of disabilities.

My story is just one example. But these gaps have ranged from inaccessible testing and vaccine sites for people who are wheelchair users, lack of options to ensure communication and even consent for people who have hearing loss or that, or who have low vision or blind in vaccine testing and testing sites.

Limited spaces in vaccine sites that are inclusive are considering the needs of people with intellectual and developmental disabilities. There's also been gaps in transportation options to even guest testing and vaccine for people with disabilities.

There's also important implications of the social measures that have been put in place during the pandemic such as limitations in transit options, which I just described, and changes in how we have obtained food, medication, access healthcare, which in some cases have created unintended and insurmountable barriers for people with disabilities during the pandemic. So, for example, someone who's blind cannot tell if others around them are wearing a mask or not, or if they're maintaining the suggested social distancing during the height of the pandemic, that certainly has impacted individuals ability to stay safe while they're getting food or opportunities to interact with healthcare during the pandemic.

These gaps in accessibility have magnified inequities generated by our virtual, physical and social environments that we live in. But honestly, those inequities have been there before the pandemic.

Additionally, there is limitations and disability data that have affected the pandemic response. So at the outset of the pandemic, most of the data on COVID-19 mortality and infection for people with disabilities was coming from nursing homes, which by definition, everyone in those settings has a disability, or from other congregate care settings where people with disabilities might be living. So in the fall of 2020, approximately 40% of all COVID-19 related mortality was occurring in those settings, in those congregate care nursing home settings, which is staggering data, it's really important though to consider that for the disability community, people in those settings is really just a fraction of the disability population.

As was just discussed, there are 61 million or one in four Americans who live, who have a disability and that does not include people living in those congregate care settings and so while there was clear and real greater risk of COVID-19 severe outcomes for people in congregate care settings, the question was what about people with disabilities in the community?

Well, it turns out, we don't do a great job of collecting disability data in a way that's allowed us to robustly track COVID-19 testing, infection and vaccine rates. To do so what we really need is disability data collected at each healthcare interaction, and healthcare settings, we routinely collect information on people's age, gender identity, race ethnicity, but information on disability is usually not collected. There were really very many important calls for better COVID-19 data transparencies from minority groups. But for the disability community, this is not an issue of transparency, it's one of inclusion, we're not a part of core data collection to begin with.

What that has led to is inability to track outcomes, collecting disability data and healthcare interactions really is critical for more than just COVID-19. It's important to move the needle on policy for healthcare quality, safety, costs, interactions, much as we've done for other groups, this is going to transcend the pandemic this call for data.

Additionally, there's been unequalled COVID-19 data collected and reported on from across disability groups and categories. So as was just described the disability, people with disabilities are heterogeneous group. There has been better opportunities for data collection and reporting for certain groups, for example, individuals with intellectual and developmental disabilities during the pandemic, which in part has to do with funding structures put in place before the pandemic to support research for those individuals.

The number of people with intellectual developmental disabilities that are living in congregate care settings and group home settings where COVID-19 data could be collected and the ability to leverage things like ICD codes and service utilization, information from health records which isn't always possible for people from other disability groups. So while this information from people with intellectual and developmental disabilities really has been critical and I know other panelists are going to talk about this, it's been so important to advancing our understanding of the impact of COVID-19 for the disability community, we also have to remember it's just a fraction of the picture.

We need to think about the ways in which the pandemic has impacted people across the community of people with disabilities. So these gaps in accessibility and disability data, as I indicated are not unique to the COVID-19 pandemic, but instead are a reflection of deeper societal inequities that predate the pandemic.

The pandemic has taught us a really important lesson that we're all connected, the health of each of us is intricately connected to the people and the community and the environment that we live in. But because of the gaps in accessibility and data, the COVID-19 response has often missed the mark for many people in our population. What that means is that the exclusion of people with disabilities in the pandemic response has important ramifications for all of us.

So although these inequities became evident early on in the pandemic, as the vaccine rollout began, we realize those gaps really were persisting. So my center, the Johns Hopkins Disability Health Research Center, launched a COVID-19 vaccine dashboard for people with disabilities to track state prioritization of vaccine allocation, as well as the accessibility of vaccine information on state websites, in an effort to understand these inequities.

This project was in part inspired by one of our amazing students, Sabrina Epstein, who had noted that there was variation in vaccine prioritization across states for people with disabilities. And even though this project is now no longer collecting data, snapshots from this work can be found on our website, disabilityhealth.jhu.edu/vaccinedashboard, we're working to compile summary data, and we're now conducting deeper analyses which we'll be sharing on this site.

So what this dashboard did is we collected information from all 50 states, the District of Columbia and five U.S. territories. We updated this content weekly, and we prioritized the accessibility of our information on our dashboard, because it's so critical to share back this information and make it accessible to the disability community that we serve.

We first launched the COVID-19 prioritization dashboard, the first part of our dashboard, focusing on vaccine prioritization in February 2021 and we worked with The Center for Dignity in Healthcare for People with Disabilities as our collaborators who were supporting the backend effort and abstracting data.

We collected data on the prioritization of four groups, long-term care nursing home residents, people living in other congregate care settings, people with chronic conditions, and a group referred to as additional disability groups, that included people receiving direct support care, and live in the community.

People with intellectual and developmental disabilities were often prioritized separately, so we pulled them out and included them in that category as we did recipients of certain Medicaid programs.

On this slide, I'm showing a snapshot of our vaccine prioritization dashboard. Please note, this data is updated. It's from April 21. For each state, we listed the current phase of a vaccine rollout or who is eligible to get a shot in their arm, prioritization tier for each of the four groups we were tracking, as well as how each category was defined by that date, and the URL or the website address of the COVID vaccine site we were collecting data from.

So from this information, we also created visualizations to summarize this data, we use both maps and bar graphs to enhance accessibility and we included text summaries of these results to include what states were currently vaccinating each of the four groups we were tracking. Note again, this is all data. This is from March 31, hopefully everyone in attendance now knows that the opportunity for vaccine is wide open for adults, which we were tracking.

Our second dashboard focused on accessibility of COVID information with vaccine information. So we collected data from COVID-19 vaccine information state websites, as well as state vaccine registration website. For this part of the dashboard, we worked with WebAIM out of University of Utah, who are experts in website accessibility and developers of a tool called WAVE. WAVE is used to score website accessibility based on the content.

So working with WebAIM, we assessed the number and type of accessibility errors. We also use an additional algorithm to account for differences across websites, such as the length and the density of the web page, so we can compare across websites. We then use those scores to rank states by their accessibility score. Our dashboard compiled this data, and we share the URLs of the websites that we were using.

Similar to our other dashboard, we visualize this accessibility data and to do this, we categorize those accessibility scores into tertiles or three groups and created maps of that data. We additionally included tech summaries of our results to enhance the accessibility of our content on this dashboard.

So what was the impact of all this? Well, we launched our prioritization dashboard on February 8, we ended it on April 21 and we wrapped up our accessibility dashboard on May 19. Less than 24 hours after launching our prioritization dashboard, The National Council on Disability cited that dashboard in a letter to the National Governors Association, asking people or asking the Governors to reprioritize people with disabilities in the vaccine rollout.

Since then, our dashboard has been cited by local, state and national advocacy groups and policymakers as well as federal agencies. This project has been included in articles in the New York Times, Washington Post's Political, NBC and most recently in a Time magazine article, Dr. Kara Ayers, from The Center for Dignity in Healthcare for People with and I both discussed this project at a Biden Harris COVID-19 Health Equity Task Force Meeting. And at its peak, we had about well, we had over 2,000 unique visits per day.

I'm honestly astounded by this response. We really didn't anticipate much use at all to be honest. But it's a clear reflection for the need for this type of data, data focused on health equity for people with disabilities. And I'll also add that the majority of people working on this project identified as having a disability myself included, we certainly valued and we're focused on starting with the community and ending by giving back to the community and I think that's also part of the success.

So we're now moving to analyze the data we collected in deeper ways, as I indicated, but some best practices and lessons learned have become clear. As we've learned from other minority and marginalized groups, disability research, as I just indicated, should always start by partnering with the communities served, with the disability community. Far too often, disability research moves ahead without ensuring its focus on addressing the most pressing and important issues that that community is facing.

Disability is the only minority group that anyone can join at any time and this group intersects all gender, racial, ethnic, economic, and geographic groups, meaning disability is part of all our communities. This project has shown us the need for disability to be included in all efforts to advance health and health equity of our communities.

We must also prioritize accessibility. We've learned this lesson many times over but the pandemic has shown us the implications of neglecting accessibility. It's not just about the disability community, accessible information spaces, healthcare and other aspects of society impact everyone. Think of the broad implications of curb cuts and sidewalks and how the benefit goes far beyond the disability community.

As a data scientist, I cannot ignore the urgent need to close disability data gap. As we say at my center, who counts depends on who is counted. Without disability data, inequities will persist for the disability community. Data is necessary to identify disparities, track change and advocate for policy, and when we say that includes both quantitative and qualitative data, we truly do need both. We need data that allows us to examine the experiences of people with intersecting identities, such as disabled people from racial and ethnic and gender minority groups and from people across disability groups and categories.

I want to thank my collaborators on this work, The Center for Dignity in Healthcare for People with Disabilities, WebAIM and special thanks to our funder, without whom none of this work would have been possible, The American Association of People with Disabilities, I'm showing on the slide away, you can contact me, can go to our website disabilityhealth.jhu.edu, can follow us on Twitter at jhudisability. Thank you.
Caitlin Ellis - Program Manager, NIHCM
Great, thank you so much, Dr. Swenor for highlighting how the pandemic impacted people with disabilities including gaps in accessibility and data collection and how that affected the pandemic response and for sharing your own personal experience and how that impacted your work.

Under the leadership of Gail Boudreaux, Anthem has been investing in communities and working to support at risk populations that have been most impacted by COVID-19. To share more about their efforts, we'll hear from Merrill Friedman, Anthem's Senior Director of Disability Policy Engagement, Merrill outlined some of the challenges that they have seen, including the digital divide and access to Telehealth and how vaccine information is accessed and vaccines distributed. Merrill brings extensive experience to our panel discussion, she has served on numerous national boards and commissions, and was appointed by President Barack Obama to the President's Committee for People with Intellectual Disabilities. We're so fortunate that she can be with us today to share her expertise and Anthem's work on this critical issue, Merrill.
Merrill Friedman - Senior Director, Disability Policy Engagement at Anthem, Inc.
Thank you so much. Can you hear me, okay?
Caitlin Ellis - Program Manager, NIHCM
Yes.
Merrill Friedman - Senior Director, Disability Policy Engagement at Anthem, Inc.
Perfect, thank you. So good afternoon everybody. Thanks for joining us today. I'm going to jump around a little on slides anyway. But I am going to jump around a little bit, because so much of this really was teed up earlier. So if I'm not completely aligned with my slides, please forgive me. But hopefully we'll have a fabulous discussion anyway.

I think when we look, generally speaking right across the board, and talk about health equity for people with disabilities, during the pandemic and beyond, we're all looking to the future, right, we want to know what the future is going to look like, as we're in this, some people feel we're in a transition phase of reengaging, but I don't think we can lose sight of all of the things that have occurred throughout the pandemic, because really, these disparities existed before, the pandemic really shone a light on them that was, I will hit quite astonishing.

And so I think we have to take all that into consideration as we look at reengaging, but also realize as many people are out and about, and seemingly going back to activities like where they were prior to the pandemic, that many people with disabilities, many older adults and many new people who have joined the disability community as a result of COVID do not feel like we're coming out of the pandemic at all and so it is very much something that we need to address collectively and not lose sight of what's happened.

I'll also talk a little bit about vaccine hesitancy, vaccine acts supporting people in this new era and how the disability community and this is already teed up, right we are, you can join the disability community at any time and throughout COVID, we have many people join the disability community. So it's a great time to be really talking about disability advocacy, and all of the resources that exist for people with disabilities. There are long lasting effects for people with chronic conditions, as well as a swell of people experiencing mental health conditions. And then if we start to really talk about intersectionality, and the impact on people of color, people identify as LGBTQ, we need to be very collective, very inclusive at who's within these -- joining us within the conversations.

I'm going to see, if I can figure out this. Okay, there's a little bit of delay on the slide movement. So please forgive any clunkiness there. So why the disproportionate impact, people with disabilities and chronic health conditions really do rely on a lot of people for support and care and services across the board. So not every single person relies on a lot of people, but we do have a lot of folks coming in and out of people's homes, right which during the pandemic was very frightening for people. So we talked about delayed healthcare, as a country right now, really looking at some of the people disabilities and chronic health conditions that were not able to delay healthcare and so we really had to focus our work on ensuring that people who were going into people's homes were supportive, and that people were able to feel comfortable throughout that.

When we get to some of the Telehealth stuff, I always talk, work through the early, very early on in a pandemic, by about March, April, we did about three years, or five years worth of changes and advancements in Telehealth in about three weeks. And it was tough, there were some bumps and hurdles, but it really did for those people who were able to access technology, and were able to utilize the services of Telehealth, it really did help a lot of people in that process, part of the disproportionate impact relies on accessible communications and information and I probably should say lack of accessible communications and information. There are a lot of people that did not, lot of reporters, a lot of state government officials that didn't have ASL interpreting.

In announcements early on, we did not have information in plain language, information was changing rapidly and accessible formats were not keeping up. So I think this movement of saying we're going to be thoughtful, potential, agile, responsive, really has to include people with disabilities in this discussion and how we do that.

We're disproportionately impacted, and therefore we need to be, if you want things to go right, or at least as right as they can, for people with disabilities, it really helps to have us involved at the very beginning, I thought when we started to win in Anthem, look at okay, what are we going to do, we have to change our service coordination model, we can't go into people's homes, we have to use different platforms like Zoo, and create ways for people to sign and DocuSign. And we need to engage people more frequently.

We reached out to community leaders within the disability community as well as Anthem's National Advisory Board on Improving Health Care Services for Older Adults and People with Disabilities, we said, here are some ideas and we have but my gosh, give us your ideas, right, talk to us what works, what doesn't, I got very involved, we all did talking to our members, getting ideas from our members, because we didn't want to just find ways to try to engage with people with disabilities throughout this pandemic without asking what would even work. So I think it really just seems so fundamental. But for some reason collectively, we have a very hard time doing that. We don't do it enough.

So I'll say like on every single slide and every single bullet, please engage people with disabilities in the conversations as we prepare and work on emergency preparedness, or as we talk about how to access services, or if we're talking about what accessible communication should look like, are they in plain language, easy, read large print Braille, constantly be talking to people with disabilities to make sure that you're making things accessible and practical. Okay, I'll get off my soapbox.

There are also a lot of people with disabilities, or lower wage earners may not be able to afford some of the conveniences that other people started to afford, like Instacart. And if you've looked at Instacart, and some of these other delivery services, the prices were going up due to worker shortages, due to supply and demand. We all recalled very early on, you couldn't get toilet paper, right, you couldn't get sanitizer. So as all those prices went up, plus you had service charges that made that very inaccessible to people who is unaffordable. We talked about technology and setting up for people who were working from home and people whose jobs didn't allow for them to work from home, people were also at greater risk of contracting the virus because they may have been using public transportation.

So it's not just people coming in and out of your home, are you using public transportation, are you out about, do you need dialysis, right, do you need to get to work. So I think we have to really consider going forward preparing, and I hope not in the near future, for any other crisis like this, that we're starting to take those things into consideration and making sure that there are accommodations that exist.

I think when we talk about not even specific to COVID, there will be other opportunities for us to do better and to take the lessons learned that we have gathered throughout this last 18 months, because our system needed help before. So we need to ensure that personal care attendants of direct support professionals are considered essential health workers. They're the ones who are saving lives on a daily basis. They're helping support people from home, we want more people to be living at home and living independently and living in their communities and engaging so we need to develop that in-home health worker and attendant care versus personal assistance services, direct service professionals, that workforce needs to grow, gain and have a trajectory of professionalism and support, should have had access ready access immediately to PPE, we move PPE to attendance and direct support professionals very quickly and have health workers, because we knew the risks both for the workers and for the individuals who are receiving care. And so I think next time we go about this, but that shouldn't even be on the table for discussion should be an automatic. That's my opinion.

But I do think, our direct care workers are saving lives and should be supported as such. Incentive payments should be included, right. We talked about all these things. We move quickly to try to get them included, but they should be part of an infrastructure. People with mental health disabilities that were experiencing exacerbations throughout the pandemic, some people were experiencing mental health condition for the first time, our mental health conservative starting to navigate not just the mental health experience, but mental health services. So we've been -- we are very closely of course with NAMI and Mental Health America to look at screenings and outreach and resources and peer platforms to help people through this time. We even had a few opportunities to test out a virtual peer support program so people can stay connected.

Let's see if I can get us to the next slide my multi-tasking today. Here we go. So we cover a lot of this right, but things need to be accessible for people. We need to get access to technology and internet, we sent lots of laptops and iPads and iPhones and different technology out to people. Chromebooks to get for young people who were trying to learn in school were other people who were given an opportunity to potentially work from home, but didn't have the access to it. And then they access to the technology for any healthcare access services.

Social and community resources, and supports my gosh, we talk about social isolation so much. And at a time, when people were encouraged to physically distance social isolation became more and more prevalent, and I remember doing a consumer's what they called it, it was a consumer webinar early on. It was April, May, and people were saying, even just pull up in my driveway and talk to me just drive by and talk to me, people were so incredibly lonely, older adults, people with intellectual developmental disabilities, others who are not comfortable with the technology and didn't feel like that was a connecting.

We know that loneliness kills more people than smoking cigarettes. We have to find ways to help people stay connected in a virtual world, but help people feel comfortable and use the know-how right the information to be connected. And then of course, broadband is going to be one of those things we are going to be talking about for a long time. We have to extend broadband, so people have the opportunity to dial in, if you will, to do that physical access barriers have existed for forever. Clearly, people weren't seeing there, physicians and their service providers as much during that time, but I still think as we prepare more for other disasters, physical access, barriers need to be addressed.

And then attitudinal barriers for providers and others. Implicit and explicit bias have misconceptions about people with disabilities, and not acknowledging, people's ability to self-direct their care and services and live independently with the supports required to do so. And really changing the attitudes and the resources that we have formed providers with the more that we inform providers of the independent resources or the resources that help to support independence out there. The easier it will be for providers to more naturally talk about those versus other segregating care and resource opportunities. So I think we have to take all of these into consideration moving forward.

Let's see, here we got the Digital Divide. I know we've talked about it. So I'm not going to spend a lot of time on it to kind of speed up this piece here. But just remember, you met it's not a "one-size fits all," and we need to be able to accommodate people throughout the technology wave that we all live in. My computer crashed four times already this morning. I was like praying, it wasn't going to crash during this. It is just not. It's not the be all and end all. But it certainly is a game changer that we want to rely on. And that people are asking for us.

So I'll kind of begin to close out here and say, as we look at addressing disparities for people with disabilities. We can do and provide resources all day long, but we have to be intentional. We have to talk to people with disabilities and have them in the conversation saying that I am a person who self identifies with a disability, ADHD, but having people engaged at the table. When we're talking about public health planning, this is emergencies and disasters, whether they be tornadoes or power grid outages or another pandemic, or even working through the pandemic that we continue to exist with today with COVID-19.

So I think everything starts there for me. And then finally, talk a little bit about we did form at the beginning of 2020. I think 2021, the vaccine information collaborative for people with disabilities and older adults, and we just kind of gathered lots of disability and aging leaders and said what can we do, we don't want to reinvent the wheel, we don't want to duplicate other people's work. But we want to get accessible information out to people on the easiest way. So we put a resource together, it is on the console, really talking about vaccine advocacy, and it covered a lot of things that I was talking about before. So I'm not going to go through it here, but our resources up, and we are always happy to engage and I'm happy to take questions when we get to them. I'll turn it back to Cait Ellis [ph].
Caitlin Ellis - Program Manager, NIHCM
Thank you so much, Merrill for breaking down how COVID-19 exposed existing disparities for people with disabilities and outlining. Some clear intentional steps that can be taken to advance health inequity for this community.

Our final presentation will be from Tawara Goode, the Director of the National Center for Cultural Competence at Georgetown University. She is also the Director of the Georgetown University Center for Excellence and Developmental Disabilities, and an Assistant Professor in the Department of Pediatrics at Georgetown University Medical Center. Tamara is a recognized thought leader in the areas of cultural and linguistic competence. And we were so pleased to have her with us today to discuss her work looking at the pandemics impact on people with disabilities, and how frameworks can be used to improve how we've approach these critical issues. Tamara? Tawara, it looks like you're still on mute.
Tawara Goode - Director, National Center for Cultural Competence at Georgetown University
All right, I found my way off mute. Thank you very much. Today my remarks will be looking at the multiple perspectives of the impact of COVID-19 of persons with disabilities have lived experience with the emphasis on data and policy. I will do my best not to repeat what has already been said by co presenters.

I am going back on slides. Previous slide and so what is it that we know about the impact of COVID-19 on persons with disabilities? So I can say that, regardless of all of the data that's been collected, we still don't know enough. And data are still indeed being collected. And as we look at some things that we do know, I won't repeat what has already been said but esteemed colleague at Ted Kennedy at Johns Hopkins. But what we do know is that people with disabilities had delayed access to care, they had poor quality of healthcare and mental healthcare. They experienced discrimination and biases by healthcare professionals, including life-saving on therapies, they experienced increased isolation, job loss, disruption and supports and services.

We also know from this literature, there's extensive deficits in the nation's current data collection system what was alluded to earlier, particularly looking at examining COVID-19. And its impact by disability, race, ethnicity, language spoken across the United States territories, and in tribal communities.

Given that we hear a lot around statistics. I thought it was really important to bring up this particular quote, I find it very powerful, and it actually drove some of the work that we have done in our publishing about the COVID experience. So that it's basically saying that statistics are people with the tears wiped away, that is a very, I find a powerful statement.

And so if we go back and we have that lens of people with the tears wiped away, during the early stages of pandemic, we at the Georgetown University Center for Excellence and Developmental Disabilities, we went about collecting just stories and experiences from a range of people they had intellectual developmental and other disabilities. And this happened between April and May of 2020. Again, just a 11 people. These individuals were from diverse racial, ethnic, and cultural backgrounds. And getting these stories, it really gave us a chance to look at the statistics before the tears could be wiped away. So in other words, we're able to look at the social cultural context of the lives of individuals living in the District of Columbia during COVID-19.

I want to share with you a framework that we use to analyze these -- just these 11 stories that they were on, they were indeed powerful. This is a framework you can access on our website. We call it disabilities disparities framework. And if we look at public policy and resources, and think about that, during a time of COVID, we know that those public policy resources, both in the public and private sector had a significant impact on the level above, meaning, the availability of supports and services including healthcare, the accessibility, the acceptability, the quality, and the utilization.

And as we think about the accessibility, the acceptability, and in particularly the acceptability, I think, what around the cultural implications of what that is. Sometimes services were indeed available, but they certainly were not acceptable to the individuals who need that. And again, as we think about people with disabilities during this COVID pandemic, and in every aspect of their life, it really has a significant impact. So we use this framework to analyze data.

And so among the 11 people that we saw, that had intellectual developmental on other disabilities, we found that nine of the 11 had issues around accessibility. Eight of the 11 it around availability, acceptability, as indicated in slides that you see, quality is one of the 11. We know that each person experienced disruption and utilization of services due to widespread impact of the pandemic. And they had major limitations on aspect of their lives as it many others across the country.

All of the persons who were interviewed reported disparities and supports and services that included health and mental healthcare, and home supports, physical and other therapies, public transportation, employment, and again, the days that they were able to work performing independent activities of daily living, and the facility-based services and closures.

We also knew in terms of access to the capacity to use technology, which has been referenced repeatedly, what we did see is that many people could not indeed access what was needed, because everything, almost everything was web based. And then finally, when we look at the mental health impact, we saw fear, vulnerability, anxiety, frustration and isolation that really impacted at least these individuals that we heard their stories.

All right. Another effort in which we were engaged during this period of time, was an outside of the report grant that we have reconcile in the past and changing the future. And we're looking at engaging young adults with intellectual and development disabilities, who also have mental health needs and researchers and research.

In this project, we were able to get additional funding to use an analytical framework and an existing database to identify service experiences, outcomes across diverse populations. And we did this in real time.

My partners in this are the University of Florida, Jessica Kramer, and Joan Beasley, the Center for START Services at the University of New Hampshire that has a focus specifically on individuals with intellectual developmental disabilities who also have mental health needs. We were engaged in this research together.

We use this framework that I created called the Convergence of Cultural Contexts. And as you can see, in the middle, there's a child, youth, and adult and this is really looking at the multiple cultural identities and the cultural context that that child, youth, and adult may bring to the table. In this instance, a personal disability. In the next circle, we see the family and so that we look at the impact of the family, they again, the cultural context in which the child family and adult are living. And then we've looked at that child family adult again within a cultural context of the communities in which they live across the country.

And lastly looking at the socio-economic, political and demographic environment, and that was impacted significantly by COVID. So we use this framework that we use in many ways to analyze that an existing data set. In the outer ring that you will see are the many, many different services to persons with intellectual developmental and other disabilities may need to access and so from the healthcare system, to early intervention, to mental health care system, et cetera. But what was the impact of COVID for this particular population.

And so again, the sheer -- these are things that we were able to glean from the data so that the Center for START Services administered a tool, a survey for caregivers of persons with intellectual development, disabilities of mental health needs. There are about 1,455 surveys that you indicate, as you see there. So this was during March and July of 2020, collecting these data. And so things that we learned just using this convergence of cultural context framework was the sheer number of systems and sectors that family caregivers needed to navigate in order to meet the needs of their children, or adults during this time period.

We found that there were disparities and service systems needs and use based on race, ethnicity, language spoken, and other cultural factors, which we're able to glean from using this framework. And we also looked at the extent to which telehealth and virtual services were available, accessible, acceptable and utilized by the caregivers, and that vary significantly, given this specific population. So looking at telehealth as a "one-size fits all," that was not always a good piece of that.

And lastly, the impact of the pandemic on the person with intellectual and development disabilities, the caregiver, and the family unit as a whole. But we were able to do that using this framework to examine the social cultural environment and the communities in which they live. And so again, as we think about an answering the question, like what do we know about what impacts people with intellectual and development disabilities during the time of COVID, using different ways to examine that's really very important.

The last one I'd like to share with you is a conference or a symposium that was convened in May, entitled eliminating compounded disparities for people with disabilities and a year COVID-19. It really looked at the experiences in New York city, however, the persons who contribute to this were perspectives from across the country. And these are the panels that were offered. I had a large role in planning this symposium, but understanding the political determinants of health than their impact on persons with disabilities, the lived experience, specifically communities of color, disability in the physical and mental health impact of COVID-19, which you've heard alluded to already, public policy and government response and a pandemic, the lessons learn. And lastly, the way forward.

And so as we think about not only what we should be looking at a systematic way of being able to do that, in addition to data collection, as this this symposium shared to engage members, diverse members across the country, and in specific geographic locales. These were the partners, as you see here on Pace University, HRC, New York, the Mayor's office, their Department of Social Services, and Trinity Church, Wall Street, again, engaged in the faith community in these efforts.

So I'd like to be able to summarize. My closing thoughts are that COVID-19 is still with us. And it probably is going to be with us for many years to come. And we have to continue this learning about the impact on persons with disabilities. One particular area that's a huge deficit has been alluded to by both my co presenters is that we have to collect, analyze and report data that's inclusive of the cultural context, including race, ethnicity and primary language but to go deeper for that, looking at a socio-economic status and other cultural factors. These eight things are key and critical when we think about how we are looking at prevention, treatment and other supports for persons with intellectual developmental and other disabilities for future public health emergencies.

And lastly, it really is essential that our knowledge about the impact on persons with disabilities that is not simply limited to quantitative data. Again, I can't emphasize that enough, we have an obligation to really collect data in many, many different ways in which we can gain insight. This has impact on how policies inform, our resource allocation, the needed supports and services, in order to advance equity.

Lastly, I want to end on the work of Daniel Dawes, who was a keynote for that conference. And he's placed a lot of emphasis on policy. And I think that we talk about the social determinants of health a lot. However, in his wisdom, for every social determinants of health, there was some proceeding legal, legislative, regulatory, or other policy decision that resulted in the social determinants of health. And those are the political determinants of health. So as we continue to look at the experiences of persons with intellectual, developmental, and other disabilities across the lifespan, and during our COVID pandemic that we cannot ignore the political determinants.

And with that said, I will stop I know that we need time for questions.
Caitlin Ellis - Program Manager, NIHCM
Great, thank you so much Tawara for sharing those powerful narratives and the value of using frameworks to better understand the issues and inform the response. And for sharing information about the symposium. We would like to use the remaining time to engage in a Q&A session with our audience. Please continue to submit your questions in the Q&A tab. I'll ask our panelists to come off of mute. We have had several questions come in around the impact of the pandemic on children with disabilities and their families. And I was wondering if anyone could speak to what you have seen, perhaps around the loss of school-based services, and how you're thinking about families with children with disabilities. As you're looking at your efforts, if there's any partnerships or resources or information that you think would be valuable to the audience.
Tawara Goode - Director, National Center for Cultural Competence at Georgetown University
This is Tawara. There was a sizable number of children and the data that was collected from the Center for START Services. And one huge thing that I can say is that that was around education. And the fact that the online and virtual options for education did not work very well with many of the families, particularly families or children with autism, and other disabilities. But they had great degree of difficulty. So I will share that also think that we don't have a lot of data that's been collected and reported on the impact of the education in particular, perhaps in the area of healthcare, overall, in terms of the impact of children with disabilities, and their families.
Bonnielin Swenor - Director, Johns Hopkins Disability Health Research Center
All right. This is Bonnie talking a second that comment. I think we do need much more data to look at this really important issue. I'll also add that I do think that there were some kids with certain types of disabilities that maybe did benefit from a virtual learning environment. And this is what data would help us dig into and understand more and to doctor had excellent ending of we need both quantitative and qualitative data to really know more about that. Also add another layer here.

I know that the question was, perhaps specifically about children with disabilities. As a parent with a disability with two kids in virtual learning, we also have to think about it from that angle, right. So parents with disabilities, sometimes the content for their kids where they had to engage their children, who may or may not have disabilities themselves was not always equitably accessible.
Caitlin Ellis - Program Manager, NIHCM
Great. Thank you so much for those responses. A few of our speakers have noted that many people joined the disability community during the pandemic due to COVID-19 and long haul COVID. Is anyone able to expand on what is needed to support this emerging and growing population? And are there resources or best practices specific to their needs?
Merrill Friedman - Senior Director, Disability Policy Engagement at Anthem, Inc.
So I can jump in here a minute here. I think it's many of the same resources that we use to inform people who newly encounter disability as they age, right at any age, and so it is really a lot of provider education, ensuring that we are socializing the services, whether it be at University Center for Excellence on Disability or an Independent Living Center, or the Autistic Self Advocacy Networks putting people with IDD or the National Council of DD Councils, right, or the AAA's are just really making sure that we're elevating those resources that exist in the community for people. And that when we look at peer support, and we start to look at people who may experience limb difference now or chronic lung and respiratory diseases, mental health conditions are all lots of different disabilities that are sticking with people at this particular point, that probably wasn't the most articulate way to say that.

We really do need to make sure that we are informing people of those resources that are out there for them, like we would for anybody else. And then part of that, that is also building the capacity of communities to continue to support people with disabilities, because the number of people with disabilities continues to grow anyway. So adding the number of people who were considered long haulers right now and experiencing disabilities or in chronic health conditions would be supported through those processes. And I think data has been mentioned so many times that we really do need to collect the data on what people are experiencing. So we know where to really build our capacity and our resources.
Caitlin Ellis - Program Manager, NIHCM
I'd like to comment just a little bit on that, especially, I guess the phrasing and the question about resources and best practices like to really separate resources from best practices. I don't think we know enough to really say this is a best practice, it is way too early on. And then as we think about on this notion of then moving to evidence-based practice, I would say evidence-based for home. So in absence of comprehensive, multi-faceted way in which we're looking at data, using a cultural lens, that I would say that perhaps some of the resources work for some of the people. And I would say that perhaps some of the resources do not work for other people, and that we just simply don't have enough data to say what is a promising practice at this point in time.
Bonnielin Swenor - Director, Johns Hopkins Disability Health Research Center
Yes, I also. This is Bonnie, want to add. I think that is such an important and often missed nuance, right. And that's really been elevated in the time of COVID. Not just for the long haulers. But for the disability community in general, in the absence of data, and the pursuit of equity. How do you move forward when the focus is on evidence? And I think that's just such an important question we need to think more about. I also just want to add that, Merrill commented about community and I think that's important in such a critical challenge for this group of individuals who are in new community within our community of disability.

So many people from various areas of the disability community will contact me or my center because they want to know people like them. And that's such an important part of the experience in navigating life. And I sometimes think we can overlook that. People with disabilities are the experts have their own lives. And so I think sometimes having autonomy and confidence in that expertise comes from getting to know other people like them. So my point is, is I don't think this community is growing. There's some strength there, but how do we support that community as well as addressing the inequities and maximizing health for this group to be determined.
Caitlin Ellis - Program Manager, NIHCM
Great, thank you all. Unfortunately, we are out of time. Today, I would like to thank all of our excellent speakers for being with us and sharing their valuable work and perspectives. Thank you to Barry Samuels who provided our ASL interpretation during this event. And thank you to our audience for joining us for this important discussion.

Your feedback is important, please take a moment to complete a brief survey which can be found at the bottom of your screen. We do have other resources available on our website that may be of interest, including additional materials from our speakers, and NIHCM's ongoing work on COVID-19 and racial equity. We will also be releasing an infographic on disability. So please stay tuned. Thank you so much for joining us again today.

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Achieving Health Equity for People with Disabilities During the Pandemic and Beyond

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Good afternoon. I'm Cait Ellis, Program Manager at the National Institute for Health Care Management Foundation. On behalf of NIHCM, thank you for joining us today. Our goal today is to share information on the impact of the COVID-19 pandemic on people with disabilities, and to discuss actionable strategies to address challenges and barriers to care, including vaccine access.

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With infections increasing once more, and hospitalization rising among older adults, health experts offer a timely warning: a coronavirus infection can look different in older patients.

Rosemary Bily outside her house in Oceanside, NY. She and her husband, Eugene, and their son-in-law Rich Lamanno contracted Covid in March of 2020 after attending a family party. Credit... Gregg Vigliotti for The New York Times

One day in March of 2020, Rosemary Bily suddenly grew so tired she could barely get out of bed. "She slept a lot," said her son-in-law Rich Lamanno. "She was wiped out for most of a month." Ms. Bily, now 86, also developed nausea and diarrhea, along with a slight cough, and subsisted mostly on Tylenol and Gatorade.

A few days later her husband, Eugene Bily, 90, started coughing and became lethargic as well.

Had it not been for a family gathering a few days earlier, the children of the Bilys would not have suspected the new coronavirus. They might have blamed the flu, or simply advancing age. "What we heard on TV was 'high fever, can't breathe' - and they had neither," Mr. Lamanno recalled.

But about a dozen guests had gathered at a restaurant in Rockville Centre, Long Island, earlier that month to celebrate a niece's birthday, and one by one most of them fell ill with Covid, including Mr. Lamanno and his wife.

As the symptoms spread, doctors told the worried family that the Bilys most likely had Covid-19. Because tests were in short supply at the time, neither was tested; the family also feared taking them to overflowing local hospitals. But subsequent antibody tests confirmed that Eugene and Rosemary Bily, who live in Oceanside, N. Y., had contracted and survived the virus long before any vaccine was approved or available.

Mr. Lamanno outside his in-laws' home in Oceanside. Credit... Gregg Vigliotti for The New York Times

The population over 65, most vulnerable to the virus's effects, got an early start on Covid vaccination and has the highest rate in the country - more than 80 percent are fully vaccinated. But with infections increasing once more, and hospitalization rising among older adults, a large-scale new study in the Journals of Gerontology provides a timely warning: Covid can look different in older patients.

"People expect fever, cough, shortness of breath," said Allison Marziliano, lead author of the study. She is a social and health psychologist at the Feinstein Institutes for Medical Research, part of the large Northwell Health system across New York State.

But when the researchers combed through the electronic health records of nearly 5,000 people, all over the age of 65, who were hospitalized for Covid at a dozen Northwell hospitals in March and April of 2020, they found that one-third had arrived with other symptoms, unexpected ones.

The team, searching through records using language software, found that about one-quarter of older patients reported a functional decline. "This was falls, fatigue, weakness, difficulty walking or getting out of bed," Dr. Marziliano said.

Eleven percent experienced altered mental status - "confusion, agitation, forgetfulness, lethargy," she said. About half the group with atypical symptoms also suffered from at least one of the classic Covid problems - fever, trouble breathing, coughing.

"Clinicians should know, older adults should know, their caregivers should know: If you see certain atypical symptoms, it could be Covid," Dr. Marziliano said.

The rate of atypical symptoms rose significantly with age, affecting about 31 percent of those aged 65 to 74, but more than 44 percent of those over 85. These symptoms occurred more commonly in women, in Black patients (but not in Hispanics) and in those who had other chronic diseases, particularly diabetes or dementia.

Because people in the atypical group were less likely to experience breathing problems and require ventilation, they were less likely to need intensive care. But both groups spent about 10 days in the hospital, and roughly one-third of each group died.

Mr. Bily, at right, receives home hospice care, and Mrs. Bily has fully recovered from the virus. "She's doing well," Mr. Lamanno said. "She has resumed her normal life." Credit... Gregg Vigliotti for The New York Times

"These people were in the hospital for as long," Dr. Marziliano said. "Their mortality rate was as high. So this shouldn't be dismissed."

The research mirrors findings from other, smaller studies of older people conducted early in the pandemic in the United States and Europe. During a Covid outbreak in a nursing home in Providence, R.I., for instance, a Brown University study found that the most common symptom was loss of appetite, followed by lethargy, diarrhea and fatigue.

"We're not necessarily surprised by this," said Dr. Maria Carney, a geriatrician and an author of the Northwell study. "Older adults don't always present like other adults. They may not mount a fever. Their metabolisms are different."

Younger diabetics, for instance, may become sweaty and experience palpitations if their blood sugar falls, Dr. Carney explained. An older person with low blood sugar could faint without warning. Older people who suffer from depression may have appetite loss or insomnia but not necessarily feel sad.

In May of 2020, Dr. Carney heard from a daughter worried about her mother, who was in her 80s and had suddenly grown weaker. "She didn't have fever or a cough, but she was just not herself," Dr. Carney recalled. Doctors at a local emergency room had diagnosed a urinary tract infection and prescribed antibiotics, the daughter reported. But five days later, her mother's condition was worsening. "She needs a Covid test," Dr. Carney advised.

Diagnosing Covid quickly in older patients can make a world of difference. "We have things to offer now that we didn't have in the first wave," said Dr. Eleftherios Mylonakis, chief of infectious diseases at Warren Alpert Medical School of Brown University, who led the Providence nursing home study. "We have better understanding, more treatments, better support."

Among the improvements: using anticoagulant drugs to prevent clotting and using monoclonal antibodies (the treatment that former President Trump received at Walter Reed Hospital) that strengthen the immune system. But, Dr. Mylonakis added, "It's paramount to start any kind of treatment early."

Understanding that something as vague as weakness, confusion or appetite loss might signal a Covid infection can also help protect friends and family, who can then isolate and get tested themselves. "It not only helps the individual, but also can contain the spread of the virus," Dr. Mylonakis said.

A Covid diagnosis can also ward off needless tests and procedures. "We can avoid unnecessary testing, poking and prodding, CT scans," Dr. Carney said. CT scans are expensive, burdensome and take time to schedule and analyze; a nasal swab for Covid is quick, relatively cheap and now widely available.

With widespread vaccination, the symptoms of Covid-19 in older adults may become even more subtle. Fevers are easy to measure, and difficulty breathing will send anyone to an emergency room, Dr. Carney pointed out, whereas "we don't necessarily notice if someone has stopped eating."

Her counsel, for older patients and their caregivers and doctors, is to stay alert for changes that occur quickly, over a matter of days. "When there's a change in behavior, physical or cognitive, it may not look like an infection, but keep Covid at the top of your list," she said.

The woman with the worried daughter had indeed contracted the virus; she died in a hospital.

But the Bilys pulled through and still live in their Oceanside split-level home. Mr. Bily contended with many health problems even before the pandemic. In the past 18 months, he underwent two hip surgeries and several other hospitalizations. In June, he began receiving home hospice care.

Rosemary Bily, however, has fully recovered from the virus. At 86, she drives to the supermarket and the drugstore, visits her hair salon weekly, keeps in touch with family via iPad and smartphone and helps care for her granddaughters.

"She's doing well," Mr. Lamanno said. "She has resumed her normal life."

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For Seniors Especially, Covid Can Be Stealthy

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With infections increasing once more, and hospitalization rising among older adults, health experts offer a timely warning: a coronavirus infection can look different in older patients. One day in March of 2020, Rosemary Bily suddenly grew so tired she could barely get out of bed. "She slept a lot," said her son-in-law Rich Lamanno.

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Top 10 Technology Trends in the Era of COVID

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States ranked by percentage of COVID-19 vaccines administered States ranked by percentage of population fully vaccinated States ranked by percentage of population who've received at least one COVID-19 shot States where COVID-19 is spreading fastest, slowest COVID-19 hospitalizations by state COVID-19 death rates by state States ranked by confirmed COVID-19 cases COVID-19 patients in ICU, state by state Hospitals postponing elective procedures
March 8: Daily cases fall to lowest level since Oct. 6; Senate passes $1.9 trillion relief bill - 3 COVID-19 updates

March 5: Daily COVID-19 deaths fall; Senate to debate $1.9 trillion relief bill today - 4 updates

March 4: Us giving 2M vaccines daily; California to reserve 40% of doses for low-income residents - 4 COVID-19 updates

March 3: Texas, Mississippi to lift COVID-19 restrictions; US will have enough vaccines for all adults by May, Biden says - 5 updates

March 2: Global cases rise for 1st time in 6 weeks; Merck to produce J&J vaccine, officials say - 5 COVID-19 updates

March 1: J&J vaccine available in 1-2 days, CEO says; House passes $1.9 trillion relief plan - 5 COVID-19 updates

February 26: FDA panel to review J&J vaccine today; hospitalizations lower than spring, summer surges - 8 COVID-19 updates

February 25: New variant in NYC; CDC backs vaccine finder website - 7 COVID-19 updates

February 24: J&J's vaccine is safe, FDA says; California variant more contagious, early research shows - 7 COVID-19 updates

February 23: FDA aims to quickly OK booster shots for variants; US passes 500,000 deaths - 6 COVID-19 updates

February 22: Hospitalizations fall for 40 consecutive days; masks may be needed in 2022, Fauci says - 6 COVID-19 updates

February 19: States seek excess vaccines reserved for nursing homes; US commits $4B to Covax initiative - 7 COVID-19 updates

February 18: US life expectancy fell drastically in 2020; US seizes 11M counterfeit N95s - 7 COVID-19 updates

February 17: Vaccine will be available to all Americans by late July, Biden says; US boosts states' weekly vaccine supply - 6 COVID-19 updates

February 16: States have $160M worth of unused rapid tests; winter storms disrupt vaccination efforts - 5 COVID-19 updates

February 15: 1st South Africa variant reinfection case confirmed; UK variant likely deadlier, scientists say - 6 COVID-19 updates

February 12: Retail pharmacies begin vaccinating through federal program; France 1st country to recommend single vaccine dose for COVID-19 survivors - 8 updates

February 11: Fully vaccinated people can skip quarantine, CDC says; South Africa variant found in 4th state - 7 COVID-19 updates

February 10: COVID-19 deaths down in every region; new antibody drug gets emergency approval - 5 updates

February 9: Daily cases fall to lowest level since October; Florida sees 200+ UK variant cases - 7 COVID-19 updates

February 8: 10% of Americans have gotten COVID-19 shot; South Africa variant found in 3rd state - 5 updates

February 5: Cases down 47% from January peak; J&J submits vaccine for emergency approval - 5 COVID-19 updates

February 3: AstraZeneca vaccine cuts virus transmission; COVID-19 deaths fall in 25 states - 5 updates

February 2: US vaccinations outnumber COVID-19 cases; reinfection more likely if variants become dominant - 7 updates

February 1: South Africa variant found in 2nd state; WHO reverses vaccine guidelines for pregnant women - 8 COVID-19 updates

January 29: COVID-19 hospitalizations drop 3,000 in 1 day; South Africa variant likely already spreading in US, CDC says - 6 updates

January 28: Cases fall 30% since January peak; most pregnant women shouldn't get Moderna vaccine, WHO says - 8 COVID-19 updates

January 27: COVID-19 hospitalizations fall, but deaths rise; US boosts states' vaccine supplies - 6 updates

January 26: US aims to vaccinate 1.5 million daily; Brazil variant found in Minnesota - 5 COVID-19 updates

January 25: Assume UK variant is deadlier, Fauci says; social distancing, masks needed until late July, model predicts - 9 COVID-19 updates

January 22: Weekly hospitalizations dip after 16-week increase; vaccines appear less effective against South Africa strain - 6 COVID-19 updates

January 21: Biden to sign 10 exec orders on pandemic response; variants may drive high infection rate through spring - 6 COVID-19 updates

January 20: Biden to issue mask mandate today; new US variant may be driving California's surge - 6 COVID-19 updates

January 19: New variant found in Germany; vaccination rates lag among Black Americans - 7 COVID-19 updates

January 15: Biden shares relief package, appoints Warp Speed head; hospitalizations level off - 4 COVID-19 updates

January 14: Daily COVID-19 deaths top 4,000 for 3rd day; WHO team arrives in China to investigate virus origin - 5 updates

January 13: COVID-19 deaths spike in South, West; CDC requires negative test for air travelers entering US - 4 updates

January 12: US to recommend immediate vaccination for those 65+; herd immunity unlikely in 2021 - 6 COVID-19 updates

January 11: UK variant found in 8 states; hospitalizations top 100K for 40 days - 6 COVID-19 updates

January 8: Daily COVID-19 deaths pass 4K; 50+ UK variant cases confirmed in US - 5 updates

January 7: 3 states have highest COVID-19 infection rates in world; UK variant in Pennsylvania - 5 updates

January 6: UK variant found in Georgia; COVID-19 hospitalizations flare in South, West - 6 updates

January 5: UK coronavirus variant in New York; 6 cases in California - Here's what you should know

January 5: UK variant detected in 4 states; COVID-19 hospitalizations hit record high - 5 updates

January 4: COVID-19 has killed 350,000 Americans; South African variant alarms officials - 5 updates

December 31: COVID-19 variant found in 2nd state; Warp Speed leaders acknowledge slow vaccine rollout - 4 updates

December 30: Biden taps 3 officials for COVID-19 response team; McConnell blocks bill for $2K stimulus checks - 7 updates

December 29: 2 million Americans have been vaccinated; House passes bill for $2K stimulus checks - 6 COVID-19 updates

December 28: 1 in 17 people have gotten COVID-19; Trump signs relief bill - 5 updates

December 23: Trump requests changes to relief bill; US secures 100M more Pfizer doses - 5 COVID-19 updates

December 21: Congress inks deal for $900B relief package; Moderna vaccine to reach some hospitals today - 7 COVID-19 updates

December 18: US sees 1M cases in 5 days; emergency approval for Moderna vaccine expected today - 8 COVID-19 updates

December 17: COVID-19 hospitalizations triple September numbers; Pfizer vaccine vials contain extra doses, FDA says - 9 updates

December 16: US cases up 51% in 1 month; surges slow in some Midwest states - 6 COVID-19 updates

December 15: COVID-19 deaths surpass 300K; Moderna vaccine may win emergency approval this week - 4 updates

December 14: First healthcare workers may be vaccinated today; hospitalizations near 110,000 - 5 COVID-19 updates

December 9: White House shares $916B relief proposal; Pfizer vaccine gets allergy warning in Britain - 6 COVID-19 updates

December 8: US records most deaths in 1 week; Pfizer vaccine meets FDA criteria for authorization - 5 COVID-19 updates

December 7: COVID-19 hospitalizations up 85% in 1 month; CDC calls for universal masking - 5 updates

December 2: Vaccinate healthcare workers first, CDC panel says; US hospitalizations near 100K - 5 COVID-19 updates

December 1: Vaccine will be widely available by June, Warp Speed leader says; White House COVID-19 adviser resigns - 5 updates

November 30: Fauci warns of 'surge upon a surge'; Moderna seeks emergency approval for COVID-19 vaccine - 6 updates

November 24: New York to reopen emergency hospital; CDC urges contact tracers to change strategy - 5 COVID-19 updates

November 23: Holiday travel spikes despite CDC warning; Regeneron's antibody cocktail wins emergency approval - 7 COVID-19 updates

November 20: Pfizer to apply for emergency approval of vaccine today; COVID-19 cases up 26% in 1 week - 5 updates

November 19: Some Americans face 5-day wait for test results; death toll passes 250K - 5 COVID-19 updates

November 18: US daily death toll highest since May; Pfizer's vaccine 95% effective - 7 COVID-19 updates

November 17: COVID-19 surges in 48 states; US hits 1M pediatric cases - 7 updates

November 16: US records 1M cases in week; Moderna's vaccine 94.5% effective - 6 COVID-19 updates

November 14: 184,514 new COVID-19 cases in 1 day; states ramp up safety measures: 5 updates

November 13: US hits 150K+ daily cases for 1st time; 18 states set hospitalization records - 5 COVID-19 updates

November 12: Hospitalizations rise for 18th day; developmental disorders tied to 3x higher COVID-19 death risk - 4 updates

November 11: COVID-19 hospitalizations hit all-time high; CDC takes stronger stance on masks - 6 updates

November 10: US sees 6th day with 100K+ new cases; Eli Lilly's antibody treatment gets emergency approval - 5 COVID-19 updates

November 10: El Paso has more COVID-19 cases than 29 states; NYC 'dangerously close' to second wave - 10 regional notes

November 9: Biden forms COVID-19 task force; Pfizer's vaccine 90% effective, early data shows - 6 updates

November 6: US shatters daily COVID-19 case record again; some patients smell phantom scents - 6 updates

November 5: US hits 100K+ daily cases for 1st time; PPE strains felt nationwide - 4 COVID-19 updates

November 4: 13 states see record COVID-19 hospitalizations; FDA warns of false positives for rapid tests - 6 updates

November 3: US entering 'most deadly phase' of pandemic, Birx warns; COVID-19 patients can break quarantine to vote, CDC says - 6 updates

November 2: Daily COVID-19 count nears 100K; 9 states hit record hospitalizations - 6 updates

October 30: US sees 90K+ cases in 1 day; state officials say they don't have funds to distribute vaccine - 6 COVID-19 updates

October 29: 'Disaster in warp speed': COVID-19 outbreaks ramp up as Wisconsin hits record cases, deaths + hospitalizations in same day - 5 COVID-19 updates

October 28: 44,000 Americans hospitalized; Medicare, Medicaid to cover COVID-19 vaccines with emergency authorization - 5 updates

October 27: Only 25 ICU beds open in North Dakota; US sees most new COVID-19 cases in 1 week - 6 updates

October 26: COVID-19 hospitalizations up 40% from September; Texas plans field hospital, Utah discusses care rationing - 5 updates

October 24: US breaks record for single-day COVID-19 cases, topping 80,000

October 23: US sees 75K+ new cases in 1 day; FDA approves 1st COVID-19 treatment - 5 updates

October 22: 16 states see record COVID-19 hospitalizations; CDC expands definition of 'close contact' - 6 updates

October 21: Cases rise in nearly every US region; death rate falling for hospitalized COVID-19 patients - 6 updates

October 20: GAO to probe political interference at health agencies; FDA panel to review COVID-19 vaccines - 5 updates

October 19: Hospitalizations rise in 39 states; Pelosi sets Oct. 20 deadline for relief bill - 6 COVID-19 updates

October 17: US reports most new COVID-19 cases since July - 4 national updates

October 16: Cases up in 41 states; remdesivir has little effect on survival, WHO study finds - 4 COVID-19 updates

October 15: Sen. Harris halts travel after 2 staffers test positive; 'regional COVID storm' hits rural US - 8 updates

October 14: 20 states record COVID-19 highs; Redfield warns of emerging threat - 4 updates

October 13: COVID-19 hospitalizations hit 6-week high; J&J pauses vaccine trial over 'unexplained illness' - 9 updates

October 9: World sees 1M cases in 3 days; Trump no longer poses transmission risk, physician says - 4 COVID-19 updates

October 8: COVID-19 cases rise in 25 states; Trump may resume public events Oct. 10 - 8 updates

October 8: 34 COVID-19 cases tied to White House; Wisconsin to open field hospital amid surge - 5 COVID-19 updates

October 7: 7 states see record hospitalizations; CMS gives hospitals 14 weeks to report COVID-19, flu data - 9 updates

October 6: Top officials push back on FDA vaccine standards; Trump isolates at White House - 7 COVID-19 updates

October 5: What we know about President Trump's treatment, hospitalization + 5 more COVID-19 updates

October 2: Trump tests positive; Wisconsin sees record death increase - 5 COVID-19 updates

October 1: Cases rise in 25 states; kids make up 10% of all cases - 7 COVID-19 updates

September 30: COVID-19 cases up 55% among college-aged adults; NYC to fine people who refuse to wear masks - 6 updates

September 29: Global death toll hits 1M; House unveils $2.2 trillion relief bill - 4 COVID-19 updates

September 28: Test positivity rate exceeds 20% in 2 states; kids may have different immune response to COVID-19 than adults - 5 updates

September 25: Young adults make up 1 in 5 US cases; male healthcare workers more likely to die from COVID-19 - 5 updates

September 24: Trump administration set to aggressively enforce data reporting requirements; COVID-19 transmission debate divides health systems - 5 updates

September 23: FDA to tighten vaccine approval requirements; face shields alone don't reduce virus spread, study suggests - 8 COVID-19 updates

September 22: NIH staffer to depart after anonymous posts criticizing agency; vaccine for kids may not be ready by fall 2021 - 5 COVID-19 updates

September 21: CDC removes new guidance on COVID-19 transmission from website: 3 updates

September 18: HHS changed testing guidelines despite CDC experts' objections; health workers account for 14% of global cases

September 17: Warp Speed officials to distribute vaccine within 24 hours of approval; CDC director touts benefits of universal masking - 5 COVID-19 updates

September 16: Virus has killed at least 121 children, teens; 'pre-COVID' life won't return before 2022, WHO expert says - 6 updates

September 15: World sees record case increase; judge overturns Pennsylvania's virus restrictions - 6 COVID-19 updates

September 14: Midwest cases skyrocket; HHS aides tried to 'water down' CDC reports, emails show - 9 COVID-19 updates

September 11: COVID-19 may have been in LA as early as December; virus deaths tied to air pollution - 4 updates

September 10: Trump admits to downplaying COVID-19; nearly half of Americans have misconception about virus - 6 updates

September 9: HHS will permit pharmacists to give COVID-19 vaccines, surgeon general says: 4 pandemic updates

September 8: US sees fewest daily cases in nearly 3 months; LabCorp test can detect flu, COVID-19 + RSV - 7 updates

September 4: 'Very low chance' vaccine will be ready in October, Warp Speed leader says; virus causes 'carnage' in lab-grown heart cells - 4 COVID-19 updates

September 3: Prepare for vaccine distribution as soon as late October, CDC says; US redirects WHO funds to vaccine efforts - 4 COVID-19 updates

September 2: US cancels contract for more ventilators; plasma shouldn't be standard of care for COVID-19, NIH says - 5 updates

September 1: Pandemic will be controlled in 6 months, most Americans predict; CDC shares data on healthcare worker infections - 5 COVID-19 updates

August 31: Pediatric deaths, hospitalizations rising faster than adults; FDA may consider emergency vaccine approval - 6 COVID-19 updates

August 28: 3,000 health departments push back on revised testing guidance; Hurricane Laura may boost infection rates, experts say - 5 COVID-19 updates

August 27: Testing czar defends guideline changes; DOJ may probe nursing home deaths in 4 states - 6 COVID-19 updates

August 26: CDC waives testing recommendation for people without symptoms: 5 COVID-19 updates

August 25: Flu may worsen testing delays, experts warn; US sees 'rolling hotspots' - 4 COVID-19 updates

August 24: Plasma wins emergency approval; 1st case of COVID-19 reinfection confirmed - 5 updates

August 21: Children may be more infectious than adults; deaths should fall next week, CDC director says - 6 COVID-19 updates

August 20: Cases fall nationwide for 4th week; Chinese government uninformed of COVID-19's true dangers for weeks, US finds - 5 updates

August 19: Pandemic won't be contained until June, half of physicians say; FDA withholds emergency approval for plasma - 5 COVID-19 updates

August 18: COVID-19 is 3rd leading cause of death; HHS reporting process is temporary, Birx says - 5 updates

August 17: Testing rates fall for 1st time; new research points to lasting immunity - 7 COVID-19 updates

August 14: Vaccine won't have copay, HHS says; Congress to investigate Operation Warp Speed - 7 COVID-19 updates

August 13: US sees deadliest day of summer; major labs cut testing turnaround times - 6 COVID-19 updates

August 12: HHS data lags by week or more, experts say; preventive nasal spray in the works - 5 COVID-19 updates

August 11: US may block citizens with COVID-19 from reentry; Russia approves vaccine - 6 updates

August 10: Pediatric cases up 40% since mid-July; researchers find racial bias in formula for hospital aid - 4 COVID-19 updates

August 7: LA may cut power on large gatherings; Fauci cautiously supports in-person classes - 7 COVID-19 updates

August 6: These 9 cities are seeing case increases, Birx warns; experts call for testing overhaul - 7 COVID-19 updates

August 5: 6 states form testing pact; 34 AGs urge US to boost remdesivir supply - 5 COVID-19 updates

August 4: White House walks back comments that virus is 'extraordinarily widespread': 3 COVID-19 updates

August 3: COVID-19 'extraordinarily widespread' in new phase of pandemic, Birx says: 6 updates

July 31: Providers to be paid for promoting self-isolation after COVID-19 test; HHS data system plagued by delays, analysts say - 7 updates

July 30: White House creates new hot spot strategy; young adults may be fueling uptick in COVID-19 patients over 65 - 6 updates

July 29: 4 states at risk of new surges; 21 need stricter measures to contain virus, White House says - 5 COVID-19 updates

July 28: Cases flattening in hot spots; masks may lessen severity of symptoms - 6 COVID-19 updates

July 27: New cases stabilize; more young people dying in South - 5 COVID-19 updates

July 24: HHS renews public health emergency; 5 states see record daily increases - 4 COVID-19 updates

July 23: COVID-19 in the US: New mask mandates, 7 state records, 11 cities urged to take 'aggressive' steps to manage virus spread

July 22: Pandemic will likely 'get worse before it gets better,' Trump says; US inks deal for 100M vaccine doses - 4 COVID-19 updates

July 21: US records smallest daily case increase in 1 week; 7 states see record hospitalizations - 5 COVID-19 updates

July 20: White House tries to block testing, tracing funding in relief bill; 57,000+ Americans hospitalized with COVID-19 - 7 updates

July 17: 3 states see record death counts; Georgia governor sues to stop mask mandate - 5 COVID-19 updates

July 16: Russian hackers target vaccine research; Georgia governor reverses local mask mandates - 8 COVID-19 updates

July 15: 7-day case average hits record high; clinicians asked to prioritize COVID-19 tests for sickest patients - 6 updates

July 14: 3 states account for 18% of world's cases; more COVID-19 therapies may be available in fall - 6 updates

July 13: NYC reports zero COVID-19 deaths; Florida sees 15K cases in 1 day - 6 updates

July 10: COVID-19 death rate resumes climb; current surge worse than spring - 9 updates

July 9: 28 states where COVID-19 is spreading fastest, slowest: July 9

July 9: US cases jump 72% in 2 weeks; PPE shortages reemerge - 5 COVID-19 updates

July 8: WHO acknowledges evidence of airborne spread; US sunbelt is new global epicenter - 9 COVID-19 updates

July 7: US nears 3M cases, still 'knee-deep' in 1st wave, Fauci says: 4 COVID-19 updates

July 6: More than 5,000 hospital-acquired COVID-19 cases reported since mid-May, CDC says

July 6: 5 states see record hospitalizations; scientists question WHO's stance on indoor transmission - 6 COVID-19 updates

July 2: Young adults in Alabama throwing COVID-19 parties with payout for first person infected

July 2: US sees 5th record increase in 8 days; 19 states pause, roll back reopenings - 6 COVID-19 updates

July 2: 26 states where COVID-19 is spreading fastest, slowest: July 2

July 2: Where new COVID-19 cases are rising, falling, staying the same - July 2

July 1: US could see 100K COVID-19 cases daily, Fauci warns; HHS likely to extend emergency declaration - 7 updates

June 30: COVID-19 activity by region - June 30

June 30: 'Worst is yet to come,' WHO chief says; Hospitalizations up in 7 states - 6 COVID-19 updates

June 30: 25 states where COVID-19 is spreading fastest, slowest: June 30

June 30: California hits single-day high for new cases; 60% of Houston Methodist COVID-19 patients under 50: 10 headlines from states experiencing COVID-19 surges

June 29: Where new COVID-19 cases are rising, falling and staying the same - June 29

June 29: Contact-tracing 'not going well,' Fauci says; remdesivir gets price tag - 4 COVID-19 updates

June 26: Daily US cases hit new high; White House reconvenes task force - 6 COVID-19 updates

June 25: 'People have completely let their guard down,' Houston Methodist CEO says; US cases hit all-time high - 5 COVID-19 notes

June 24: White House to end funding of 13 testing sites; 7 states see record hospitalizations - 5 COVID-19 updates

June 23: COVID-19 backlash is pushing health officials to resign; 26 states see jump in cases - 6 updates

June 22: White House preps for 2nd wave; AHA calls for emergency declaration extension - 4 COVID-19 updates

June 22: 11 states with fastest, slowest spread of COVID-19

June 22: 5 regions where COVID-19 cases are rising

June 19: Adults in 20s, 30s driving COVID-19 surges in some states: 5 updates

June 18: COVID-19 surge strains Alabama hospitals; employers can't require antibody testing, EEOC says - 7 updates

June 17: Future COVID-19 vaccine to be free for some, White House says; 9 states see record increases - 6 updates

June 16: Common steroid cuts COVID-19 deaths 35%; virus 12 times more deadly with underlying conditions - 6 updates

June 16: COVID-19 activity by region: Cases rise in South, West

June 15: Cuomo threatens to lock down NYC again; race may be key indicator of COVID-19 mortality - 5 updates

June 12: Houston may revive lockdown after record jump in cases & 6 other COVID-19 updates

June 11: FEMA plans call for PPE reuse through summer; J&J moves up COVID-19 vaccine trial - 5 updates

June 10: COVID-19 is 'worst nightmare,' Fauci says; cases rise in 19 states - 6 updates

June 9: Global peak could be months away; 24 states not reporting probable cases - 4 COVID-19 updates

June 8: Cases jump in 23 states; 30K more deaths may occur in June, CDC estimates - 8 COVID-19 updates

June 5: 2 major COVID-19 studies retracted; HHS to track race, ethnicity data - 4 updates

June 4: Top 5 vaccine candidates selected; global cases rise at quickest pace yet - 6 COVID-19 updates

June 3: 100M vaccine doses may be ready by 2021; CMS boosts infection control fines for nursing homes - 5 COVID-19 updates

June 2: Testing sites close amid unrest; 1 in 4 virus deaths tied to nursing homes - 5 COVID-19 updates

June 1: Minnesota hospitals on 'verge of being overrun' amid protests, pandemic - 4 COVID-14 updates

May 29: Remdesivir sent to hospitals without eligible patients + 4 more COVID-19 updates

May 28: 2nd wave 'is not inevitable,' Fauci says; CDC clarifies message on virus transmission - 5 COVID-19 updates

May 27: 48% of Americans delayed care amid pandemic; antibody tests may be wrong half the time - 5 updates

May 26: FDA veteran reassigned to vaccine efforts + 4 more COVID-19 updates

May 22: US won't shut down amid possible 2nd wave, Trump says; 35% of COVID-19 patients asymptomatic - 5 updates

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Becker's Healthcare has consolidated its most essential news and editorial content about COVID-19 here for readers for ease of reference. If you have any questions or comments about this resource center, please email Molly Gamble at mgamble@beckershealthcare. com. Beyond this, Becker's is covering

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Established in 1676, Lock & Co in St James's, central London, is considered to be the oldest hat shop in the world.

Throughout the centuries, the business has survived numerous recessions and two world wars, but how has it coped during the pandemic?
Video by Gem O'Reilly and Sam Francis

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How the world's oldest hat shop survived lockdown

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Established in 1676, Lock & Co in St James's, central London, is considered to be the oldest hat shop in the world. Throughout the centuries, the business has survived numerous recessions and two world wars, but how has it coped during the pandemic? Video by Gem O'Reilly and Sam Francis

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THE FIRST WAVE. directed by Matthew Heineman. New York, NY - New York City at dusk. (Credit: National Geographic)

The 29th edition of the Hamptons International Film Festival will open on Thursday, October 7, 2021, with the World Premiere of Academy Award-nominated director Matthew Heineman's The First Wave, a documentary film spotlighting the everyday heroes inside one of the country's hardest hit hospitals at the epicenter of the COVID-19 pandemic as they come together to fight one of the greatest threats the world has ever encountered.

As part of HIFF's Signature Program Views from Long Island, HIFF will feature the World Premiere of Kelcey Edwards' The Art of Making. The documentary follows a diverse cast of young artists at defining moments in their careers as they explore whether the art world ecosystem meant to nurture them is actually failing them.

Screening as part of the festival's Conflict and Resolution section, JR's Paper & Glue features world renowned artist JR (Academy Award nominee for Faces, Places) turning the camera on his own work as he builds some of his monumental projects.

Academy Award-nominated filmmaker Liz Garbus' Becoming Cousteau, which will hold its New York Premiere as part of the Air, Land & Sea section, takes an inside look at legendary explorer Jacques-Yves Cousteau and his life, career, and mission to protect the Earth.

Garth De Bruno Austin's The Last Horns Of Africa, which will have its East Coast Premiere as a part of the Compassion, Justice and Animal Rights section, features gripping and never-before-captured footage of the current rhino poaching war raging across Africa.

"Oscar-nominated filmmaker Matthew Heineman has made a stunning film highlighting not only the resilience of the human spirit, but the selflessness of healthcare workers who risk their own lives to keep us safe. We are honored to open our 29th edition with the world premiere of his film, which succeeds at exploring the gravity of a historic moment through his intimate style of filmmaking," said HamptonsFilm Artistic Director David Nugent. "We are also thrilled to announce a strong group of films screening as a part of our Signature Programs - including films by local artists as well as those wrestling with the issue of the sanctity of our planet and the lives of the animals with whom we share it."

The 29th Annual Hamptons Film Festival will run October 7-13, 2021 with live and in-person events and screenings across the Hamptons.

2021 Hamptons International Film Festival Lineup

***OPENING NIGHT***
THE FIRST WAVE
World Premiere
dir. Matthew Heineman (USA), 2021

With exclusive access to one of New York's hardest-hit hospital systems, Oscar®-nominated and Emmy® Award-winning director Matthew Heineman's THE FIRST WAVE spotlights the everyday heroes at the epicenter of COVID-19 as they come together to fight one of the greatest threats the world has ever encountered. Leaving a devastating trail of death and despair, this once-in-a-century pandemic changed the very fabric of daily life and exposed long-standing inequities in our society. The "first wave" of COVID-19 ravaged New York from March through June 2020. Employing his signature approach of character-driven cinema vérité, Heineman documents those harrowing first four months, embedding with a group of doctors, nurses and patients on the frontlines as they all navigated the crisis. With each distinct storyline serving as a microcosm through which we can view the emotional and societal impacts of the pandemic, THE FIRST WAVE is a testament to the strength of the human spirit.

THE ART OF MAKING IT
World Premiere
dir. Kelcey Edwards (USA), 2021

Against the backdrop of a culture in crisis, THE ART OF MAKING IT follows a diverse cast of young artists at defining moments in their careers to explore whether the art world ecosystem meant to nurture them is actually failing them. Are we at risk of losing the creative voices of a new generation as universities, galleries and museums face cataclysmic changes? Or, are we on the verge of recreating outdated modes of experiencing art to make it accessible to all? Embracing the conundrum of how artists must be in the market yet not of it, THE ART OF MAKING IT is both a cautionary tale about what America stands to lose if we don't rethink what we value and why and a love letter to those who persevere in their artistic practice in spite of the extraordinary odds against ever achieving success.

BECOMING COUSTEAU
New York Premiere
dir. Liz Garbus (USA), 2021

Adventurer, filmmaker, innovator, author, unlikely celebrity and conservationist: For over four decades Jacques-Yves Cousteau and his explorations under the ocean became synonymous with a love of science and the natural world. As he learned to protect the environment, he brought the whole world with him-he sounded alarms more than 50 years ago about the warming seas and our planet's vulnerability. In BECOMING COUSTEAU, two-time Academy Award-nominated filmmaker Liz Garbus takes an inside look at Cousteau and his life, his iconic films and inventions, and the experiences that made him the 20th century's most unique and renowned environmental voice-and the man who inspired generations to protect the Earth.

THE LAST HORNS OF AFRICA
East Coast Premiere
dir. Garth de Bruno Austin (United States), 2021

With unprecedented access, THE LAST HORNS OF AFRICA is a gripping and intimate look at the current rhino poaching war raging across Africa. We follow the journeys of two conservation heroes who put their lives on the line to protect the rhino in their care, while a top-secret, covert operation endeavors to bring down South Africa's most notorious rhino poaching syndicates. Hidden away in South Africa is the world's largest rhino orphanage, run by Petronel Nieuwoudt, who deals with the aftermath: the orphaned rhino calves knowingly left for dead by poachers. Through her eyes, the viewer gets an insight into the incredible bonds that are formed and the heart-wrenching reality of where these calves have come from. Meanwhile, in Kruger National Park-ground zero for rhino poaching-Don English, a veteran ranger, commands his brave team on the front line of the rhino horn war as they set out on an almost insurmountable task of protecting the rhinoceros in an area the size of Israel. From never-before-seen footage of South Africa's largest undercover wildlife investigation and interviews with poachers, the filmmakers risk their lives as they are thrust into the underground world of illicit rhino horn deals organized by South Africa's ruthless rhino poaching kingpins. THE LAST HORNS OF AFRICA is a firsthand look at the complexities and moral debates of contemporary conservation, which has found itself entangled in the dark web of corruption and the illegal wildlife trade.

PAPER & GLUE
dir. JR (France, USA), 2021
In PAPER & GLUE, JR turns the camera on his own work as he builds some of his most monumental projects. From early illicit graffiti videos captured on Paris rooftops at night, to the US-Mexico border, to the favelas of Rio de Janeiro, to a current collaboration at a California supermax prison, the film follows JR as he turns these communities inside out, turning images of residents into eye-catching and immersive art installations. PAPER & GLUE follows the Oscar-nominated FACES PLACES, which was directed by JR along with Agnès Varda.

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THE FIRST WAVE, Matthew Heineman's COVID-19 Documentary to Open Hamptons International Film Festival

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The 29th edition of the Hamptons International Film Festival will open on Thursday, October 7, 2021, with the World Premiere of Academy Award-nominated director Matthew Heineman's The First Wave, a documentary film spotlighting the everyday heroes inside one of the country's hardest hit hospitals at the epicenter of the COVID-19 pandemic as they come together to fight one of the greatest threats the world has ever encountered.

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In The Same Breath by Nanfu Wang.

The SXSW award-winning documentary In the Same Breath recounts the experiences of people on the ground in the earliest days of the novel coronavirus and the way two countries dealt with its initial spread, from the first days of the outbreak in Wuhan to its rampage across the United States.

In the Same Breath, directed by award-winning filmmaker Nanfu Wang ("One Child Nation") debuts Wednesday, August 18 (9:00-10:40 p.m. ET/PT) on HBO.

Directed with a deeply personal approach by Wang, who was born in China and now lives in the United States, the film explores the early confusion and parallel campaigns by authorities to try to contain the virus as well as shape the public narrative through misinformation, resulting in a devastating impact on citizens of both countries.

Filmmaker Wang celebrates the Chinese New Year in her hometown about 200 miles outside Wuhan and then returns to the United States just as the first news reports about a dangerous new coronavirus start to surface. Working from the U.S., Wang's adoptive country, she hears troubling reports coming out of the region via social media and tasks local videographers in Wuhan to capture the early days of the virus's effects on the ground. Wang records wrenching audio testimonials from family members in China who have lost loved ones and she profiles several families in Wuhan struggling to come to terms with how quickly the virus took hold of their city and buckled an unprepared and overwhelmed health care system - foreshadowing what was soon to come in the U.S.

With emotional first-hand accounts from medical professionals, patients, and grieving family members, and startling, on-the-ground footage from both Wuhan and the U.S., In the Same Breath is a revelatory illustration of the devastating toll that resulted from official missteps at containment of the infection and the widespread phenomenon of social media misinformation, while also highlighting the strength and resilience of the people who risked everything to communicate the truth.

The critically acclaimed documentary celebrated its world premiere as the Opening Night film (Premieres) at the 2021 Sundance Film Festival and has gone on to play and win awards at multiple prestigious festivals including SXSW (winner of the Audience Award), Hot Docs Film Festival, Seattle International Film Festival, San Francisco International Film Festival, Full Frame, Opening Night of MoMA Doc Fortnight.

Watch the trailer for In the Same Breath.

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IN THE SAME BREATH. Award Winning Coronavirus Documentary Debuts on HBO [Trailer]

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The SXSW award-winning documentary In the Same Breath recounts the experiences of people on the ground in the earliest days of the novel coronavirus and the way two countries dealt with its initial spread, from the first days of the outbreak in Wuhan to its rampage across the United States.

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New evidence shows that patients with Long COVID syndrome continue to have higher measures of blood clotting, which may help explain their persistent symptoms, such as reduced physical fitness and fatigue.
The study, led by researchers from RCSI University of Medicine and Health Sciences, is published in the Journal of Thrombosis and Haemostasis.

Previous work by the same group studied the dangerous clotting observed in patients with severe acute COVID-19. However, far less is known about Long COVID syndrome, where symptoms can last weeks to months after the initial infection has resolved and is estimated to affect millions of people worldwide.

The researchers examined 50 patients with symptoms of Long COVID syndrome to better understand if abnormal blood clotting is involved.

They discovered that clotting markers were significantly elevated in the blood of patients with Long COVID syndrome compared with healthy controls. These clotting markers were higher in patients who required hospitalisation with their initial COVID-19 infection, but they also found that even those who were able to manage their illness at home still had persistently high clotting markers.

The researchers observed that higher clotting was directly related to other symptoms of Long COVID syndrome, such as reduced physical fitness and fatigue. Even though markers of inflammation had all returned to normal levels, this increased clotting potential was still present in Long COVID patients.

"Because clotting markers were elevated while inflammation markers had returned to normal, our results suggest that the clotting system may be involved in the root cause of Long COVID syndrome," said Dr Helen Fogarty, the study's lead author, ICAT Fellow and PhD student at the Irish Centre for Vascular Biology in the RCSI School of Pharmacy and Biomolecular Sciences.

This work was funded by the Welcome Trust, the Health Research Board (HRB) Irish Clinical Academic Training (ICAT) programme as well as the HRB-funded Irish COVID-19 Vasculopathy Study (ICVS). The work was also supported by a philanthropic grant from the 3M Foundation to RCSI University of Medicine and Health Sciences in support of COVID-19 research.

"Understanding the root cause of a disease is the first step toward developing effective treatments," said Professor James O'Donnell, Director of the Irish Centre for Vascular Biology, RCSI and Consultant Haematologist in the National Coagulation Centre in St James's Hospital, Dublin.

"Millions of people are already dealing with the symptoms of Long COVID syndrome, and more people will develop Long COVID as the infections among the unvaccinated continue to occur. It is imperative that we continue to study this condition and develop effective treatments."

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Blood clotting may be the root cause of Long COVID syndrome, RCSI Research

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New evidence shows that patients with Long COVID syndrome continue to have higher measures of blood clotting, which may help explain their persistent symptoms, such as reduced physical fitness and fatigue. The study, led by researchers from RCSI University of Medicine and Health Sciences, is published in the Journal of Thrombosis and Haemostasis.

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What if the U.S. decided to vaccinate the rest of the world against COVID-19?

That's what more than 175 health experts proposed to President Biden in an Aug. 10 letter sent to senior White House officials and shared with The Washington Post.

"We urge you to act now," the letter reads. "Announcing within the next 30 days an ambitious global vaccine manufacturing program is the only way to control this pandemic, protect the precious gains made to date and build vaccine infrastructure for the future."

The experts are asking the Biden administration to do three things:

Scale up production of mRNA vaccines in the U.S. with a goal of manufacturing 8 billion doses a year to distributeglobally. MRNA vaccines, say the co-signers, are faster to produce and more effective against variants than other types of vaccines.

Help set up manufacturing hubs around the world to make even more mRNA vaccines.

Export 10 million mRNA vaccines a week to COVAX or other global vaccine-sharing programs. According to the letter, the U.S. has over 55 million doses of mRNA vaccines in storage but is only administering 900,000 shots a day.

Only 24% of the world's 7.8 billion people have been fully vaccinated, according to figures compiled by Our World In Data, which gets its information from governments and health ministries. If the letter's proposal is adopted, 4 billion people - more than half the global population - could be fully vaccinated by the end of 2021 with U.S.-manufactured doses.

These are highly ambitious goals. But the signatories say they are necessary to curb rising infection rates as the delta variant surges in Africa, Latin America and Asia - regions where vaccines are least available. These measures can also protect against emerging variants, some of which may be resistant to current vaccines.

To better understand the letter's demands, we spoke with Dr. Paul Farmer, a Harvard Medical School professor and co-founder of the global health organization Partners In Health, who co-signed the letter alongside health academics, civil society leaders and others. This interview has been edited for length and clarity.
Why did you and your colleagues decide to draft and send the letter?
This is a group of global health folks with long experience responding to health crises in this country and in others. But this time, we have some new tools that are revolutionary. In sharp contrast to global plagues in the past, not even a year after identifying the pathogen, we have these highly effective vaccines, particularly mRNA vaccines. [The COVAX goal of] hitting 20% of the populations [of low-income countries] in the coming year is low. So, we thought, is there a way for us to spur into action what we see as a fairly supportive administration in Washington?
Is it fair to single out the U.S. to shoulder the global burden of vaccinating against COVID-19? Why not ask other wealthy countries to chip in?
It's not fair. We're cognizant that we're asking the U.S. to do more than any other country. But we have the vaccines and the technology [to cover the vaccination gap for the whole world]. So, it's a wonderful opportunity for us to say no to vaccine nationalism and yes to establishing a global standard of care for COVID and prevention of COVID.

Also, most of the signatories of the letter are Americans. So, we're begging our own country to do more because we think it can and we think it should.
Is this going to be an impossible challenge?
It's not impossible. Otherwise, we wouldn't have pushed the Biden administration so hard on the specifics. Is it going to be difficult? It sure is. We came to those big numbers by looking at the projected need and also the likelihood, if not certainty, that boosters would be needed. But we think the Biden administration has the resolve and wherewithal to do it.

We learned from the success of PEPFAR [President George W. Bush's HIV/AIDS initiative] that the higher we set our goals, the more people are enrolled in care and the more children protected. We're not drawing on nothing. We're not trying to be unreasonable. We're trying to be optimistic and audacious because that's what the moment calls for.
What first step would you like the Biden administration to take toward meeting the demands in the letter?
I'd like to see us facilitate vaccine production in Africa. They deserve a chance, especially because they have the highest burden of lethal infectious disease. If we are going to be pushing boosters on top of trying to vaccinate the whole continent against COVID, it's hard for us to see any option other than on-continent production.
Is there a place in particular that you think would make a great vaccine production hub?
I'm confident this could be done within months or a year in Rwanda, which has rolled out a very effective health-care delivery system - from community health workers to clinics to district hospitals to referral hospitals - over the last 15 years. And certainly South Africa, which is already a vaccine producer.
COVAX was supposed to ensure that vaccines were distributed equitably around the world. Does the fact that you and your colleagues felt compelled to send this letter mean COVAX has failed? Have you received a response from the Biden administration?
Looking at history, we've never pulled off a global vaccine rollout as quickly as we're trying to now. It took us almost two centuries to declare smallpox vanquished after a vaccine was developed. Even antiretroviral therapy for HIV took the better part of a decade for its widespread delivery. So, I'm not sure we find ourselves in the midst of some epic failure.

This is the most rapid development of novel vaccines that we have ever seen. Now the task is to see who can help us shorten the time between development and delivery. There's nobody in the world that can do more on this than the Biden administration.

We don't need or expect a letter back. Many of us have friends there, so we have a pretty good idea that some of the best people in the administration don't think this is a bad idea or imprudent or ridiculous. Of course, the buck stops with the boss, and the boss is President Biden. But our experience [as global health experts] with this administration so far has been a positive one.

So do I think we will see some response to this? I think we will.

Joanne Lu is a freelance journalist who covers global poverty and inequity. Her work has appeared in Humanosphere, The Guardian, Global Washington and War is Boring. Follow her on Twitter:

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They're Asking Biden To Vaccinate The World. It's Not Fair. But It's Not Impossible

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What if the U.S. decided to vaccinate the rest of the world against COVID-19? That's what more than 175 health experts proposed to President Biden in an Aug. 10 letter sent to senior White House officials and shared with The Washington Post. "We urge you to act now," the letter reads.

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NPR's A Martinez talks with Rev. Moneka Thompson, a staff chaplain at the UAB Hospital in Birmingham about the COVID-19 surge in her state, where ICU beds are completely full.

A MARTINEZ, HOST:

Now let's hear from another voice grappling with this surge in Alabama. Reverend Moneka Thompson is a staff chaplain at UAB Hospital in Birmingham, Ala. Reverend, welcome.

MONEKA THOMPSON: Thank you.

MARTINEZ: We just heard from several exhausted hospital workers in Alabama. Can you take us inside the hospital? What's the situation there like right now?

THOMPSON: So they have a very understandable frustration. This is a frightening - it is a overwhelming situation. Our staff are doing the best they can given the circumstances. And my role as the chaplain is to support, not only the patients, their caregivers or loved ones, and also our staff, our medical staff and team, who are absolutely some of the hardest working people in this entire country right now.

MARTINEZ: We just heard voices. I mean, they - to me, they just sounded exhausted, tired, frustrated. How is the staff holding up where you're at?

THOMPSON: So they absolutely are exhausted. They are frustrated. They are understandably angry. And so I think it is helpful for me to be that supportive presence for them as well as the rest of our staff chaplain team here and our counselors who work here at UAB. We have the opportunity to check in with them on a daily basis to offer those words of encouragement, to help them deal with the moral injury that this event is causing them.

MARTINEZ: You're right there in the mix, too. How do you stay supportive when I'm sure you're tired as well?

THOMPSON: So we are understandably all tired. And so for me, my faith is important for me. And I utilize it through prayer, through my personal meditation time, through listening to meditative music and writing. And I encourage my medical staff and team to do some of the same practices or utilize whatever non-religious or other practices may give them meaning and validation.

MARTINEZ: On that, has your work changed over the course of the pandemic? And I'm wondering if maybe in the last recent weeks, considering how the numbers have surged, has anything been different for you?

THOMPSON: So we are seeing significantly more COVID patients now than what we were about two months ago. So - and again, many of those families are not allowed to come in-person to see them. And so offering support just to the patient in person and offering that telephone support to those family members who are not allowed to see them - so it's a bit of a dual role.

MARTINEZ: Considering how long this has gone on, I mean, when you talk to relatives and friends of people who are in dire straits, I mean, what do you say to them? This has gone on far longer than I think anyone thought it would.

THOMPSON: You know, my heart absolutely goes out to them. I offer them my deepest condolences for how the patient may, unfortunately, not be progressing. And many of them - as was just aired in the interview with the previous physicians, many of the patients and their families - they still don't believe that this is real. They still believe this is a lie. And it's just amazing to see the lack of belief in the midst of everything that they're facing. And so I'm trying my best to be encouraging to them when it is a very bleak situation. And so it's very difficult, to be quite frank with you.

MARTINEZ: It is amazing, though, right? You mention belief, and that ties into faith and having faith that this will be over. But for some people, they don't have faith that this is even really happening, when it is.

THOMPSON: Right. That's correct. So many of them still do not believe. And unfortunately, the vast majority of the patients that we have now are not vaccinated. And some have been asking for vaccination at this point that, unfortunately, is too late.

MARTINEZ: What would you like to see and hear from leaders in your state?

THOMPSON: You know, I wish - I understand the mask mandate is so polarizing. Vaccination mandate is so polarizing. But I wish we had some standard where we could encourage at least a mask mandate at this point. Because we are in such dire straits in health care. And who is coming to rescue us?

MARTINEZ: Reverend Moneka Thompson is a staff chaplain at UAB Hospital in Birmingham, Ala. Reverend, thank you very much for taking the time.

THOMPSON: Thank you.

Copyright © 2021 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

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Alabama Hospitals Run Out Of ICU Beds. Chaplain Says It's A Frightening Situation

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NPR's A Martinez talks with Rev. Moneka Thompson, a staff chaplain at the UAB Hospital in Birmingham about the COVID-19 surge in her state, where ICU beds are completely full. A MARTINEZ, HOST: Now let's hear from another voice grappling with this surge in Alabama.

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Can the Vaccinated Develop Long Covid After a Breakthrough Infection? (Published 2021)

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While the vaccines are effective at preventing serious illness and death, the risk of developing post-Covid health problems after a breakthrough infection isn’t known.

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American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA)

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American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA)

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Authorities in Bali's Buleleng regency are taking their boats out to administer the COVID-19 vaccine to fishermen out at sea, as efforts continue to make sure everyone gets their jab.

In a statement, Buleleng Police Chief Andrian Pramudianto said that many fishermen haven't been vaccinated because they aren't able to join the vaccination program held on land due to the demands of their profession.

A medical team from the Buleleng Police set out to the sea yesterday to reach some of these fishermen, and 11 of them have so far gotten their first COVID jab.

"Keeping in mind the expansive waters off Buleleng regency and the fact that these fishermen haven't been vaccinated, we approached them instead by facilitating this vaccination service," Andrian said.

"This program will continue and next week we will target the fishermen in the western side."

As of Aug. 18, over 3.1 million people in Bali have received their first dose of the COVID-19 vaccine, while nearly 1.5 million are now fully vaccinated.
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Out at sea? No problem. Bali authorities take their boats out to vaccinate fishermen

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Authorities in Bali's Buleleng regency are taking their boats out to administer the COVID-19 vaccine to fishermen out at sea, as efforts continue to make sure everyone gets their jab. In a statement, Buleleng Police Chief Andrian Pramudianto said that many fishermen haven't been vaccinated because they aren't able to join the vaccination program held on land due to the demands of their profession.

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A doctor is leveraging the power of social media to warn people how large the gap is between how they view the severity of COVID-19 symptoms and how medical professionals understand them.

And his effort is attracting tremendous attention in Japan.

Kosuke Yasukawa, 39, a physician who treats COVID-19 patients in the United States, made an infographic that illustrates this difference in perceptions and posted it on Twitter. It quickly went viral.

The graphic warns that someone with moderate COVID-19 symptoms will likely experience the most difficult struggle of their life when battling the illness.

The public, however, thinks that someone with moderate symptoms will simply experience some difficulty in breathing.

Patients with moderate symptoms are likely to have a fever, cough and struggle to breathe well for days due to pneumonia.

"For many people who have never experienced a serious illness, it will be the most difficult condition they experience in their lives," said Yasukawa, an assistant professor at the medical department of Georgetown University.

If it becomes necessary to administer oxygen to a patient, they would be classified under "moderate II." But based on the U.S. standard, they would fall into a category of "serious."

If patients are put on ventilators, their condition would be considered "serious." But according to the U.S. standard, they would be categorized under "critical."

Yasukawa is trying to give people a reality check about the dangers of COVID-19. Even for patients with moderate symptoms, their pneumonia can worsen within just a few days and their condition might become serious.

He created the illustration out of concern that the public does not understand the terms describing the severity levels of COVID-19 symptoms in the same way that the medical community does.

Just 10 days after posting his graphic on Twitter on July 20, 14 million people had seen it.

According to the graphic, the general population views mild symptoms as being "like a cold," while doctors recognize them as "not needing help breathing."

Yasukawa said that all patients without pneumonia are categorized as "mild" in Japan.

But mild symptoms vary greatly from person to person.

Some patients only have a fever or cough for a short time, while other people also suffer from vomiting, diarrhea or other symptoms.

"Many people suffer greatly from a variety of symptoms for days and days," he said. He added that some people also suffer from side effects, such as malaise, shortness of breath and taste disorders, for months.

"Please don't think of it as just a cold," he said.

The stark warning comes as the much more powerful Delta variant rages like wildfire in Japan and abroad.

Yasukawa is urging people to continue to take basic anti-virus measures such as wearing masks, washing their hands, social distancing, getting vaccinated, and ensuring that there is proper ventilation.

(This article was compiled from reports by Haruna Ishikawa and Yoshiaki Abe.)

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Doctor tackles gap in public's view of COVID-19 symptoms | The Asahi Shimbun: Breaking News, Japan News and Analysis

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A doctor is leveraging the power of social media to warn people how large the gap is between how they view the severity of COVID-19 symptoms and how medical professionals understand them. And his effort is attracting tremendous attention in Japan.

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Reporter's COVID-19 Notebook | The Asahi Shimbun: Breaking News, Japan News and Analysis

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Reporter's COVID-19 Notebook by The Asahi Shimbun. The Asahi Shimbun is widely regarded for its journalism as the most respected daily newspaper in Japan.

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MAYAGÜEZ, PUERTO RICO - Abigail Matos-Pagán entered a bright-blue house in Mayagüez earlier this summer and was met by Beatriz Gastón, who quietly led the way to her mother's small room. Matos-Pagán had come to provide a covid-19 vaccine for Wildelma Gastón, 88, whose arthritis and other health concerns confine her to bed.

Wildelma Gastón asked for her rosary to be placed on her chest and motioned to her "good arm," where Matos-Pagán injected a first dose of the Moderna vaccine. The Gastón household, made up of five family members, breathed a collective sigh of relief. Though the vaccine had been available for months, Wildelma had been unable to reach a vaccination site. According to the Centers for Disease Control and Prevention's COVID Data Tracker, Puerto Rico's vaccination rate in March was one of the lowest among U.S. states and territories despite receiving more than 1.3 million vaccine doses. The rollout highlighted disparities in access to medical services, and the challenges of tracking and reaching remote citizens, such as Wildelma.

With each trip to school or work, family members worried about bringing the virus into their home and the threat to Wildelma's life. Matos-Pagán also vaccinated two of Beatriz's children, who are students at the University of Puerto Rico-Mayaqüez, during her visit.

"We have been waiting a long time for this moment," Beatriz Gastón said as she hugged Matos-Pagán goodbye, expressing gratitude for the home visit. To her, the vaccine is more than protection from the coronavirus - it clears the way for the family to be together with her mother.

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To Matos-Pagán, it is her latest calling. The nurse practitioner, who has guided relief efforts after hurricanes and earthquakes in Puerto Rico and elsewhere, has made it her mission in the U.S. territory to vaccinate as many people as possible against covid. Some residents of Mayagüez, a city on the western shore of the main island, candidly call her "The Vaccination Queen" and show up at her home asking for help in getting a shot.

According to The New York Times' case tracker, as of Friday, Puerto Rico has had more than 182,000 covid cases and at least 2,594 deaths. About 57% of the population is fully vaccinated, but many of the unvaccinated are hard to reach because they live in remote mountainous communities or have chronic illnesses that leave them homebound. Matos-Pagán has vaccinated around 1,800 people in Puerto Rico so far, including 1,000 who have chronic illnesses or are bedridden.

In the pandemic's early days, Carmen Blas' health declined, and she began using a wheelchair. Blas, 78, was confined to her home, on the third story of an apartment building, which kept her safe from contracting covid, but later she couldn't find transportation to a vaccination site. In June, her two children, Lisette and Raymond, visited from Wisconsin to help and immediately called the public health officials to get Blas inoculated.

"I usually come back every year and this was the longest I've ever been away. It was especially hard as my mother's health worsened, and I worried I might never see her again," said Raymond, who planned to extend his visit for as long as he was needed.

Matos-Pagán came to Blas' home in Aguadilla, Puerto Rico, to give her the vaccine. The family cheered the moment the vaccination was over.

"It's been really special to have intimate moments in someone's home during vaccinations. You can tell how much it means to their entire family," Matos-Pagán said afterward.

Mobilizing during a crisis is nothing new for Matos-Pagán. In the aftermath of Hurricane Maria, which cut off water and electricity to the entire island and claimed more than 3,000 lives, Matos-Pagán conducted initial community assessments in Puerto Rico's remotest and hardest-hit cities. Flooding and debris made many roads inaccessible, blocking these communities from basic needs such as food, water, prescription medications and transportation. Then, after a series of earthquakes in 2020 rocked the island, leaving even more people without housing or in substandard structures, Matos-Pagán organized local nurse practitioners to provide community health care. They supplied at-risk populations with their medicines when pharmacies closed, and teams set up mobile medical tents near overcrowded hospitals.

"I'm hyper and busy in my daily life, but when there is a crisis, I am calm and still. Grounded. I feel like I'm where I belong," she said.

Abigail Matos-Pagán gives Wildelma Gastón a covid vaccine at her home in Mayagüez, Puerto Rico. Gastón is confined to bed because of arthritis and other health problems.(Alicia Carter)

Matos-Pagán was born in New York City. She became interested in medicine after watching nurses support her mother, who died of complications from an aneurysm when Matos-Pagán was 9. Her mother's death taught her "nothing was permanent," she said, which has inspired her to act when disaster strikes and support people through personal tragedy and loss.

Matos-Pagán returned to Puerto Rico to study nursing and later earned a master's degree and a doctorate at the University of Puerto Rico-Mayagüez. Through her work, she holds various titles: first commander of the Puerto Rican Disaster Response Team, and director and founder of the Coalition of Nurses for Communities in Disaster.

Her experiences managing medical professionals and resources during hurricanes have taken her to locations across the U.S. Atlantic coast and the Caribbean. During the covid pandemic, she was recruited to assist in triage leadership for an ICU floor short on resources in El Paso, Texas, and a hard-hit senior living facility in Maryland.

"Not everyone is built for this. It's really sad, depressing work," Matos-Pagán said. "But even when there are mass casualties, you can still save lives and get people's basic needs met. I've seen communities come together in the most incredible ways. It's a challenge, but that's what keeps me going."

And, even as she is rapidly trying to get more covid shots into the arms of Puerto Ricans, Matos-Pagán is preparing for the next crisis. Hurricane season officially began in June, and she will be on disaster-ready duty until the end of November.

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'The Vaccination Queen': Nurse Practitioner Takes Covid Shots House to House in Puerto Rico

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MAYAGÜEZ, PUERTO RICO - Abigail Matos-Pagán entered a bright-blue house in Mayagüez earlier this summer and was met by Beatriz Gastón, who quietly led the way to her mother's small room. Matos-Pagán had come to provide a covid-19 vaccine for Wildelma Gastón, 88, whose arthritis and other health concerns confine her to bed.

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Out of the Pandemic, A Better Approach to Homelessness

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How two communities have transformed their homelessness response and prevention strategies ,

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Spring was a tough time for public health in Montana. As health workers fought to control the spread of COVID-19 and save lives, elected officials in the state were passing new laws to make it more difficult for them to do their much-needed work.

One of Montana's new laws gives elected officials the power to repeal or change an order that is designed to protect the health of the state's residents. Another strips health officials of most of their ability to safeguard workers and consumers at businesses during a public health emergency.

The flurry of laws from legislators caused some Montana public health officials to resign, said Drenda Niemann, MPA, health officer of Lewis and Clark County Public Health, where two workers handed in their resignations.

"We are put in a situation where we have public health work to do, but at the same time have to rely on elected officials to make public health decisions, even though they have no public health background and are swayed by their voters," Niemann told The Nation's Health.

The chilling actions by Montana legislators are not isolated incidents, unfortunately. Local and state agencies across the U.S. are seeing an assault on their public health authority. Through spring, at least 300 bills and resolutions had been introduced targeting oversight of emergency public health actions in 45 states, according to a May paper in the Brigham Young University Journal of Public Law.

A new North Dakota law prohibits requiring masks in any situation, including cases of tuberculosis, a highly transmissible respiratory disease. In Arizona, a law ends requirements for vaccinations at state hospitals and universities, though they are still required for grade schools. And a law in Kansas takes away the governor's ability to order business closures during a public health emergency. Those are just three of the many harmful new policies highlighted in "Proposed Limits on Public Health Authority: Dangerous for Public Health," released by the Network for Public Health Law and the National Association of County and City Health Officials in May.

"These laws pose a real threat to the ability of public health practitioners to do their jobs in emergencies and day to day," Jill Krueger, JD, director of the Northern Region Office of the Network for Public Health Law, told The Nation's Health.

In Montana, Lewis and Clark County Public Health issued an order requiring people at businesses to wear masks to protect them from COVID-19. But H.B. 257, a state bill that became law May 7, took away that power. If COVID-19 cases spike significantly - a possibility, given that only 41% of Montanans were fully vaccinated as of June and variants were circulating in the state - county health officials will not be able to require that people mask up at businesses.

"It discredits the education and experience we have in this field," Niemann said. "It sends the message into our communities that public health can't be trusted with this work.'

"It discredits the education and experience we have in this field. It sends the message into our communities that public health can't be trusted with this work." - Drenda Niemann

Over a month after the Montana law went into effect, Lewis and Clark County officials were still debating who would be on the governing body to make emergency public health decisions. None of them will likely have a background in health.

In Ohio, S.B. 22, a state bill that became law on June 23, empowers the state Legislature to rescind any order or rule issued by the governor or the Ohio Department of Health on the spread of a contagious or infectious disease. The law also limits the ability of local boards of health to issue isolation and quarantine orders.

If an outbreak of measles or another highly infectious disease occurs, Ohio public health workers may find they have no recourse, based on the new law.

Joe Durham, JD, a lawyer representing the board of health in Franklin County, Ohio, said he believes a medical diagnosis of measles would allow county health officials to impose quarantine and isolation. But the law would not allow quarantine or isolation based on a COVID-19 diagnosis from a self-test, he told The Nation's Health. It would need to be through a medical office ordering a lab report.

Joe Mazzola, MPA, county health commissioner of Franklin County Public Health, said the Ohio law hampers the department's work.

"These types of laws put public health in a lot of jeopardy because not having the ability to act timely and having to defer to other bodies impedes our ability to carry out our public health responsibilities," Mazzola told The Nation's Health.

While public health and elected officials have occasionally butted heads during past disease outbreaks, COVID-19 has amplified the stakes. James Hodge Jr., JD, director of the Western Region Office of the Network of Public Health Law, called the recent measures a "power grab" by legislators who want to appease constituents, even if it endangers public health.

Federal policymakers can respond to the new state and local laws by invoking federal powers and constitutional law, according to the Brigham Young University Journal of Public Law paper by Hodge and Jennifer Piatt, JD, both of Arizona State University.

For example, opponents of Ohio S.B. 22, which also creates a governing body to make emergency public health decisions, could invoke constitutional law because the measure "crosses a constitutional boundary designed to maintain divisions among branches of government," the paper said.

Many of the new laws have the potential to be struck down if challenged in court, Hodge said. "Emergency powers invariably put a lot of flexibility at the local, state and federal levels, and you simply can't bootstrap all that due to a single machination from legislators," he told The Nation's Health.

Public health experts will discuss the ongoing attacks against public health authority during APHA's 2021 Annual Meeting and Expo this fall. A featured session on Monday, Oct. 25, will share strategies that health supporters can use to challenge laws that undermine public health.

For more, visit www.networkforphl.org.

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New state, local laws threaten vital public health authority: Backlash from COVID-19 protections

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Spring was a tough time for public health in Montana. As health workers fought to control the spread of COVID-19 and save lives, elected officials in the state were passing new laws to make it more difficult for them to do their much-needed work.

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Over a choppy phone call to the remote Nicobar archipelago, I told Indigenous leader Ayesha Majid that my friends in Delhi were dropping like flies. A horrific second wave of COVID-19 was ravaging India; crematoria were running out of wood and graveyards were running out of space. "Brother, how did this happen?" she asked in disbelief.

Earlier this year, COVID resurged in India with a vengeance. For a week in May, the country contributed over half of the daily COVID cases reported globally. COVID deaths in urban India are now abating, but people in rural India have been dying in droves.

Thus far in the second wave, however, the almost 24,000 Indigenous Nicobarese people, living on 11 tiny islands in the Bay of Bengal, have recorded not a single infection. The Nicobar archipelago is home to not only to these Indigenous peoples but also to more than 13,000 officials, defense personnel and settlers from mainland India. Early in the pandemic, they had thoughtlessly brought the virus to this remote outpost by traveling there from the adjacent Andaman archipelago.

But despite initial panic, past trauma from a devastating earthquake and tsunami, illiteracy, poverty, lack of the most rudimentary facilities and remoteness from clinics and hospitals (seriously ill Nicobarese must usually travel to a hospital on the Andamans, a journey of up to 30 hours by sea) this remote community has managed to shield itself from the pandemic. Its experience shows that top-down policies that overlook regional and cultural values do more harm than good-whereas their bottom-up approach to self-protection carries important lessons for other vulnerable communities worldwide.

On March 24, 2020, the Indian prime minister ordered an abrupt 21-day coronavirus-induced nationwide lockdown, confining over 1.38 billion people to their homes. Overnight, millions of poor Indians- migrant workers, daily wage earners, smallholder farmers, the homeless and members of oppressed castes and tribes-found themselves in an extremely precarious situation. The lockdown was eventually extended in phases to 68 days. Among the world's strictest, it precipitated a human tragedy, driving mass migrations and forcing 75 million people below the poverty line.

The day after the announcement, several Nicobarese leaders gathered nervously on Kamorta Island, a tiny dot of land in the vast eastern Indian Ocean. As Majid, who chairs one of the tribal councils, explained the situation, memories of a past trauma began to haunt the gathering. In December 2004, a deadly tsunami and the ensuing humanitarian aid had ravaged the Nicobarese society. Many Indigenous leaders began to fear that a similar calamity was again looming over their community.

In this remote tribal reserve, where concepts such as pandemics were utterly foreign, the abrupt lockdown engendered a novel crisis. When the local administration ordered the Nicobarese to not step out of their houses, many failed to understand why they were suddenly being restricted from fishing, hunting and tending to coconut plantations-activities essential to their survival. The police told them that a deadly virus was on the loose, indiscriminately claiming victims around the world; and that even the most advanced and resourceful governments had failed to suppress it. Social distancing, self-isolation and mask-wearing were the only protections against the virus, the Nicobarese learned. But such measures were alien to their worldview. The Indigenous peoples have a strong sense of community, living in large, multigenerational families and generously sharing resources.

Worse, traumatic memories of the tsunami resurfaced, paralyzing the Nicobarese and plunging them into a state of panic. In 2004, towering waves had devastated the Nicobars in the blink of an eye, extinguishing 3,449 lives by the official count (and 10,000, or roughly one third of the Nicobarese community as per the estimates of independent researchers). Those who survived were left so traumatized that they could not bear to look at the sea for months. The Nicobarese perceived COVID as a similar, imminent catastrophe. As memories of past trauma revived, their mental health took a hit. Many could not help worrying that the virus was lurking in their tropical forests, prowling on their beaches or secretly waiting to seize them outside their houses. The age of humans, some thought, had finally come to an end. Many believed they were certainly going to die.

At this critical juncture, Majid persuaded the village leaders of the central Nicobar Islands to mount a coherent COVID-19 response to support their reeling community. They relied on both tradition and science. They counseled the panic-gripped people, patiently addressed their endless queries and busted several myths. A group of women began to sew masks for distribution among the Nicobarese, as well as for the local civil and defense personnel. The tribal councils set up a dedicated quarantine facility, simplified and disseminated crucial coronavirus-related information in Nicobarese languages and appealed to the Indigenous peoples to practice self-regulated isolation, wash hands frequently andtake special care of the elderly. The councils also set up numerous temporary grocery shops in the villages to prevent risky trips to larger markets and deployed teams of volunteers to prohibit the movement of people in or out of the villages.

While the emotional support instantly boosted the community's morale, the dissemination of scientific knowledge about the virus prepared the islanders to fend off contagion. After the tsunami, the traditional livelihoods of the Nicobarese had eroded, and many families now live precariously. The sudden lockdown worsened their predicament. Lifestyle changes since the tsunami have also brought in previously unknown ailments such as diabetes, making the Indigenous peoples even more vulnerable to serious illness should they get infected. So instead of adopting a one-size-fits-all approach, the tribal councils focused on the marginalized people and addressed their multilayered vulnerabilities. For instance, they prepared a list of needy families and supplied them with essential commodities. This assistance came as a lifeline to many; when the volunteers reached out to distant villages, they discovered that several households had no provisions left. "They had nothing to eat. Many could not contact anyone as they had no mobile phone or television to receive or exchange the information. They were so scared that they did not know what to do," says Majid.

Coronavirus cases surged in India despite the lockdown, but thanks to the Nicobar's remoteness, the Indigenes were temporarily safe in their villages. When travel restrictions to the Andaman and Nicobar Islands were relaxed in May 2020, however, thousands of residents who had been stuck in mainland India began to return, several of them carrying the virus. The tribal councils were alarmed: in a close-knit traditional society, where people live in multigenerational houses, a single case of coronavirus was potent enough to devastate the Indigenous community.

Over the past five centuries, alien germs and epidemics spread by European colonizers have exterminated scores of Indigenous societies around the world. The tragic fate of the neighboring Great Andamanese, whom imported epidemics had all but obliterated in the 19th century, reminded the Nicobarese leaders about their own unique vulnerabilities. Being a historically isolated community, the Nicobarese are highly susceptible to alien diseases, a vulnerability exacerbated by the inadequate public health system. Thus, maintenance of isolation-a natural protection that the Nicobarese enjoyed against the contagion-was crucial to their survival

The tribal councils began to lobby the local administration, pleading for restrictions on the movement of people to the Nicobars. Even so, the administration banned travel to the islands only after the coronavirus had infected people in northern and southern Nicobar Islands, which have significant populations of mainlanders. Fortunately, everyone survived and, with the infected people and their families diligently following COVID protocols, the disease did not spread. The tribal councils ensured that the Nicobarese watched over one another and immediately reported any symptoms of COVID to their leaders.

In this manner, the Nicobarese people managed to contain the spread of the first wave of the pandemic and seem to have escaped the second. Now that the Indian government has started a COVID-19 vaccination drive in the archipelago, the tribal leaders are again playing a crucial role in dispelling vaccine-related myths. Majid has led by example, encouraging her community to fearlessly get the injection.

The Nicobarese response offers some important lessons for effective management of the pandemic. The Indigenous peoples could successfully navigate through the crisis because their leaders acted promptly, collectively and selflessly; embraced the strengths of tradition and science; practiced democratic decision-making; created space for the community's active involvement; emphasized accountability, integrity and transparency; ensured women's equal participation; and prioritized the needs of vulnerable and marginalized people.

Throughout the world, the poor, vulnerable and marginalized sections of the society are being disproportionately affected by the pandemic. But a closer look also reveals that several Indigenous communities are engaged in spirited fight against the pandemic, using their community ties to effectively protect themselves. It is time we learned from the unique worldviews and equitable and inclusive responses of such Indigenous communities to the pandemic.

This is an opinion and analysis article; the views expressed by the author or authors are not necessarily those of Scientific American

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How a Remote Indigenous Community Fought the Pandemic

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Thanks to a response based on local culture and values, India’s Nicobar islanders haven’t had a single infection during the nation’s horrific second wave