But before you start, there are a few things you should keep in mind before you craft homemade hand sanitizer. First, it’s crucial that you understand that proper hand washing will always be better than simply rubbing your digits with hand sanitizer. Using the right amount of alcohol-based disinfectant (3 milliliters) for 25 to 30 seconds is fine in a pinch, but soap, water, and a good scrub are the absolute best way to protect yourself against contagious diseases.

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Knowing how to make hand sanitizer is useful if you ever find yourself in the middle of a health emergency like the COVID-19 pandemic. But these and other DIY recipes are only for extreme cases when hand washing is not an option and supplies are low. Professionals use these formulations in underserviced healthcare settings, and if at some point hand sanitizer is not available at local stores, you can use them too.

Lastly, your homemade hand sanitizer won’t last forever. The main active ingredient in the recipes below is isopropyl alcohol, a volatile compound that will evaporate over time and compromise the effectiveness of your hand sanitizer. When alcohol concentration drops below 60%, your hand sanitizer won’t be able to kill COVID-19 or influenza, for example. The shelf life of store-bought hand sanitizers can vary—the industry standard is three years, but it can go up to five. How long your DIY hand sanitizer lasts will depend on the type and size of the container you use and how often you open it, along with room temperature and humidity. Unfortunately, all of these factors make it hard to predict exactly how long your hand sanitizer will be good for, so proceed with caution. 

The WHO has a comprehensive guide on how to make hand sanitizer—the only problem is that if you follow their instructions, you’ll end up with a lot of it. Like, exactly 2.6 gallons of it. If you want to make enough to last you, your family, and all your friends through a zombie apocalypse, you definitely can. But if you want to keep things on a smaller scale, we’ve adapted the measurements for you.

5. Sanitize your spray bottles and pour in your hand sanitizer. Spray some of your leftover alcohol into your bottles and let them sit until the alcohol has evaporated. Then pour in your sanitizer.

6. Label your bottles. Hand sanitizers pose a real risk of involuntary alcohol poisoning, especially among children, who were largely affected by it during the first months of the COVID-19 pandemic. You don’t want anyone to accidentally ingest your newly made hand sanitizer. Take the time to label your bottles with their contents and the date, and keep them away from unsupervised kids.

6. Label your containers. Hand sanitizers pose a real risk of involuntary alcohol poisoning, especially among children, who were largely affected by it during the first months of the COVID-19 pandemic. You don’t want anyone to accidentally ingest your newly made hand sanitizer. Take the time to label your bottles with their contents and the date, and keep them away from unsupervised kids.

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Over the first two years of the COVID-19 pandemic, the coronavirus directly or indirectly killed about 15 million people worldwide, according to estimates from the World Health Organization. In the United States, more people died in 2020 and 2021 than during the 1918 influenza pandemic, which was widely called the most deadly in recorded history. 

The word “deadly” certainly applies to the virus that causes COVID-19. And yet, epidemiologists hesitate to give SARS-CoV-2 the superlative of deadliest virus in human history. To them, the raw number of mortalities caused by a given virus doesn’t always paint the full picture of a pathogen’s danger—especially when comparing viral outbreaks across time.

Raw mortality numbers have to be taken in the context of the world’s total population, says Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health. “A lot of people talk about how COVID deaths eclipsed what we saw in 1918,” she says. “It’s really important to remember that the population of 1918 was a fraction of what it is today.” In that context, the flu of 1918 rises back up in the ranks in terms of deadliness.

Using the “case fatality rate” metric to determine what virus is the deadliest, rabies would likely come out on top. That’s because, if an infection becomes symptomatic, rabies is fatal to humans in more than 99 percent of cases. Globally, approximately 59,000 people die from rabies every year. Very few of those deaths—an average of two in the US—occur in the developed world because of rabies vaccines for household pets and swift medical interventions after bites.

But “a virus doesn’t have to have a very high case fatality ratio to cause a tremendous amount of death and disruption,” Nuzzo says. “It’s more about looking at the environments in which the viruses are spreading, and our social and human vulnerabilities to it.” 

A virus with a lower case fatality rate can kill more people if it’s highly transmissible, with a long period of time before severe or obvious symptoms set in. This allows an infected person to expose many others. That’s why SARS-CoV-2 caused such a rapid and devastating outbreak around the globe. It’s easily transmitted via airborne droplets, and doesn’t always or immediately cause severe illness. 

[Related: Can viruses be good for us?]

Globalization sped it along, too. “When a virus spreads at the pace of a human being walking, that’s very different than when you can hop on an airplane and be anywhere in the world in 36 hours,” Nuzzo says. 

During large outbreaks such as epidemics or pandemics, epidemiologists look at another metric, called excess deaths: how many more people died during a period of time than typically do over that same window. Excess deaths can account for other indirect ways that a virus causes death, Nuzzo says, such as patients who need critical care but can’t get it in overburdened hospitals.

Here’s how some of the most devastating viruses in human history tell different stories of how high a death toll can rise:

Influenza

The 1918 influenza pandemic still far and away ranks as the deadliest global outbreak of the 20th century. Thought to be caused by an H1N1 virus, it spread globally in 1918 and 1919. An estimated 500 million people were infected (approximately a third of the global population) and 50 million people died worldwide, about 675,000 of whom were in the United States, according to the Centers for Disease Control and Prevention. 

Without sophisticated testing and tracking, death toll estimates rely heavily on excess death calculations. Some suggest the true toll was closer to 17 million, while others set it much higher at 100 million. William Schaffner, professor of preventive medicine and professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine, cautions against over-interpreting comparisons between the historic flu data and modern viral outbreaks.

[Related: Can you get diseases from bad bathroom smells?]

 “We are determining cases and even counting deaths with much more precision now than we did then,” he says. At the time, there were also no flu vaccines and no antibiotics to treat secondary bacterial infections, which likely drove the excess death toll higher.

Today, the youngest and oldest people are most likely to die from influenza. But during the pandemic over 100 years ago, Schaffner says, deaths bore a different signature: mortality peaked among young and middle-aged adults, too. Why that happened is still unclear, he says, but it contributed to the historic toll of that pandemic.

Influenza continues to hold its place as one of the deadliest viruses, despite the availability of vaccines. Variants of the influenza virus have led to other pandemic-level events, such as the 2009 outbreak colloquially called the swine flu pandemic. But the virus is also endemic in our society, and infects an estimated 1 billion people globally every year, according to the World Health Organization. Of those cases, the WHO reported in 2019, somewhere between 290,000 to 650,000 result directly or indirectly in deaths. 

An estimated 40.1 million people have died from AIDS-related illnesses since the start of the epidemic, according to the Joint United Nations Program on HIV and AIDS. That is nearly half of the number of people estimated to have become infected with HIV since the start of the epidemic, at an estimated 84.2 million. 

The case fatality rate of HIV/AIDS was historically quite high. Some estimates put it around 80 percent without treatment. But much has changed since the 1980s. Today, there are ways to manage HIV and mitigate the immunodeficiencies associated with an infection, and most patients are diagnosed sooner after an infection. In the United States, the rate of HIV-related deaths fell by nearly half from 2010 to 2017, according to the CDC. 

That excess deaths metric likely reached a much higher number by the time officials declared the public health emergency over in early May. The Omicron wave that swept around the globe in late 2021 and early 2022 saw one of the largest surges in cases of COVID-19 and, although the variant didn’t seem to be more deadly than previous variants, with millions of people infected, a high death toll in the hundreds of thousands was inevitable. 

Early in the pandemic, the case fatality rates calculated for SARS-Cov-2 varied considerably. Many estimates were likely higher than the true number, as researchers scrambled to devise tests for the virus and milder cases slipped through the cracks. In early 2020, estimates of the case fatality rate by country ranged as high as 25 percent or more. Since then, case fatality rates have dropped, and now, according to Johns Hopkins University, they are as high as 4.9 percent. In the US, the case fatality rate is 1.1 percent. 

Mortalities continued to stack up into the 20th century, with an average of three out of every 10 people infected dying. The disease, which is caused by variola virus, is estimated to have killed more than 300 million people from 1900, until a global vaccination campaign halted its path of devastation in 1977. It was the first disease ever to be eradicated. 

[Related: The first honeybee vaccine could protect the entire hive, starting with the queen]

But it was the very thing that made it particularly fearsome that was its downfall, Schaffner says. “It created such a distinctive rash that people could identify it and fear it. And that was one of its Achilles heels,” he says. Because it was so easily identifiable, and spread so slowly, vaccinating the local population near an outbreak swiftly curtailed transmission. Such an approach, he says, was part of the vaccination strategy that eradicated the great pestilence. 

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COVID-19 is no longer a public health emergency in the US. The Biden administration’s deadline follows the World Health Organization’s announcement last week that removed COVID’s status as a global health crisis.

Infectious disease experts tell Popular Science that it’s an encouraging step and a sign that we are in a very different place than where we were in 2020. And while the recent decisions in no way mean the virus is gone—it’s expected to be endemic like the flu—access to COVID testing, treatments such as Paxlovid, and the vaccines have put the US in a position to coexist with it.

That said, managing your safety will come at a higher cost now. In one of the biggest changes from ending the federal emergency response, insurances are no longer required to cover the costs of COVID testing or reimburse people if they bought an over-the-counter home COVID-19 test. The federal government is also ending its free COVID-test program over the mail. 

As the financial burden of testing shifts to families and individuals, knowing where and when to get tested will keep you protected as the country transitions into this new stage of the pandemic. “We’re still seeing up to 1,000 deaths a week in the US from COVID for people that are older and at risk,” warns Del DeHart, a medical director of the infectious diseases department at the University of Michigan Health-West. “For those people, COVID is still not over and so testing for early treatment is going to be critical.”

Where to get COVID tests

There are still options for getting free COVID tests around the US The last day to order four free at-home COVID tests from the government is May 31, but local community clinics can give away free COVID tests or at a lower cost until supplies run out. 

Access to free testing might also depend on where you live. David Souleles, the director of the COVID-Response Team at the University of California, Irvine, says some state governments are taking measures to avoid financial barriers with COVID testing. California, for example, issued a mandate for health insurances to continue providing reimbursement for eight monthly at-home tests. Check your state government’s website to see what policies are in place following the end of the public health emergency.

If you are uninsured, the US government will continue to provide access to swabs through the Increasing Community Access to Testing Program. This government program partners with specific healthcare sites such as Walgreens and Quest Diagnostics to provide no-cost COVID tests with priority for people with a known exposure to the virus or who are showing symptoms.

[Related: An at-home test for both COVID-19 and the flu gains approval]

At-home rapid tests and PCR laboratory testing will still be available at your local pharmacies and doctor’s office, but it’s up to your insurance company if they want to bear the cost or require a copayment. What’s more, insurance companies may charge different prices for COVID tests; if they cover the cost, they may set limits on how many tests they will cover per individual. 

Prices for COVID test kits in stores like CVS range from $9.99 to $28.99, meaning testing can quickly get expensive. DeHart is concerned that the prices will create a financial barrier that will deter people from getting tested. If affordability becomes a question, it’s important to make every COVID test you take count.

When it’s still important to get tested for COVID

While most COVID mandates have lifted around the country, some employers and places might require you to get tested. For instance, healthcare workers employed in facilities like nursing homes will likely continue routine COVID testing. And as of now, many hospitals still require routine COVID testing for admitted patients, though it remains unclear whether the hospitals will cover the cost or if the test will be added to a person’s medical bill.

For voluntary testing, it’s important to evaluate your risk of having a severe COVID infection. DeHart says individuals above the age of 65 and those with immunosuppressive conditions should get tested regularly, along with loved ones in close contact with those that fall under this category. Souleles also recommends taking a test before visiting a relative in assisted living or anyone who is considered at high-risk of exposure. 

Other scenarios may apply, too, Souleles adds. “We would still encourage people to test before and after travel and before and after gatherings if they have the ability to do so. Anytime that you have the ability to test before you’re going to be around lots of people is great, and anytime you have the ability to test three to five days after being around a lot of people, that’s also a good thing.”

[Related: Long COVID recovery is finally getting the attention it deserves in the US]

If you have COVID-like symptoms, get tested before going out in public, even if the side effects seem mild. Testing early will give you more chances to get Paxlovid, which is most effective when taken within the first five days of seeing symptoms, and potentially avoid life-threatening complications. 

If you need to purchase a COVID test, treat it like you would any other over-the-counter goods. This includes checking the expiration dates to avoid a false positive or false negative result. You will also want to throw out any recalled COVID tests. If purchased for a later date, keep COVID tests at room temperature and away from the hands of pets and young children.

What to do if you test positive for COVID

If the test comes out positive, follow the Centers for Disease Control and Prevention’s (CDC) guidelines. Stay home and isolate yourself from others in the household for five days. People experiencing moderate symptoms like difficulty breathing should isolate for 10 days. Monitor your condition and go to the hospital if there are any severe or life-threatening complications. 

If you must go outside, wear a high-quality mask and avoid going to places where you would have to take it off. Also contact your doctor to see if you are eligible for any COVID-19 treatments and start those as soon as possible.

You can stop isolating after five days if you have no symptoms. If you continue to show symptoms, the CDC says you should stay put until your symptoms improve or you are fever-free for 24 hours without using medication.

[Related: Getting COVID more than once might be even worse than we thought]

Keep in mind that COVID tests are only one of the many tools available to reduce your risk of severe infection and death. Both DeHart and Souleles strongly urge people to get vaccinated and get their booster shot when eligible. Insurers will still be expected to cover the bivalent COVID vaccine as a routine immunization, and the Biden administration’s Bridge Access Program for COVID-19 Vaccines and Treatments will continue to provide vaccines free-of-charge to the uninsured.

“Stay up to date with your vaccines,” says Souleles. “It’s still the most important tool that we have right now.”

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With the federal public health emergency for COVID-19 set to expire at the end of the day on May 11, take a few minutes today to order the handful of free at-home COVID-19 tests the US government is holding for you. Don’t procrastinate: guaranteed insurance coverage for tests ends with the emergency, so they might not be free starting on May 12.

For now, every residential address in the US, Puerto Rico and other US territories, as well as those linked to overseas military and diplomatic personnel, can request four free rapid antigen tests from the federal COVID tests website. Although coverage may change when the public health emergency ends, the US Department of Health and Human Services says the government will continue to distribute tests via that website through the end of May.

And if you still have tests you ordered at any point since the program launched in January 2022, don’t throw them out—use the Food and Drug Administration’s searchable at-home test database to see if their expiration dates have been extended. Studies have shown that repeat COVID-19 infections increase the risk of hospitalization and death, so it’s worth hanging onto as many usable tests as you can. It’ll help you avoid spreading it among your family, friends, and community.

What’s changing with insurance coverage for COVID tests

The end of the public health emergency also means private insurance is no longer required to cover COVID tests without cost-sharing. The Biden administration has encouraged health insurers to continue, but after May 11, you may have to pay for any tests you order or pick up. To understand exactly what to expect, you’ll need to check with your plan to see how it will handle COVID tests.

If you’re insured by a state Medicaid program, though, you’re in luck. These are required to cover COVID tests without cost-sharing until September 30, 2024, the HHS says. After that, coverage may vary by state.

Medicare coverage, meanwhile, is a mixed bag. Anyone with traditional Medicare can continue getting PCR and antigen tests with no cost-sharing when the lab tests are ordered by a doctor and some other health care providers. If you’re enrolled in Medicare Advantage, cost-sharing may change when the health emergency ends, so the HHS recommends you check with your plan after May 11.

Despite the end of the health emergency, the government may continue to distribute free tests from the national stockpile through states and communities. If you’re looking for a free COVID tests, you can check the Centers for Disease Control and Prevention’s no-cost COVID-19 testing locator.

Those living in multi-family, co-living, or other shared living spaces can place more than one order as long as the USPS knows the address houses multiple unrelated families, but may be unable to if the government doesn’t know several families live there. If that happens, you can file a service request or call the USPS help desk at 1-800-ASK-USPS (1-800-275-8777) to try to get it fixed.

If you need help placing an order, you can call 1-800-232-0233 Monday through Friday between 8 a.m. and 8 p.m. Eastern Standard Time, or between 8 a.m. and 5 p.m. on the weekend, for assistance in English, Spanish, and more than 150 other languages. There’s also a teletype (TTY) or text telephone number at 1-888-720-7489 and the aforementioned USPS help desk.

People with disabilities can call the disability information and access line at 1-888-677-1199 between 9 a.m. and 8 p.m. EST, Monday through Friday, or email DIAL@usaginganddisability.org.

If you provide an email address when you order, you will get shipping notifications and can track the package on the USPS website. You can’t pick the tests up anywhere, even your local post office—they will always come to the address you provided, the agency says.

As long as your tests haven’t expired, the government recommends you take them if you begin having COVID symptoms like a fever, sore throat, runny nose, or loss of taste or smell; at least five days after you are in close contact with someone who has since tested positive for COVID; or before you gather with a group, especially if that group includes people at risk of severe disease or who aren’t up to date on their vaccinations (keep in mind that you may not know who’s at risk, either).

It’s also worth noting that you should let your tests come to room temperature before using them—especially if they were delivered in freezing or blistering hot temperatures. Although the tests are built to survive a range of conditions, they might not work as well if they’re cold, the government says. Generally, rapid antigen tests are meant to be used in an environment that’s somewhere between 59 and 86 degrees Fahrenheit (15 to 30 degrees Celsius), but your tests should come with specific instructions about this. The government recommends letting the unopened package sit indoors for at least two hours before opening and using any of the tests inside.

How to take a rapid antigen test

Each test kit comes with directions for how to use it, and they all involve swabbing the inside of your nose. You should get results within 30 minutes and you won’t have to leave your home. If you don’t follow the instructions, the result could be wrong. For visual learners, the Centers for Disease Control and Prevention has a how-to video, and it also has one for people who use American Sign Language.

[Related: The Postal Service helps keep millions of Americans alive and well]

If the results come out negative, the test didn’t find COVID in your body, and you might have a lower risk of spreading the disease. It’s worth noting that these at-home antigen tests generally aren’t as accurate as PCR tests, for example, which are processed by laboratories. So if you think you got a false negative, the government suggests testing again within a few days, leaving at least 24 hours between tests.

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On May 5, the The World Health Organization (WHO) announced that we are no longer in a global COVID-19 emergency. The emergency was first declared over three years ago in the early days of the pandemic. During the 15th meeting of the International Health Regulations Emergency Committee regarding COVID-19, the members highlighted a decreasing trend in deaths, decline of COVID-19 related hospitalizations and intensive care unit admissions, and higher levels of population immunity to the virus as the basis of their decision. 

“With great hope, I declare COVID-19 over as a global health emergency,” WHO director general, Tedros Adhanom Ghebreyesus announced during a media briefing. 

[Related: Biden will end COVID-19 national emergencies in May. Here’s what that means.]

However, Tedros stressed that just because the global emergency declaration is ending, it does not mean that COVID-19 is not still a threat to public health. “As we speak, thousands of people around the world are fighting for their lives in intensive care units. And millions more continue to live with the debilitating effects of post-COVID19 condition,” Tedros said. 

The WHO first made the emergency declaration on January 30, 2020, when only 213 people were known to have died from the novel virus. The declaration was a signal to the international community that COVID-19 posed a threat to the whole world and that they should begin to prepare. 

The WHO will continue to list COVID-19 as a pandemic, similar to how they designate HIV. While it acts as a symbolic milestone, this decision does not change much, but it is a significant moment in the evolving human relationship with the novel virus that brought life to a screeching halt in 2020 after it first emerged in China in December 2019.

Many countries, including the European Union, have already ended their COVID-19 states of emergency and have moved away from mitigation efforts. The United States is scheduled to lift its COVID-10 emergency on May 11.

The WHO decision was not welcomed by all public health experts. Respiratory physician and member of Brazil’s National Academy of Medicine Margareth Dalcolmo told The New York Times that it was too soon to lift the emergency, due to the urgent tasks such as research into COVID variants and development of better vaccines. She added that the designation of a global public health emergency also creates leverage for lower-income nations to access needed treatments and support.

Around the world, 765,222,932 confirmed COVID cases, including 6,921,614 deaths, have been reported to the WHO as of May 3. However, these figures are likely a vast undercount of the pandemic’s true toll on human life. In 2022, the WHO said 15 million more people had died in the first two years of the pandemic than they would have in normal times, with developing and indigenous nations experiencing the worst of the devastation. Close to eight million more people than expected died in lower-middle-income nations by the end of 2021.

[Related: White House invests $5 billion in new COVID vaccines and treatments as national emergency ends.]

“One of the greatest tragedies of COVID-19 is that it didn’t have to be this way. We have the tools and the technologies to prepare for pandemics better, to detect them earlier, to respond to them faster, and to mitigate their impact But globally, a lack of coordination, a lack of equity, and lack of solidarity meant that those tools were not used as effectively as they could have been,” Tedros said.

Additionally, on May 4, the United States Centers for Disease Control and Prevention released provisional data that COVID-19 dropped to the fourth leading cause of death in the US in 2022, falling behind heart disease, cancer, and unintended injuries like shootings, car accidents, and drug overdoses. In 2020 and 2021, only heart disease and cancer were ahead of COVID-19 as leading causes of death.

Death rates due to COVID-19 fell for nearly all Americans and the virus was the underlying cause of roughly 187,000 deaths in the US in 2022.  According to the CDC, the highest COVID-19 death rates were in the South and in the adjacent region that stretches west to Texas, Oklahoma, and New Mexico.

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The national COVID-19 emergency is drawing to a close, which means certain treatments and tests that have previously been available without cost is soon to change. However, working on effective vaccines and therapies for COVID-19 is far from over. The federal government recently announced plans to spend over $5 billion in order to speed up new vaccines and treatments, according to a Department of Health and Human Services (HHS) spokesperson and a Biden administration official.

The plan, called Project NextGen, was first announced in the Washington Post on April 10 and aims to provide better protection from future coronaviruses that could become public health threats. It is the follow-up to the Trump Administration’s Operation Warp Speed, which sped up the production of COVID-19 vaccines in 2020. Project NextGen would take a similar approach by partnering public and private-sector organizations to accelerate development of different vaccines and therapies in an ever changing virus. 

[Related: Biden will end COVID-19 national emergencies in May. Here’s what that means.]

“It’s been very clear to us that the market on this is moving very slowly,” White House coronavirus coordinator Ashish Jha, the White House coronavirus coordinator, told the Post on April 10. “There’s a lot that the government can do, the administration can do, to speed up those tools … for the American people.”

According to Jha, Operation Next Gen will have three main goals: creating long-lasting monoclonal antibodies, speeding up the development of mucosal vaccines to possibly reduce transmission and infection risks, and speeding efforts to develop a universal coronavirus vaccine that protects against COVID-19 and other coronaviruses. 

Medical treatments for COVID-19 have lost effectiveness as the virus has continued to evolve. Even once-hailed “miracle” monoclonal antibodies are no longer effective in the face of the Omicron variant. 

“Our ability to develop … vaccines that generate mucosal immunity will have very large benefits for other respiratory pathogens we deal with all the time, like flu and RSV,” Jha said.

Mucosal vaccinations given in the nose can provide patients “sterilizing immunity” against the virus. Some of these types of vaccines are already in development around the world, with China and India rolling out the nasal vaccines, but it is not clear how well they are working. The ChAdOx1 vaccine failed to induce nasal immunity in a phase 1 trial late last year, but a nasal vaccine in Germany has shown some promise after experiments with hamsters. 

[Related: China approves world’s first nasal COVID-19 vaccine booster.]

Michael Osterholm, an epidemiologist who worked with the administration to develop the new program, told USA Today that the rapidly developed current vaccines are “really good, but they’re not great. There is a substantial amount of work [to be done] to take these good vaccines and hopefully achieve better vaccines,” he added.

Jha did not announce a timeline for when the new products will be available to the general public, but did note that it would be based on factors including drug manufacturer production plans and Food and Drug Administration (FDA) reviews. 

Previous vaccine funding requests have been repeatedly denied by Congress, with Republicans insisting that the Biden Administration use funds left over from previous pandemic aid packages. The White House directed HHS to free up $5 billion for Operation Next Gen and the agency responded by shifting funds from testing and other priorities. 

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Following its March meeting, the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE) has revised their global COVID-19 vaccination recommendations. The new vaccine guidelines focus on group risk levels and are based on current conditions. These are subject to change as the pandemic and virus evolve. 

For high-risk and high-priority groups, SAGE recommends an additional booster dose of the COVID-19 vaccine six to 12 months after their last dose. This group includes immunocompromised people of any age, those roughly over 60 years-old, front-line health workers, and pregnant people six or 12 months after their last booster.

[Related: The FDA says get used to COVID-19 vaccine boosters.]

For medium risk individuals, like children and adolescents who have health risks, and healthy adults under about age 60, the group recommends the primary vaccination series and first booster doses, but not routine additional boosters.  

For the lowest-risk groups, SAGE recommends that countries vaccinate based on cost-effectiveness and disease burden. This group includes healthy children six months to 17 years-old. 

“The public health impact of vaccinating healthy children and adolescents is comparatively much lower than the established benefits of traditional essential vaccines for children – such as the rotavirus, measles, and pneumococcal conjugate vaccines,” SAGE wrote in a statement.

The new guidelines come as higher income countries are taking different approaches to future vaccinations. The United Kingdom and Canada are currently offering high-risk individuals another dose of bivalent boosters six months after their last dose.

Health officials in the United States are still weighing this option, but the new WHO advice contrasts with the Food and Drug Administration’s proposed plans to treat COVID-19 boosters like annual flu shots. In those plans, new formulas based on dominant circulating strains would be offered to ever fall, possibly regardless of risk status. 

“Countries should consider their specific context in deciding whether to continue vaccinating low risk groups, like healthy children and adolescents, while not compromising the routine vaccines that are so crucial for the health and well-being of this age group,” SAGE Chair Hanna Nohynek said in a statement.

The group also called for urgent global efforts to catch up on routine vaccinations for preventable diseases like measles, mumps, and tuberculosis that have been missed due to the pandemic.

[Related: A good night’s sleep could help vaccines work better.]

“As we all know, the COVID pandemic has taken a heavy toll on immunization programs,” said SAGE Chair Hanna Nohynek said on Tuesday, according to CNN. “It’s been a tremendous effort, and many countries have done very well reaching high coverages, but it is still requiring efforts to reduce the inequities, and we need to reach the high-priority groups, and we need to close the coverage gaps.”

Nohynek cited rising cases of measles in regions that the World Health Organization tracks. Measles is called a “tracer,” or a sign that other vaccine-preventable diseases are present. Polio is also already circulating in several countries, with new samples detected in New York’s wastewater. To combat this, SAGE recommends strengthening vaccine coverage and supplementing with a dose of injectable polio vaccine in places with  “persistent poliovirus circulation.”

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As a New Yorker, there’s a difference in whether it’s cold or “brick” outside. Cold weather is when you throw on a sweater before heading out. When it’s brick, you try to stay home as much as possible to avoid ending up like a human glacier. But the local lingo didn’t apply much this winter, with record-low snowfall and above-average temperatures across New York City.

A warm winter is more than just losing a few snow days. It’s knowing that the world will be dealing with more scorching heat waves and droughts, and natural disasters like the deadly flooding caused by Hurricane Ian in Florida and Cuba last year.

Climate change is only one of humanity’s long list of problems. This month we mark the third anniversary of the COVID pandemic, a disease that has killed millions worldwide and is becoming more chronic like the flu. On top of that, Turkey and Syria are still facing the aftershocks of a historically deadly earthquake, and soaring food prices from Russia’s invasion of Ukraine could worsen global hunger for years to come. 

[Related: How to manage your mental health as traumatic events pile up]

There seems to be no shortage of community-wide tragedies. Likewise, these events are taking a toll on people’s psyches. Whether conscious or subconscious, you might mourn a loss of safety and security, on top of the more obvious layers of sorrow. But these feelings can also help you be the change you need to move forward in this ever-evolving world.

Collective grief is both a shared and unique experience

Some tragedies, like a mass shooting or police brutality, resonate among an entire group of people. “Grief is a normal reaction to loss,” says Kriss Kevorkian, a thanatologist and founder of the counseling service, A Grieving World. “When it’s collective grief, we’re experiencing that on a larger scale with more people.”

Collective grief can take hold even if you don’t personally know the people directly affected. When the Uvlade school shooting occurred, there was a nationwide outpouring of anger and sorrow over the murders of the teachers and children. Violent events like these force you to rethink life and the safety of your family, says Kevorkian.

Younger generations have become the most vulnerable to collective grief, especially with environmental anxiety. Kevorkian says that government failure to stop climate change has caused children to become more helpless and apathetic. When young people like Greta Thunberg do speak out on climate change, they are mocked and subject to verbal abuse.

Your brain and body on grief

Grief doesn’t stay in one corner of your body—it consumes your entire being. You might feel more tired than usual from tossing and turning all night. Maybe you’ve lost your appetite or have trouble keeping food down. Research shows that the first few months of grief can affect your body’s immune system activity and increase your risk of blood clots.

When your mind is weighed down by sadness, anger, and loneliness, there is little space to focus on other matters. Having “grief brain” can make it feel like you’re in a fog. Everyday tasks such as watering the plants or taking out the trash become really challenging. As you try to process your loss, you might forget things like where you placed your keys or an important doctor’s appointment. 

Grief brain happens because your mind recognizes the stress and emotional trauma as a threat, triggering the entire body’s fight-or-flight response. Brain regions like the amygdala signal the alarm through stress hormones that elevate your heart rate and increase your blood pressure, upping your anxiety and panic to keep tabs on the stressor. 

When you don’t deal with the heavy emotion, your brain protects itself by going into constant survival mode. Believing it’s in danger, it allocates more energy and resources to fear centers like the amygdala. Your brain might also decide to escape the stressor by metaphorically running away. It might dissociate from daily happenings, for example, to give you a mental break from negative emotions. “Deciding how to approach your grief can foster healing as opposed to delaying it when we try to ignore or deny reality,” says Jasmine Cobb, a social worker specializing in grief and trauma at Visual Healing Therapeutic Services in Texas.

Consume your grief before it consumes you

The good news is that grief-related stress on the brain is reversible. Meditation and mindfulness can train you to focus on the present moment instead of reliving the past or dissociating from future threats. Going outside for a 30-minute walk instead of doom-scrolling or watching the news can help clear and calm the mind. Crying can also be a healthy release of stress as it releases feel-good hormones such as oxytocin and endorphins. 

There is no normal amount of time you’re supposed to grieve. You can spend months or years mourning, only for a news story or movie to trigger your pain all over again. “There are three words I really can’t stand, ‘get over it,’” says Kevorkian. “Grief never ends.” 

While time can help with the grieving process, it’s important that you’re actively working on your emotions and any unresolved issues related to the loss. Cobb says speaking with someone you can confide in is important, whether it’s a family friend, therapist, or a spiritual leader. There is also power in shared grief. People who have gone through a similar experience can help provide support in overcoming your grief. “Find your community who can hold a torch for you when you’re unable to do that for yourself,” advises Cobb.

Turning collective grief into collective action

Grief is one of life’s greatest teachers, says Kevorkian. It shows you how to live in the present and appreciate all that you have right now. Beyond acceptance, taking action can help you wrestle with some of the hopelessness you might feel when dealing with events out of your control, Kevorkian explains.

[Related: The biggest tool we have to fight climate anxiety is community]

One example of a group turning pain into lasting change is Mothers Against Drunk Driving (MADD). In 1980, 13-year-old Cari Lightner was killed by a drunk driver—a man who had just gotten out of jail two days after his fourth DUI arrest. For the next few years, Cari’s mother, Candace, used her daughter’s photo and story of her accident to raise awareness and change California traffic safety laws. Candace went on to form MADD, a political-advocacy group that gives other grieving parents the opportunity to feel like their tragedy was not in vain. 

“It’s easy for us to stay in bed under the covers and wallow in despair,” says Kevorkian. But finding the courage to take action can help you get out of your head and connect with others sharing similar distress. Hopefully, with time and work, the world will seem a little less bleak.

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The month of March brings with it the third anniversary of COVID-19 shutdowns beginning in the United States. The year 2020 became synonymous with change and fear, as major sporting events were canceled, thousands were infected with the novel virus and died, and work and school shifted online for millions. The world changed forever–especially for children.

In a survey of parents conducted in the fall of 2022 by Pew Research Center, 48 percent of parents with children in grades K-12 said that the first year of the pandemic had a very or somewhat negative impact on their children’s emotional well-being. Additionally, a 2022 review of survey studies by the National Institutes of Health (NIH) found that “the impact of the COVID-19 pandemic on mental health of children and adolescents is multifaceted and substantial,” and urged more well-designed studies looking at the mental health effects of the pandemic. 

[Related: COVID-19 vaccines are still essential in preventing death in children and teens.]

Now, a group of researchers in Sweden is turning to children’s drawings and their own explanation of what they drew to get a better sense of their feelings, beliefs, and ideas about COVID-19. A small study published March 2 in the journal Acta Paediatrica found that the common themes were detailed images of canceled activities, illness, and death, and the children had quite a bit of knowledge about the disease.

The team collected 91 drawings from kids between the ages of four and six years-old that were submitted to the Swedish Archive of Children’s Drawings between April 2020 and February 2021. The project was part of investigations into children’s voices in the public space during the pandemic.

“It was a very fun study to carry out. I was actually quite uncertain as to whether a medical journal would publish the article, but they did, including the children’s drawings and everything,” co-author Anna Sarkadi said in a statement. Sarkadi is a physician specializing in children’s health and social medicine from Uppsala University in Sweden

They analyzed the drawings using a type of visual analysis called semiotic visual analysis which looks at the image’s denotation (what images represent and how) and connotation (the associated meaning). The analysis also looked at the child’s own explanations accompanying the drawings.

The findings revealed that even the youngest children were strongly affected by the pandemic. In addition to canceled plans and images showing sick and dying people, fear, worry, and missing grandparents were common themes among them. Coronavirus was often described as a monster, while other children described how to protect themselves from the virus. One drawing even showed two children in a sword fight against a giant virus.

[Related: It’s harder for kids with food allergies to catch COVID.]

“The drawings were often covered in a lot of snot. On one drawing, a child wrote, ‘You throw up, then you cough, then you feel better or die,’ with extremely clear illustrations,” explained Maria Thell, a co-author and doctoral student at Uppsala University, in a statement. 

The study found that the children also know quite a bit about the virus, including how it spread and its symptoms. Out of 91 drawings, 14 showed hand washing, 17 showed symptoms like coughing, and 44 showed a depiction of the virus itself. 

“As a researcher with a background in child and youth science, I would love to develop this method further,” said Thell.

This team’s research will continue and the drawings from seven to 11 year old children will be studied next. 

“By encouraging young children to draw pictures using open prompts, such as how a disease feels, looks like or what is different now, it is possible to understand their interpretations of a situation and related emotions,” the authors write in the study. 

Additionally, they write that pediatricians can use children’s drawings to gage emotional response to COVID-19 in addition to other health issues and get a unique glimpse into their world. This can help adults have a better idea of what kids understand or don’t understand and detect any “unhelpful fantasies’ they may have conjured up. 

A survey of children in the United Kingdom found that seven to 11 year-olds were highly aware of the social restriction, illness, and death caused by the virus and similar reviews of children’s drawings have been conducted in Spain and Greece.

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Many Americans remained locked down and logged online throughout 2021, changing the way people shopped for countless goods and services. Initial coverage frequently focused on the ensuing supply chain woes, but new research is showcasing another grave consequence to all that consumption—the ocean shipping industry boom generated massive amounts of greenhouse gasses. 

Although their pollution statistics rarely make into the news as much as everyday cars, “dirty cargo ships” running on fossil fuels bring an estimated 40 percent of America’s goods into the country each year, and are a major impediment towards transitioning to a greener society. Because individual ships are often connected to dozens of international companies, it is often difficult to assign emissions regulation responsibilities. Meanwhile, thousands of ships burn sulfur-heavy “bunker fuel” that, while sometimes “scrubbed” via exhaust cleaning systems, still produces hazardous waste often dumped into oceans.

[Related: Is acid rain forming from the Ohio train derailment site?]

Commissioned by Ship It Zero, a coalition advocating for ocean freight companies’ transition to clean-energy, the “All Brands on Deck” report analyzes 2021’s international imports from 18 of America’s foremost retailers, including Walmart, The Home Depot, Target, Amazon, and Samsung. The findings aren’t pretty—an estimated 4.7 million containers traveling aboard over 1,650 ships generated approximately 3.5 million metric tons of greenhouse gas emissions in 2021 alone. That’s equivalent to the carbon dioxide belched from 754,000 traditional gas-powered cars, or the energy required to power 440,000 US homes. As Canary Media also notes, “ships spewed enough smog-forming nitrogen oxide to equal the annual emissions of seven coal-fired power plants.”

Most of these imports entered the country through a few major port hubs: Los Angeles and Long Beach, California, alongside Houston, Texas, and Savannah, Georgia. The report explains that due to port  locations, much of the ocean vessels’ asthma- and cancer-causing pollutants most often affect port-adjacent and coastal communities with disproportionately Black, Indigenous, and Brown working class populations.

Walmart, Target, and Home Depot were among the worst offenders analyzed. Their combined  shipping contracts generated over 1.7 million metric tons of CO2 and 33 metric tons of methane in 2021. “Buoyed by reliance on the cheapest, most deadly fossil fuels on the planet, international shipping companies and the corporations that rely on them make billions while treating our oceans, health and climate as externalities,” explains the report’s authors. “For far too long, they’ve gotten away with it.”

[Related: Breathe easier during wildfires with a DIY air purifier.]

Ship It Zero hopes that highlighting these troubling figures and increasing pressure on corporations will spur them to speed their transitions towards cleaner shipping options, like fuel cells, marine batteries, and wind harnessing equipment. Currently, both Walmart and The Home Depot have made no public commitments to fossil fuel-free maritime shipping plans, despite generating “the highest levels of carbon dioxide, methane and carcinogenic particulate matter pollution of all companies studied,” the report reads.

As part of their suggested path forward, Ship It Zero urges these companies to ask ocean carriers to demonstrate immediate and year-over-year emission reduction efforts during contract negotiation periods. “Any ship on the water today could be retrofitted with wind- assist propulsion or other emissions reducing technologies,” argues the authors. “[P]ublic health and the climate cannot wait for an entirely new generation of vessels.”

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On February 24, the Food & Drug Administration (FDA) authorized what the agency says is the fist at-home test for detecting both COVID-19 and the flu.

The test uses one nasal swab to collect a sample from the nose and generates results in roughly 30 minutes. It can be purchased without a prescription and is authorized for use in anyone over 14 years-old, or in children two to 14 with the help of an adult. It is made by Lucira Health, a biotech company based in California’s Bay Area. 

[Related: Airplane toilets are a surprisingly good place to track COVID outbreaks.]

“Today’s authorization of the first OTC test that can detect Influenza A and B, along with SARS-CoV-2, is a major milestone in bringing greater consumer access to diagnostic tests that can be performed entirely at home,” said Jeff Shuren, director of the FDA’s Center for Devices and Radiological Health, in a statement. “The FDA strongly supports innovation in test development, and we are eager to continue advancing greater access to at-home infectious disease testing to best support public health needs. We remain committed to working with test developers to support the shared goal of getting more accurate and reliable tests to Americans who need them.”

According to the FDA, The Lucira COVID-19 and Flu Home Test can recognize positive results for influenza A with more than 90 percent accuracy and negative results with over 99 percent accuracy. For influenza B, there were not enough cases for a clinical study while Lucira was testing the product. However, in lab tests, it was 99.9 percent accurate in detecting negative results. 

With COVID-19, it is 99.9 percent accurate for a negative result and more than 88 percent accurate with a positive result. 

“As with all rapid diagnostic tests, there is a risk of false positive and false negative results. Individuals who test positive for either flu or COVID-19 should take appropriate precautions to avoid spreading the virus and should seek follow-up care with their physician or healthcare provider as additional testing may be necessary,” the FDA wrote.

The COVID-19 pandemic has changed some doctor’s hesitations regarding testing being performed by patients. A 2020 study found that people do not require medical training to test themselves for respiratory illnesses like COVID-19 and the flu.

[Related: How our pandemic toolkit fought the many viruses of 2022.]

Wilbur Lam, a pediatric hematologist and bioengineer at Emory University who helped federal officials with test development and validation, told The New York Times that this new test is the first in a series of tests that was taken for multiple illnesses at once. 

“Now we’re in this new era that’s honestly pretty exciting,” said Lam. “It’s exciting for a health care provider, it’s exciting for the technology developers, and I think exciting for the public because we have this new test. And this is only the beginning.”

According to the US Centers for Disease Control and Prevention, the US saw 236,131 new cases, 2,407 deaths, and an average of 3,461 hospitalizations last week. After getting off to an explosive and early start, flu activity is low around the country.

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Every four months, pathologist Aaron LeBeau scoops into a net one of the five nurse sharks he keeps in his University of Wisconsin lab. Then he carefully administers a shot to the animal, much like a pediatrician giving a kid a vaccine. The shot will immunize the shark against a human cancer, perhaps, or an infectious disease, such as Covid-19. A couple of weeks later, after the animal’s immune system has had time to react, LeBeau collects a small vial of shark blood.

Halfway across the country, immunologist Hidde Ploegh goes through the same steps, but with alpacas that live on a farm in western Massachusetts. The scientists are after the same thing: tiny antibodies, made only by certain animals, that may have big implications for human health.

Most antibodies — those molecules that course through our blood and tissues patrolling for pathogens — are fairly hefty as proteins go. But the antibodies made by camels and sharks and their close relatives are simpler and smaller. Since their discovery in the late 1980s, researchers have learned that these antibodies pack a big punch: They can latch onto hidden parts of molecules and can penetrate tissues more deeply, enhancing their potential as therapies. 

“They can get into little nooks and crannies of different proteins that human antibodies cannot access,” LeBeau says.

In the last decades, investigations of these diminutive antibodies have surged. Not only can they sneak into small places, they are also easy to work with — sturdier than their ordinary counterparts — and relatively cheap to make in large quantities. All these features make the antibodies promising treatments for a host of diseases, whether clotting disorders or Covid-19. Researchers are also exploring their use for diagnosing conditions such as cancer, and they’re becoming a key tool in other kinds of research, like mapping cells’ insides.

The full promise of these antibodies may still take years to realize, but researchers are very excited about their possibilities. “I think they have potential to save the world,” LeBeau says.

Luck of the blood draw

A group of biology students were the first to discover these unusual antibodies — quite by chance — back in 1989. The students of Free University in Brussels needed some blood for an exam in which they were tasked with separating an antibody into its two main parts: two heavy protein chains, which form a Y shape, and two light protein chains, which flank the prongs at the top of the Y.

Human blood seemed too risky to work with, given concerns at the time about potential HIV exposure, and the students didn’t want to kill a mouse. But the students’ professor, the late Raymond Hamers, happened to be studying sleeping sickness in large animals. He gave the students some blood from a camel, says immunologist Serge Muyldermans, who was then a post-doctoral researcher at the university.

Strangely, the students found only heavy chain proteins in the blood even though antibodies were supposed to also have light chains. As Muyldermans tells it, everyone thought that the camel antibodies had degraded — or that the students had done something wrong — so Hamers went to the Antwerp Zoo to collect fresh camel blood. But the students had not screwed up: Camels make antibodies with only heavy protein chains.

The potential applications of camelids’ small antibodies dawned on Hamers during those early years, says Muyldermans, who details their myriad uses in the 2021  Annual Review of Animal Biosciences. Like antibodies from people or mice, the camelid antibodies could be further pared down into even smaller, yet still effective, fragments — just the tips of the Y. These fragments, called variable domains, are the business end of any antibody — they act as the antibody’s “sensor” and can stick to parts of pathogens or toxins, whatever substance is recognized as foreign and a possible threat.

In standard antibodies (which camels also make), the variable domains come in pairs, one from the heavy chain and one from the light chain. But the variable domains of the camelid’s heavy-chain-only antibodies are singletons. The researchers realized these solitary fragments might be able to grab onto parts of foreign molecules that conventional antibodies were too bulky to reach.

In 1993, the team published the discovery in Nature. The next year, Hamers  patented the production of these camelid antibody fragments (they are also known as VHH antibodies or “nanobodies,” a trademarked term). A few years later, a different group of researchers reported that  sharks also make antibodies with only heavy chains and these have an even smaller tip (these shark end fragments are called variable new antigen receptors, or VNARs).

When the primary patent expired in 2013, research investigating the antibodies really surged, says Ploegh, an immunologist at Boston Children’s Hospital. “That’s sort of when the dam broke and a lot of folks got in on the game.”

Scientists have since learned a lot about the advantages of these mini antibodies. Some is practical: Unlike full-size antibodies, the fragments are stable at room temperature so there’s no need to keep them in a freezer or ship them cold. The mini antibodies of sharks can even be boiled with no effect on their function, LeBeau says. And while full-size antibodies require mammalian cells to be grown in a flask, which can be complicated and expensive to maintain, the fragments can be manufactured in large quantities using bacteria, saving time and money.

These mini antibodies also tend to self-assemble properly, keeping their correct shapes, making them a promising alternative to full-size antibodies, which have more pieces and thus can misfold. Such misfolding may expose parts that are more likely to be recognized by the immune system as foreign molecules, which can provoke a negative immune response in the body, with potentially serious consequences for patient health.

But the standout trait of the mini antibodies is their versatility. All antibodies, whether from human or shark, have variable domains at their tips, but those of sharks and camels have unique traits. They have an especially long, slender finger called a CDR3 loop that can poke into places that human antibodies can’t access. They appear to easily adopt different shapes — LeBeau describes that feature as “molecular yoga.” This means mini antibodies can get into tight spots, whether into tissues of the body or on minuscule parts of individual molecules.

Anti-cancer antibodies

Research into these unusual mini antibodies is now starting to bear fruit. In 2019, the first mini antibody medical treatment to be approved by the US Food and Drug Administration, called Cablivi, came on the market. It treats a rare blood disorder that leads to clots in small blood vessels. The treatment uses nanobodies to bind to a protein in platelets, which stops them from sticking together.

Mini antibodies could become a valuable tool for cancer treatment. Full-size antibodies are already used in immunotherapies to treat certain cancers; in some cases, the antibody tags cancer cells so that the body’s own immune system cells can then recognize and kill the rogue cells; in others, it might bring immune cells closer to the cancer cells so the body can better fight the cancer. The mini antibodies can do the same tasks, but can also be used in other ways, such as targeting proteins to reduce tumor growth or blocking blood vessels from feeding a tumor. And the smaller antibodies also may be less likely to trigger a negative immune response than full-size immunotherapy antibodies, which may lead to dramatic treatment improvements, Ploegh says.

LeBeau, for his part, is focused on developing mini antibodies targeted for prostate and lung cancer. The sharks in his lab, each named for James Bond bad guys — Goldfinger, Hugo Drax, Mr. Stamper, Oddjob and Nick Nack — keep him supplied with antibodies that he uses in lab experiments. His lab recently identified a shark antibody fragment that is specific for a highly aggressive, and currently untreatable, form of lung cancer. He’s hopeful that this new mini antibody could help combat the cancer, and has studies in progress to test it.

The mini antibodies are also helping physicians detect cancers more readily, pinpointing diseased cells with more precision. By attaching radioactive tracer molecules to specific antibodies that seek out cancer cells, physicians can locate cancerous cells on a PET scan, potentially with greater resolution than with standard antibodies because they can penetrate deeper into tissues. One such nanobody-based tracer detected several tumors in mice with  higher specificity than conventional imaging, a team reported in  PNAS in 2019.

Vanquishing viruses

Scientists are also harnessing mini antibodies to fight infectious diseases, including Covid-19. Wai-Hong Tham, an infectious disease researcher at the University of Melbourne and the Walter and Eliza Hall Institute of Medical Research, has been working to generate nanobodies that grab onto part of the spike protein of SARS-CoV-2, to prevent the virus from entering cells in the body.

In a preliminary study, published in PNAS in 2021, Tham and her colleagues identified several nanobodies from alpacas that interfered with the spike proteins’ ability to latch onto the molecular doorknob it uses to get into cells; cocktails of the nanobodies also reduced the amount of virus in experiments with mice. Ideally, Tham says, they could find a nanobody that universally blocks Covid-19 regardless of the coronavirus variant. Other nanobody cocktails also appear promising: Four nanobodies, mixed and matched in various combinations, disabled the spike protein in experiments in cells, a separate team reported in 2021 in  Science.

Mini antibodies might be delivered via mRNA technology so the antibodies assemble inside people’s cells, Tham says. Vaccine-like injections might work against other  infectious diseases, counter toxins such as  botulism, or even deliver therapeutics for cancer or other conditions.

And with a simple pill, mini antibodies could be delivered directly to the gut, which could help to block a number of pathogens, for example rotavirus, that enter the body through the digestive tract. Small microbes — such as yeast, bacteria and algae — can’t efficiently make full-size antibodies because these are too complex. However, researchers have proposed genetically engineering  spirulina (a blue-green alga that’s often sold as a nutritional supplement) or harmless bacteria called  Lactobacilli  or  Lactococcus that could deliver therapeutic nanobodies via a pill, which would be much more cost effective than producing a drug, Tham says.

Sleuthing cell mysteries

The diminutive antibodies are also a boon for scientists who study proteins and investigate interactions between molecules. The size and long finger of these antibodies can help solve protein structures, map proteins  inside cells and show how molecules within cells  interact with each other.

Researchers recently solved the structure of a human protein called ASIC1a, for example — it forms a type of channel that lets sodium into nerve cells and plays an important role in pain perception and several neurodegenerative diseases. Stabilizing the protein with a nanobody allowed the researchers to determine its structure with greater resolution, the team reported in 2021 in  eLife.

Single-domain antibodies “have the potential of mapping interactions that would be very difficult to study otherwise,” says Ploegh, coauthor of an overview of their traits in the 2018  Annual Review of Immunology. Scientists are even investigating their potential use in the brain — a tricky task because the blood-brain barrier likes to keep foreign molecules out. An international team recently reported using nanobodies as  sensors to study whether or not a protein in a mouse brain was activated, and where it was located.

Ploegh says that mini antibodies are exceptionally useful and have significant advantages over full-size antibodies, but they remain somewhat niche because of limited access to the animals that make them — not every researcher has nearby camels, llamas or, in LeBeau’s case, sharks. (“Probably very few people are crazy enough to actually build a shark tank and work with sharks. But we are,” LeBeau says.)

But this is starting to change as interest ramps up. Researchers are also developing new approaches, such as creating synthetic nanobodies and developing mice with “camelized” immune systems for research.

Scientists still don’t know why camelids and cartilaginous fishes, like sharks, are the only animals known to make heavy chain antibodies. Sharks are the most ancient living organisms to rely on antibodies as part of their immune systems, and their antibodies are more stable than those of camelids. Scientists speculate that sharks rely on these antibodies because of the high concentrations of urea in their blood, which would degrade the antibodies of most mammals.

Sharks evolved some 350 million years before camels, yet camelid heavy chain antibodies are also relatively ancient: They are found in both Old World camelids, like camels, and New World camelids, like llamas and alpacas, suggesting that the antibodies may have developed early in the lineage’s evolution. Perhaps “there are certain pathogens that are unique to the camelids that are best fought with these heavy chain antibodies,” Ploegh says.

The heavy chain antibodies of sharks might well be the most ancient immune molecules still in existence — but LeBeau is exuberant about what they could accomplish in the future. “Whenever you work with them, you see something new every day. And that’s really exciting,” he says.

And as for his two-foot-long sharks, when they outgrow their tank, they’ll retire to the local aquarium.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

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On Thursday, the Centers for Disease Control and Prevention (CDC) reported the results of a small trial that investigated the wastewater from lavatory bathrooms on international flights for SARS-CoV-2 (the virus that causes COVID-19 infections). For most of the samples, which all came from France, the United Kingdom, and the Netherlands, COVID-19 was onboard—at least in the bathroom.

[Related: COVID-19 testing scientists are the unsung heroes of the pandemic.]

For the study, conducted by the  agency along with biotech company Ginko Bioworks, the authors tested wastewater samples from 80 flights that landed in John F. Kennedy International Airport in New York City between August 1 to September 9, 2022. The team found that 65 sewage samples (81 percent) were positive. They also were able to get 27 genome sequences of WHAT from 25 of the samples and found evidence of  BA.5, BA.4.6, and BA.2.75–all sublineages of the Omicron subvariant. 

The testing added roughly three extra minutes to aircraft maintenance, did not require swabbing passengers, can be scaled up as needed, and is also relatively inexpensive. 

“This investigation demonstrated the feasibility of aircraft wastewater surveillance as a low-resource approach compared with individual testing to monitor SARS-CoV-2 variants without direct traveler involvement or disruption to airport operations,” the authors wrote in their conclusion.

The study provides an example of how aircraft and airport wastewater surveillance can help monitor the spread of pathogens around the globe. In the case of SARS-CoV-2, Viral shedding of SARS-CoV-2 can begin in feces early in an infection, potentially before a person shows symptoms like coughing or fever. 

To track the spread of COVID-19, and give communities early warnings of spikes in the virus, the CDC launched the National Wastewater Surveillance System (NWSS) in September 2020. It works for other pathogens as well and does not rely on people getting tested themselves to detect the presence of the virus. Wastewater surveillance detected the spread of polio in New York in August 2022. 

In January, some public health officials,  concerned over a COVID-19 surge in China and expressed interest in surveilling wastewater on flights from China for new variants. Citing the success of the pilot study at JFK, the CDC and Ginko Biotech gave indications that they were open to expanding the program.

[Related: How do we track COVID as people get tested less?]

“Just like we have radar to look for airplanes to make sure we know what’s coming into our country, or we take swabs and samples to make sure somebody walking through security doesn’t have explosives on their hands, this is the same thing for pathogens or viruses or bacteria,” Ginkgo Bioworks general manager, Matthew McKnight, told Politico.

Additionally, the CDC’s The Traveler Genomic Surveillance program (TGS) runs in partnership with Ginkgo Bioworks and XpresCheck, a COVID-19 testing company, to directly test some travelers in an effort to detect new variants and fill gaps in global surveillance. 

Some of the limitations of testing wastewater on aircrafts come down to flight length—testing waste is most beneficial on longer flights where passengers are more likely to use the restroom. It also remains unclear how many airlines will be willing to participate, and connecting flights will hinder tracking the origins of variants as they arrive in the United States. 

Despite the limitations, the authors found that this could be a useful public health tool for tracking pathogens. “In combination with traveler-based surveillance, aircraft wastewater monitoring can provide a complementary early warning system for the detection of SARS-CoV-2 variants and other pathogens of public health concern,” the authors wrote. 

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Moderna announced that it will keep its COVID-19 vaccine free of charge for even after the federal government stops paying for it.

“Everyone in the United States will have access to Moderna’s COVID-19 vaccine regardless of their ability to pay,” the pharmaceutical company wrote in a statement. “Moderna’s COVID-19 vaccines will continue to be available at no cost for insured people whether they receive them at their doctors’ offices or local pharmacies.”

[Related: Biden will end COVID-19 national emergencies in May. Here’s what that means.]

In their statement, the company also claimed that its patient assistance program will provide free vaccines for the “uninsured and underinsured,” after the federal government’s public health emergency expires, which should be in May. The company did not say how long the vaccines would remain free. 

Moderna faced criticism in January after it announced it was raising the market price from about $26 per shot to as much as $130. The vaccine was developed with the help of billions of federal tax dollars and private donations. Moderna CEO Stéphane Bancel is scheduled to testify before the Senate health committee on March 22 regarding the price for its COVID-19 vaccine when they are sold on the private market.

[Related: The FDA says get used to COVID-19 vaccine boosters.]

Moderna’s announcement of a potential price hike coincided with the Biden Administration informing Congress last month that it was moving towards ending the national public health emergency on May 11, 2023. This change would limit or end federal dollars towards the shots and leave uninsured Americans paying out of pocket for future boosters. 

The federal government had been paying for all COVID-19 vaccines despite insurance status, but ending the public health emergency means funds for federal support for programs aimed at serving the uninsured and those that explained testing, treatments, and Medicaid will dry up. Moderna says its patient assistance program is scheduled to be available after the public health emergency expires, though it is unclear for how long. 

The public health emergency was first declared by Health and Human Services Secretary Alex Azar on January 21, 2020. The national emergency was later declared by Former President Donald Trump in March 2020. President Biden has repeatedly extended both the national and public health emergencies since taking office in January 2021 and has extended them as recently as January 11.

In January, the World Health Organization (WHO) said that the coronavirus remains a global health emergency, despite a key advisory panel for the group finding that the pandemic may be nearing an “inflexion point” where higher levels of immunity could lower virus-related deaths. 

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On February 7, President Joe Biden gave his 2023 State of the Union Address to a joint session of a newly split Congress, with Democrats controlling the Senate and Republicans controlling the House. This is what he had to say on major science, tech, and health related issues. 

Health policy priorities—COVID and healthcare

Biden touted the progress made to combat COVID-19 since he first took office in January 2021, when the COVID-19 vaccine rollout was just getting underway since beginning in December 2020. “COVID no longer controls our lives,” he said, “while the virus is not gone, thanks to the resilience of the American people, and the ingenuity of medicine, we have broken COVID’s grip on us.” 

The administration stands to end the public health emergency on May 11. The change to formally end the national emergency declarations would restructure the federal government’s response to treating the virus as an endemic threat to public health that can be managed through normal authorities.

[Related: Biden will end COVID-19 national emergencies in May. Here’s what that means.]

He also pointed to several policies Congress can still achieve to deliver cheaper prescription drugs to the American people—for example continuing to expand Medicaid under the Affordable Care Act, and capping the cost of insulin at $35 for seniors on Medicare.

“But there are millions of other Americans who are not on Medicare, including 200,000 young people with Type I diabetes who need insulin to save their lives,” said Biden. “Let’s finish the job this time. Let’s cap the cost of insulin at $35 a month for every American who needs it.”

This was the first State of the Union after the Supreme Court overturned Roe v. Wade, and President Biden vowed to veto any national abortion ban. The Biden administration has taken steps to expand abortion access in the wake of the decision, including steps to make it easier to access the prescription pills used in a medication abortion. 

He touted the success of the PEPFAR program that has saved 25 million lives and transformed  the global fight against HIV/AIDS and the Cancer Moonshot program that Biden led while Vice President to Barack Obama. The program is a very personal initiative to the Bidens after their son Beau died of a brain tumor in 2015. 

“Our goal is to cut the cancer death rate by at least 50 percent over the next 25 years. Turn more cancers from death sentences into treatable diseases. And provide more support for patients and families,” said Biden.

When it comes to tech, CHIPS takes the spotlight

American ingenuity in tech was also on full display, with Biden highlighting the bipartisan Infrastructure Law and CHIPS and Science Act, especially when it comes to the jobs that will be created by investing in infrastructure and tech. The legislation devotes more than $50 billion intended to spur semiconductor manufacturing, research, development, and more in the United States.

[Related: Can the Chips and Science Act help the US avoid more shortages?]

“Semiconductors, the small computer chips the size of your fingertip that power everything from cellphones to automobiles, and so much more. These chips were invented right here in America. Let’s get that straight, they were invented in America,” said Biden. “America used to make nearly 40 percent of the world’s chips. But in the last few decades, we lost our edge and we’re down to producing only 10 percent.”

He also announced a new standard that will require all construction materials used in federal infrastructure projects to be made in America and stressed his administration’s commitment to providing Americans with universal access to high-speed internet. 

Climate and the environment—wins and losses

The Biden Administration’s recent flurry of environmental legislation amidst the past year’s spike in gas prices shifted the spotlight on his policies on climate change.  

“The Inflation Reduction Act is also the most significant investment ever to tackle the climate crisis. Lowering utility bills, creating American jobs, and leading the world to a clean energy future,” said Biden, before touting the investments aimed at modernizing infrastructure in the face of a changing planet from electric grids to floods and water systems and clear energy.

[Related: 4 ways the Inflation Reduction Act invests in healthier forests and greener cities.]

He also called the $200 billion in profits brought in by oil and gas companies during a global energy crisis “outrageous,” and proposed quadrupling the tax on corporate stock buybacks to encourage more investment in increasing domestic energy production and keeping costs down.    

High profile attendees included wildfire experts and cancer survivors

U2 frontman Bono, Tyre Nicols’ family, and Paul Pelosi were among the high profile guests for the 535 members of Congress. Several were innovators, activists, and scientists making a mark on the science and tech world. 

These included Jennifer Gray Thompson, the CEO of After the Fire USA,  Paul Bruchez, a rancher who has worked with other landowners to restore a part of the threatened Colorado River, Grover Fugate, the Executive Director of the Rhode Island Coastal Resources Management Council (CRMC), and  David Anderson, President and CEO of NY-CREATES and the Albany Nanotech Complex. 

Some of the guests invited to the First Lady’s Box included Maurice and Kandice Barron whose daughter Ava is a survivor of a rare form of pediatric cancer, Amanda Zurawski, a woman from Texas who almost lost her life to a miscarriage due to Texas’ abortion law, and Lynette Bonar, an enrolled member of Navajo Nation who helped open the first cancer center opened on a Native American reservation.

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On Monday, President Joe Biden informed Congress that he will end the two national emergencies currently addressing the COVID-19 pandemic on May 11.

The change to formally end the national emergency declarations would restructure the federal government’s response to treating the virus as an endemic threat to public health that can be managed through normal authorities.

[Related: A quick look at Biden’s new COVID preparedness plan.]

The announcement comes as lawmakers have already ended elements of the emergency protocol, such as changes in policy that have kept millions of Americans insured since the pandemic began in 2020. Removing federal dollars would also shift the development of future vaccines and treatments away from direct management by the government and more towards the private sector.

The public health emergency was first declared by Health and Human Services Secretary Alex Azar on January 21, 2020. The national emergency was later declared by Former President Donald Trump in March 2020. President Biden has repeatedly extended the emergencies since taking office in January 2021 and has extended them as recently as January 11.

According to the Centers for Disease Control and Prevention (CDC), more than 1.1 million people in the United States have died from COVID-19 since 2020, including roughly 3,700 last week.

Everyday Americans will see these changes directly through more expensive vaccines. The cost is expected to skyrocket when the federal government stops purchasing them, and vaccine manufacturer Pfizer says it could charge as much as $130 per dose. Additionally, those with private health insurance will have to pay some out-of-pocket costs for vaccines, especially if seeing an out–of-network provider, according to Larry Levitt, the executive vice president for health policy at Kaiser Family Foundation.

Hospitals will no longer receive extra payments for treating COVID-19 patients. Some hospitals have been receiving a 20 percent increase in Medicare’s payment rate, which could lead to higher consumer costs. The cost of COVID-19 testing and treatments like Paxlovid will also be more complicated. Charges will depend on whether they have private insurance, Medicare, Medicaid, or no health insurance and what state they live in could also affect costs.

[Related: Long COVID recovery is finally getting the attention it deserves in the US.]

Flexibilities for telehealth were extended for another two years, leading health care systems around the US to regularly deliver remote care.

Additionally, the World Health Organization (WHO) said on Monday that the coronavirus remains a global health emergency, despite a key advisory panel for the group finding that the pandemic may be nearing an “inflextion point” where higher levels of immunity could lower virus-related deaths. 

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On Thursday, the Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee unanimously voted to support a new plan simplifying future COVID-19 vaccines, making them similar to annual flu shots.

At the meeting, the advisory panel said that a single annual vaccine would be less confusing and more effective to health care workers and patients alike. 

In a 21 to 0 vote, the panel voted to direct Moderna, Pfizer/BioNTech, and Novavax to “harmonize” the first doses (or primary vaccination series) with the new bivalent booster shots that protect against the original strain of the virus and the newer Omicron variant. 

[Related: What’s really going on with myocarditis and COVID vaccines.]

“This is a consequential meeting to determine if we’ve reached the point in the pandemic that allows for simplifying the use of current COVID-19 vaccines,” said FDA’s David Kaslow, the Director of the Office of Vaccines Research and Review..

Under previous guidance, patients must first get two shots of the original vaccines (spaced weeks apart) and then a bivalent booster tailored to protect against the Omicron variant two months later. 

Members of the advisory panel were also supportive of a new approach that is more like the strategy seen with the annual flu vaccine. Currently, the annual flu vaccine is created each year to match whatever strain of the virus is circulating. This way, patients and healthcare professionals wouldn’t have to worry about how many shots they’ve already gotten and when they were administered. 

“I think this is a reasonable approach. We have to keep reminding ourselves that this is not influenza and we need to keep paying attention to that to make sure we don’t just follow that dogma because we’re used to doing it,” said Bruce Gellin, a temporary voting member of the panel and chief of global public health strategy for the Rockefeller Foundation’s pandemic prevention institute. “We’ll try this this time. I don’t think we’re setting it in stone and we’ll see how it goes. We may need to adjust along the way.”

The agency also addressed varying risks to people with different health status and ages in briefing documents released ahead of the meeting. ​“Most individuals may only need to receive one dose of an approved or authorized COVID-19 vaccine to restore protective immunity for a period of time.  Two doses of an approved or authorized COVID-19 vaccine may be needed to induce the expected protective immunity for those who have a low likelihood of prior exposure (the very young) or those who may not generate a protective immune response (older and immunocompromised individuals),” the FDA wrote.

If a more dangerous COVID variant were to emerge, the FDA said it might reconsider the strain used in the vaccine at other times of the year on an “as-needed and emergent basis.”

Additionally, the timing of annual boosters was debated since COVID-19 hasn’t fallen into a seasonal pattern like the flu—instead  COVID-19 waves emerge periodically year round.  Peter Marks, the director of FDA’s Center for Biologics Evaluation and Research said that there is some evidence SARS-2 is developing a seasonal pattern, but that comment was not universally agreed upon in the meeting. 

“When do we have to worry about the worst overwhelming of the hospitals? It will be when we have influenza, RSV, and potentially covid at the same time,” said Marks.

There is also a debate among scientists if updating the COVID-19 vaccines really does make them more effective and some critics of the FDA’s proposed new strategy argue that investing in developing better vaccines that are more appealing to people, such as intranasal vaccines that could also help curb transmission of the disease, and more robust vaccination campaigns might be more effective.

[Related: Omicron boosters are the future of COVID vaccines in the US.]

“Particularly now when Congress is not allocating new funds for COVID response, we have to be especially judicious in how we spend our money and what would be most cost-effective,” Celine Gounder, a senior fellow at the Kaiser Family Foundation, told NPR. “It’s unclear whether updating the booster formulations and repeatedly boosting people is the most effective approach to controlling COVID at this stage.”

Uptake of vaccine boosters remains slow. Roughly 40 percent of adults over 65 and only 16 percent of those 5 years and older have received the latest COVID-19 booster. 

In a separate development on Thursday, the FDA also halted the emergency use authorization (EUA) of Evusheld, a monoclonal antibody treatment used to prevent COVID-19 in immunocompromised people who are less likely to generate a robust immune response from vaccination. The treatment does not appear to protect against the variants currently circulating.

The agency advised those who are infected to seek medical care and ask about antiviral treatments like Paxlovid, remdesivir, or molnupiravir, which do work against currently circulating variants.

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In the two years since the COVID vaccines became available to the public, they have become a popular target for misinformation. Anti-vaccine activists have made some wild claims—the vaccines alter DNA, cause infertility, and implant magnetic devices for the government to track your every move—with no credible scientific evidence. But they have managed to accomplish one goal: More Americans than ever are hesitant about getting a vaccine.

So whenever a person has a rare side effect from the COVID vaccines, news spreads rapidly. For example, Florida’s surgeon general recommended boys between 18 to 39 should not get the mRNA shots, citing a questionable state analysis that claimed the risk of cardiac death jumped up by 84 percent after immunization. More recently, people were quick to blame Buffalo Bills player Damar Hamlin’s sudden cardiac arrest in early January on the NFL’s mandatory COVID vaccine requirement. Cardiologists, however, were just as quick to debunk the notion with more realistic medical explanations.

Infectious disease experts have been investigating the risk of myocarditis since the beginning of the pandemic. Thousands of studies have been published on COVID, and some have found a connection between myocarditis with both the virus and the vaccines. Here are the answers we have so far.

What is myocarditis?

Myocarditis is a disease that causes inflammation in a middle layer of the heart muscle called the myocardium. The inflammation affects muscle cell function and the heart’s electrical system, causing irregular heart beats and interfering with pumping blood to and from the body. The inflammation results from your body’s immune response overreacting to an infection it’s currently fighting. Viruses are the common cause of most myocarditis infections and are responsible for 1.5 million cases every year.

A majority of myocarditis cases are mild and self-resolving, says Keren Hasbani, a pediatric cardiologist at Pediatrix Pediatric and Congenital Cardiology Associates of Texas. Most go away in less than two weeks without complications or need to go to the hospital. 

[Related: A good night’s sleep can boost cardiac health]

Myocarditis persisting for longer than two weeks is considered chronic and can create severe complications. The longer inflammation stays in the heart, the weaker the muscle becomes. Continued injuries to heart cells can lead to permanent scarring of cardiac tissue, which can cause the condition to come back and increase the risk of stroke, heart attack, heart failure, or death.

Myocarditis can strike anyone, at any age. However, the heart condition appears to occur at twice the rate in young men than women.

What does myocarditis feel like?

In some myocarditis cases, it is possible for a person to go about their day without knowing that their heart is inflamed. When there are symptoms, they could mimic those of a viral infection, including fever, vomiting, headaches, and a sore throat. 

The most common presenting sign of the condition is a discomfort or a feeling of tightening in the chest area. Hasbani says the pain can happen anywhere between your left side to the chest bone area. Rather than the soreness you feel when you pull a pectoral muscle, Hasbani says myocarditis chest pain is often described as aches originating from a place much deeper inside the body. “People usually say it’s different from any kind of chest pain they’ve felt before.”

Individuals with myocarditis also tend to describe rapid or abnormal heart beats because the inflammation affects the heart’s electrical system. Since the organ is not functioning to its full potential, blood is not being properly distributed to other parts of the body. This can lead to symptoms such as shortness of breath, especially as the chest pain makes it difficult to take big deep breaths. The lack of oxygen can then spur on lightheadedness and fainting spells. Less common symptoms include swelling in the legs, ankles, and feet from the lack of blood distribution.

While Hasbani says it’s extremely rare, myocarditis can be life-threatening when the weakened heart cannot meet the demands of the body. In these scenarios, a person would need to be hospitalized and given medication such as adrenaline to keep the heart pumping. Doctors may also have to provide a life support machine to oxygenate and pump the blood. This allows the heart to rest and recover from the damage myocarditis inflicted. 

Is there a relationship between myocarditis and COVID?

COVID infections can cause severe and life-threatening cases of myocarditis, but the overlap is still slim. Forty out of every 1 million people are estimated to develop myocarditis 28 days after testing positive. The chances of inflammation increases among people with severe COVID illness that requires hospitalization and people with preexisting health conditions such as high blood pressure and obesity.

A 2021 study from the Centers for Disease Control and Prevention (CDC) found the risk of myocarditis is 16 times higher among unvaccinated people with COVID than unvaccinated people who have never had the disease. It also found that men and adults 50 years and older are more vulnerable to the condition. Among unvaccinated children under 16, myocarditis risk was 37 times higher in those with COVID infection than their healthy peers. 

[Related: What patients find at long COVID clinics: rejection, outdated therapies, and unanswered questions]

Hasbani says the reason why people with myocarditis from a COVID infection have more serious complications is because the body is already overworked from dealing with the extensive damage the virus is causing to other organs like the lungs, kidneys, and GI tract. Inflammation in the heart may take a backseat to all the other ongoing bodily issues and take longer to resolve. In children under 16, the CDC speculates that COVID-induced myocarditis might actually be a sign of multisystem inflammatory syndrome, which is a potentially deadly condition associated with the coronavirus. 

Can COVID vaccines cause myocarditis?

Yes, but the chances are extremely rare. One August 2022 study in England calculated the rate of hospitalizations and deaths related to myocarditis in more than 42 million people 13 and older. The subjects consisted of two different groups: individuals fully vaccinated with either the AstraZeneca, Moderna, or Pfizer-BioNTech vaccines, and unvaccinated individuals who tested positive for COVID. The researchers found a 0.007-percent chance—that’s 2,681 out of 43 million vaccinated adultsof being hospitalized or dying from vaccine-related myocarditis. Only 0.001 percent occurred within 28 days of receiving a COVID vaccine or booster. A separate study from October 2022 estimated that the myocarditis risk is seven times greater in unvaccinated versus vaccinated individuals. 

So far only the mRNA vaccines have been associated with myocarditis. The risk appears to be higher in people with a second dose of the Moderna shot than the Pfizer-BioNTech one, says Jayne Morgan, a cardiologist and clinical director of the COVID task force at Piedmont Hospital in Atlanta. The large-scale study done in England last year showed more overlap of myocarditis cases with a second Moderna dose. Meanwhile, another 2022 study measured a two- to threefold higher chance of developing myocarditis after a second Moderna vaccine, with the association being the strongest among men and people between 18 to 39. Still, Morgan warns that the rate is small compared to that of unvaccinated populations with COVID.

[Related: The truth about COVID, vaccines, ED, and infertility]

Though incidence is low, research points to young men under 40 having the highest risk of developing myocarditis, says Morgan. A September 2022 study in Israel reported 28 mild cases of myocarditis after a the Pfizer-BioNTech booster shot—out of nearly four million adults. The results showed that men between the ages of 16 to 19 had the highest risk of myocarditis (a 1 in 15,000 chance), followed by men between the ages of 20 to 24. All individuals made a full recovery after spending an average of 3.5 days in the hospital.

There is no official explanation for why young men have a greater risk of myocarditis. Some COVID researchers have hypothesized that the SARS-CoV-2 spike protein that the mRNA vaccines were designed from might trigger an overly active immune response that causes inflammation in the heart. That doesn’t mean the vaccine causes the infection, warns Hasbani: Instead, the immune system is responding to the vaccine in a way that also happens to react with heart cells in the myocardium. The effect is nearly always temporary.

Myocarditis existed well before COVID vaccines

Hasbani says any medical treatment, including vaccines, has side effects, including ones that involve the heart. The smallpox vaccine, for example, helped eliminate smallpox worldwide in 1980, but was later found to have a 10-percent risk of mild myocarditis.

One likely reason we know more about the risks of myocarditis for the COVID vaccine is that “we haven’t vaccinated this amount of people this quickly for one specific illness, and followed a large population this closely,” Hasbani explains.

With all the facts, both experts stress that the small risk of myocarditis does not outweigh the severe complications you can get from a SARS-CoV-2 infection. For instance, long COVID remains an issue for millions of patients and has been associated with far more persisting heart problems. “Giving you and your family a vaccine is much safer than taking your chance on COVID,” Hasbani adds.

If the vaccine does cause cardiac inflammation in someone, there is little chance the condition would cause a heart failure. A January 2022 analysis of more than 17 million people found just 627 cases (or 0.0035 percent) of COVID vaccine-related myocarditis. Of those, 626 individuals fully recovered and one individual died. To put that into perspective, the National Institute of Health website states: “Your chance of getting myocarditis after getting a COVID vaccine is less than the chance of being struck by lightning during your lifetime.”

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This article was originally featured on KHN.

MALMO, Minn. — Eight women, all 73 or older, paced the fellowship hall at Malmo Evangelical Free Church to a rendition of Daniel O’Donnell’s “Rivers of Babylon” as they warmed up for an hourlong fitness class.

The women, who live near or on the eastern shore of Mille Lacs Lake, had a variety of reasons for showing up despite fresh snow and slippery roads. One came to reduce the effects of osteoporosis; another, to maintain mobility after a stroke.

Most brought hand and ankle weights, which they would use in a later portion of the program focused on preventing falls, known as Stay Active and Independent for Life, or SAIL. The class meets twice a week in Malmo, a township of about 300 residents. It is run by Juniper, a statewide network of providers of health promotion classes.

A few years ago, older adults who were interested in taking an evidence-based class like SAIL — meaning a class proved by research to promote health — had only one option: attend in person, if one was offered nearby.

But then the covid-19 pandemic and physical distancing happened. Along with social isolation came the rapid introduction of remote access to everything from work to workouts.

After widespread lockdowns began in March 2020, agencies serving seniors across the U.S. reworked health classes to include virtual options. Isolation has long since ended, but virtual classes remain. For older adults in rural communities who have difficulty getting to exercise facilities, those virtual classes offer opportunities for supervised physical activity that were rare before the pandemic.

And advocates say online classes are here to stay.

“Virtually the whole field knows that offering in-person and remote programming — a full range of programming — is a great way to reach more older adults, to increase access and equity,” said Jennifer Tripken, associate director of the Center of Healthy Aging at the National Council on Aging. “This is where we need to move together.”

Since April 2020, the National Council on Aging has organized monthly conference calls for service providers to discuss how to improve virtual programs or begin offering them.

“We found that remote programming, particularly for rural areas, expanded the reach of programs, offering opportunities for those who have traditionally not participated in in-person programs to now have the ability to tune in, to leverage technology to participate and receive the benefits,” Tripken said.

In 2022, at least 1,547 seniors participated in an online fitness program through Juniper, part of a Minnesota Area Agency on Aging initiative. More than half were from rural areas.

Because of grant funding, participants pay little or nothing.

Juniper’s virtual classes have become a regular activity both for people who live far from class locations and others who because of medical needs can’t attend. Carmen Nomann, 73, frequented in-person exercise classes near her home in Rochester before the pandemic. After suffering a rare allergic reaction to a covid vaccine, she’s had to forgo boosters and limit in-person socializing.

Virtual classes have been “really a great lifeline for keeping me in condition and having interaction,” she said.

Since 2020, Nomann has participated in online tai chi and SAIL, at one point logging on four days a week.

“Now, we would never go away from our online classes,” said Julie Roles, Juniper’s vice president of communications. “We’ve learned from so many people, particularly rural people, that that allows them to participate on a regular basis — and they don’t have to drive 50 miles to get to a class.”

When seniors drive a long way to attend a class with people from outside their communities, “it’s harder to build that sense of ‘I’m supported right here at home,’” she said.

Roles said both virtual and in-person exercise programs address social isolation, which older adults in rural areas are prone to.

Dr. Yvonne Hanley has been teaching an online SAIL class for Juniper since 2021 from her home near Fergus Falls. She had recently retired from dentistry and was looking for a way to help people build strength and maintain their health.

At first, Hanley was skeptical that students in her class would bond, but over time, they did. “I say ‘Good morning’ to each person as they check in,” she said. “And then during class, I try to make it fun.”

AgeOptions, an Illinois agency serving seniors, has seen similar benefits since introducing virtual fitness programs. Officials at the agency said last year that their operations “may have changed forever” in favor of a hybrid model of virtual and in-person classes.

That model allows AgeOptions to maintain exercise programs through Illinois’ brutal winters. Organizers previously limited winter activities to keep older adults from traveling in snow and ice, but now AgeOptions leans on remote classes instead.

“If the pandemic didn’t happen, and we didn’t pivot these programs to virtual, we wouldn’t be able to do that,” said Kathryn Zahm, a manager at AgeOptions. “We would just potentially spend months limiting our programming or limiting the types of programming that we offered. So now we can still continue to offer fall-prevention programs throughout the year because we can offer it in a safe way.”

But the new approach has challenges.

AgeOptions has identified increasing access to technology as a funding priority for the next few years, to ensure seniors can sign on.

The agency found that for many “folks in rural communities it was a challenge not only for them to have the device but to have the bandwidth to be able to do video conference calls,” Zahm said.

Tripken said providers and participants need guidance and support to facilitate access to virtual classes.

“For older adults in particular, that includes ensuring those with vision loss, those with hearing loss, those with low English proficiency” can participate in virtual classes, she said.

Some programs have created accommodations to ease the technology barrier.

Participants in Bingocize — a fall-prevention program licensed by Western Kentucky University that combines exercise and health education with bingo — can use a printed copy of the game card mailed to them by AgeOptions if they lack the proficiency to play on the game’s app. Either way, they’re required to participate on video.

The mail option emerged after Bingocize fielded requests from many senior service organizations trying to figure out how to offer it remotely, said Jason Crandall, the creator and international director of Bingocize.

Crandall designed Bingocize as a face-to-face program and later added the online application to use during in-person classes. Then covid hit.

“All of a sudden, all of these Area Agencies on Aging are scrambling, and they were scrambling trying to figure out, ‘How do we do these evidence-based programs remotely?’” Crandall said.

He said Bingocize was one of the few programs at the time that could quickly pivot to strictly remote programming, though it had never done so before.

“From when the pandemic began to now, we’ve come light-years on how that is done,” he said, “and everybody’s getting more comfortable with it.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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A large comprehensive study published January 16 in BMJ Global Health is shedding light on the risks of COVID-19 infection during pregnancy.

The study of over 13,000 pregnancies across 12 countries found that those infected with COVID-19 were seven times as likely to die during childbirth and are more than three times more likely to be admitted to an intensive care unit during during pregnancy, compared to COVID-free pregnant people. About 2,000 patients had a confirmed or probable case of COVID-19.

[Related: COVID deaths in pregnant people in the US are flying under the radar.]

“This study provides the most comprehensive evidence to date suggesting that COVID-19 is a threat during pregnancy,” Emily R. Smith, an assistant professor of global health at the George Washington University Milken Institute School of Public Health and lead author of the study, said in a statement. “Our findings underscore the importance of COVID-19 vaccination for all women of childbearing age.”

The researchers also found that when compared to uninfected pregnant people, those who have the the virus were 15 times more likely to require a ventilator and fives time more likely to develop blood clots that can cause swelling, pain, or other life-threatening complications. 

Babies born to those infected with COVID-19 were almost twice as likely to be admitted to a neonatal intensive care unit (NICU) after birth and were at a higher higher risk of being born prematurely. According to Smith, preterm babies are also at high risk of having lifelong health problems including delays in early childhood cognitive development.

“This study shows the risk of getting COVID-19 for both mother and baby,” Smith said. “All countries, including the United States, should make access to COVID vaccines an urgent priority in order to save lives and prevent health problems.”

The study did not look at the benefits of vaccination in pregnancy, but other studies have shown decreases in the risk of stillbirth, preterm birth, and severe disease or death.

[Related: The CDC is urging pregnant people to get COVID-19 vaccines. Here’s how we know it’s safe.]

Division director of Maternal Fetal Medicine at the Cleveland Clinic Justin Lappen praised the study in an article for CNN, saying the findings reinforce and advance previous research that highlights the importance of preventing and treating the virus in pregnant people. Lappen wasn’t involved in the BMJ study.

There are some caveats on this study, namely that the data used in this research was conducted relatively early in the pandemic when many people were still unvaccinated and uninfected. The people in the study were likely at higher risk not just because of pregnancy, but because pre-existing immunity to fight the virus was non-existent.

According to the CDC, more than 72 percent of pregnant people in the US have had their primary series of COVID-19 vaccines, and about 95 percent of Americans are estimated to have had the virus at least once or have been vaccinated against it.

The best ways to prevent COVID-19 infection, whether pregnant or not, remain getting vaccinated, waring a high-quality face mask when indoors or in crowds, and practicing good hygiene.

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As multiple respiratory viruses circulate in the United States, a subvariant of Omicron named XBB.1.5 appears to be poised to dominate other strains of the virus. Estimates from the Centers for Disease Control and Prevention (CDC), find that XBB.1.5 has risen from about 4 percent to 41 percent of new COVID-19 infections over the month of December. The CDC estimates that it’s causing 75 percent of new cases in the northeastern US.

[Related: Omicron boosters are the future of COVID vaccines in the US.]

“For a few months now, we haven’t seen a variant that’s taken off at that speed,” Pavitra Roychoudhury, director of COVIC-19 sequencing at the University of Washington School of Medicine’s virology lab, told CNN.

It is not yet clear where this version of Omicron came from, but it may have arisen in the United States. In late October 2022, it was first detected in Connecticut and New York, according to GISAID, an international effort to catalog and track COVID-19 variants.

XBB.1.5 was created by recombination that occurred when two descendants of Omicron’s BA.2 subvariant swapped pieces of their genetic code. The result was 14 new mutations to the virus’ spike proteins compared with BA.2 and a new sublineage named XBB.

XBB drove a wave of COVID-19 cases in Singapore during the fall of 2022. In the US, XBB faced competition from co-circulating variants that have each evolved some of the same mutations. According to the World Health Organization (WHO), XBB has been found in at least 70 countries.

[Related: Omicron variants keep getting better at dodging our immune systems.]

One of XBB.1.5’s main differences from the earlier XBB variant is that it can attach itself to cells more efficiently. “The virus needs to bind tightly to cells to be more efficient at getting in and that could help the virus be a little bit more efficient at infecting people,” Andrew Pekosz, a virologist at Johns Hopkins University, told CNBC.

Another concern surrounding this new strain is waning immunity. Vaccination or previous COVID-19 infection appear to only prevent reinfection for a few months in some cases, and the virus’ evolution adds an additional immunity challenge. There has also been limited uptake of the bivalent booster, that is targeted to fight both the original strain of COVID-19 and Omicron. Only 17 percent of adults have received this updated booster, despite evidence showing that it increases protection against severe illness and death.

While it is not completely clear if XBB.1.5 causes a more severe form of the illness or will increase hospitalizations, data shows that hospitalizations in the US are about to surpass the number seen during a spike of the virus in summer 2022. Multiple factors from this continued evolution of the virus and holiday gatherings appear to be driving transmission and the increase is a sign that an anticipated winter COVID-19 wave has begun.

The best ways to prevent infection include wearing a high-quality mask, especially in crowded indoor settings, regularly testing for COVID-19, and staying up to date on vaccinations.

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Following an abrupt end to the Chinese government’s strict lockdowns and “zero COVID” policy in December 2022, its citizens will be allowed to travel abroad for the first time since the pandemic began in 2020. In response, over a dozen countries have announced testing requirements and other restrictions on travelers from China.

The United States, Canada, Spain, France, Japan and the United Kingdom have cited concerns about a surge of COVID-19 infections in China, the potential risk of new variants emerging from its outbreak, in addition to a perceived reluctance by the Chinese government to share data with other countries among their reasons for implementing the testing policy.

[Related: What’s next for China’s zero COVID policy.]

Chinese government officials are pushing back against these restrictions. “Some countries have no scientific basis for restricting entries from China, and some excessive practices are even more unacceptable,” said Mao Ning, a foreign ministry spokeswoman, speaking at a news conference in Beijing on January 3. “We firmly oppose the practice of manipulating COVID prevention and control measures to achieve political goals, and will take corresponding measures in accordance with the principle of reciprocity according to different situations,” she added.

On December 28, the Centers for Disease Control and Prevention (CDC) announced that travelers from China, Hong Kong, and Macau will be required to present a negative COVID-19 test before entering the United States beginning on January 5, 2023. The CDC says the requirement for testing applies to air passengers regardless of their vaccination status and nationality, and will apply to travelers from China entering through a third country or those who connect through the US to other countries.

“Variants of the SARS-CoV-2 virus continue to emerge in countries around the world. However, reduced testing and case reporting in the PRC and minimal sharing of viral genomic sequence data could delay the identification of new variants of concern if they arise,” wrote the CDC in a statement. “Pre-departure testing and the requirement to show a negative test result has been shown to decrease the number of infected passengers boarding airplanes, and it will help to slow the spread of the virus as we work to identify and understand any potential new variants that may emerge.”

Similar restrictions have already been imposed in Italy and Japan, while India has mandated negative COVID-19 test reports and random screening for passengers arriving by air from China, Japan, South Korea, Hong Kong, and Thailand.

[Related: China approves world’s first nasal COVID-19 vaccine booster.]

The World Health Organization (WHO) has also urged Chinese officials to be more transparent on the country’s current surge of COVID-19 infections. The WHO requested more genetic sequencing data, data on hospitalizations, ICU admissions, and deaths, in addition to data on both the number of vaccinations delivered and vaccination status, especially in vulnerable people and those over 60 years old.

This lack of transparency surrounding COVID-19 data has health experts particularly concerned. “For the most part, we really don’t know what variants are circulating in China,” Andy Pekosz, a virologist at Johns Hopkins University in Baltimore, told CBS News. “That represents sort of a black box in terms of what we might be concerned about in terms of new variants in that country.”

However, Pekosz doesn’t believe that testing alone will be enough to stop a new variant from entering the US. “What you really need is a holistic approach. You need to know the sequences of the viruses that are there,” he said. “You need to know case numbers and hospitalization rates and how they are related to new variants. All of that information helps us to then prepare for a new variant if it were to arrive. Testing alone isn’t going to prevent a new variant from arriving here in the US.”

Parts of China have been fighting outbreaks of COVID-19 since the policy shift in December, but the severity of the outbreaks have been a guessing game.

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COVID-19 caused headlines again this year, but it was matched by a slew of other newsworthy viruses: the adenoviruses suspected to be behind the rise in hepatitis cases in early spring, the outbreak of mpox—formerly known as monkeypox—in the summer, an early surge in respiratory syncytial virus (RSV), and a peak in influenza cases following the Thanksgiving holiday season. Each of these viruses has tested clinicians, epidemiologists, and virologists. But these experts have responded by employing some of the tools that were built during the COVID pandemic.

The beginning of 2022 brought the first trial run for our toolkit: huge numbers of COVID cases, caused by the emergence of the highly transmissible Omicron variant. Virologists had to re-enact the early days of the pandemic: identifying the strain, testing its disease severity, and understanding its ability to escape the immune system. The available COVID vaccines were pitted against Omicron, and thankfully, showed good efficacy. By now, these studies were familiar, and early results were shared quickly to inform how public health officials around the world acted to protect populations.

After the initial surge of cases, in spring of 2022, many jurisdictions began to reduce COVID testing and tracing. The Centers for Disease Control and Prevention (CDC) changed its guidance on face coverings, so fewer people wore masks out and about. Still, researchers continued to track Omicron and its subvariants, and those who’d worked at speed to understand the latest strain would get little respite—2022 had more pathogens to throw at them yet.

Genome sequencing predicts viral spread

Monitoring mutations is a virus-fighting tool that had been employed early in the pandemic, because it’d been proven to help many times before. Since 2008, researchers sequencing all types of viruses have been able to upload whole genomes to GISAID, a science surveillance initiative. Their work had allowed for quick research at the start of the H1N1 flu pandemic in 2009 and during the 2013 bird flu epidemic. 

“When the unknown coronavirus emerged in January 2020, GISAID had already played a key role in influenza surveillance for 12 years,” says Sebastian Maurer-Stroh, executive director of the Bioinformatics Institute in Singapore and a collaborator with GISAID. The collaborative’s array of tools, though designed for tracking flu viruses, had been built in connection with the research community and large organizations like the World Health Organization (WHO). These tools were relatively easy to adapt to track the spread of COVID, Maurer-Stroh says. 

[Related: The World Health Organization officially renamed monkeypox to mpox]

GISAID’s database of SARS-CoV-2 genomes has helped research into the pathogen’s spike protein, the area on the virus that affects how it enters our cells and causes infection. It’s also meant that countries can monitor the rise and fall of different strains in their populations and make changes to guidelines accordingly. Though submissions of new SARS-CoV-2 genomes started to trail off in early 2022, GISAID and the WHO are still tracking Omicron and the emergence of subvariants. 

But in May 2022, GISAID researchers noticed a new genome being uploaded. The hMpxV virus and the disease it caused, mpox, was already endemic in countries in Africa, but rarely caused infections outside the continent. GISAID surveillance showed that there were new lineages spreading rapidly, and by July the virus was present in 75 countries. That month, the WHO declared the outbreak to be a public health emergency. Cases have been steadily dropping since then, though the WHO reports that seven countries are still seeing new cases. As of December 15, there have been more than 80,000 mpox cases worldwide.

Wastewater provide breadcrumbs for disease outbreaks

At the same time as GISAID was monitoring DNA sequences of the mpox virus, researchers were employing another surveillance tool used during the pandemic. Wastewater taken from July to October in  New York showed that poliovirus was circulating in six of 13 sampled counties.

Wastewater sampling had detected COVID in sewers back in April 2020; in September of that year, the CDC launched the National Wastewater Surveillance System (NWSS) to monitor virus levels. Compared to mass-scale PCR testing, testing wastewater offered an easy and unobtrusive way to find out where there were hotspots of virus activity. 

“You can track a lot of viruses in the wastewater, and what we’re seeing with COVID is that it may be an easier way of doing epidemiology, at least on a bigger picture scale,” says virologist Michael Teng, of the University of South Florida Department of Molecular Medicine. Wastewater surveillance can’t pinpoint individuals, so it won’t help identify potential “superspreaders” before they infect others. But it’s a great tool for virologists to see general geographical trends in virus levels.

[Related: Polio is officially circulating in the US again]

The poliovirus spread in the state was “silent,” but posed a real threat. Cases of polio had been basically non-existent in the US since the introduction of the polio vaccine, which has an average uptake of 92 percent in kids across the country—though some counties’ rates of vaccination are as low as 37 percent.

Vaccines fight viruses in and across individuals

As evidenced by the pandemic, vaccine uptake is one of the–if not the–best tools for stopping the spread of a virus. COVID vaccines protect against infection, and if you do get the disease, you’re less likely to have severe illness if you’ve been vaccinated.

So when researchers predicted a tripledemic of COVID, the flu, and RSV heading towards the US, the message was clear: Get your flu shot and COVID booster. But with no RSV vaccine available, case numbers quickly rose in young children and elderly population.

“We had a COVID vaccine within about 11 months of when the first virus sequence came out well, but RSV was first identified in 1957, and since then we have not really had good vaccines,” says Teng, whose focus is on the respiratory pathogen. “But one of the really exciting stories for this year is that Pfizer [who developed one of the COVID vaccines] along with GSK have had really good results in tests for an RSV vaccine for the elderly.”

[Related: Fighting RSV in babies starts with a mother’s antibodies]

Teng says the purchase of COVID vaccines led to an infusion of capital in companies like Pfizer and Moderna, the latter of which has been able to invest into research it began long before the pandemic. This money meant Moderna could move forward with several vaccines in development, according to Teng, including one for HIV.

These important elements of tackling viruses in 2022—genomic monitoring, wastewater surveillance, and vaccine development—are just part of the huge fight against infectious diseases. There is, of course, still a lot we don’t know about COVID and other viruses, and we cannot predict what 2023 will bring. But researchers are armed with more information about the spread of viruses than ever before, and they’ve already begun putting the pandemic’s teachings into practice.

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Due to increased demand, pharmacy chains CVS and Walgreens have limited purchases of children’s pain relievers and fever reducers. The demand comes amid a “tripledemic” surge of respiratory infections including flu, respiratory syncytial virus (RSV), and COVID-19. Particularly vulnerable to RSV, the virus has hospitalized more than four out of every 1,000 children under the age of five this season, according to the CDC.

In November, the spike in illnesses led to a 65 percent increase in the sale of children’s fever reducers and medications compared to November 2021, according to the Consumer Healthcare Products Association (CHPA). The association represents some of the companies that make the medications including Tylenol manufacturer Johnson & Johnson, Haleon the maker of Advil, and Perrigo, which manufacturers generic store brands.

[Related: Is it flu or RSV? It can be tough to tell.]

In a statement, CHPA said that it doesn’t yet have a timeline for when the supply may catch up with demand and stressed that the manufacturers were working to replenish the medications as quickly as possible.

At Walgreens, customers are limited to online purchases of six over-the-counter fever reducers per purchase, but the company does not currently have an in-store limit.

“Due to increased demand and various supplier challenges, over-the-counter pediatric fever reducing products are seeing constraint across the country,” said Walgreens, said in a statement. Walgreens added that the limits are, “in an effort to help support availability and avoid excess purchases.”

CVS also cited the increased demand for these items for their two-product per person limit on both online and in-store purchases. A spokesperson for CVS told The New York Times, “We can confirm that to ensure equitable access for all our customers, there is currently a two (2) product limit on all children’s pain relief products. We’re committed to meeting our customers’ needs and are working with our suppliers to ensure continued access to these items.”

The American Academy of Pediatrics (AAP) is urging parents “not to panic” if they are unable to find fever-reducing medicine. “These medicines are not curative. They don’t alter the duration of the illness or anything like that. They are essentially purely for comfort,” Sean O’Leary, chair of the Committee on Infectious Diseases for the AAP, told NPR earlier in December. “Fevers from common respiratory viruses in and of themselves are not harmful.”

[Related: No, you can’t get the flu from a flu shot.]

While weekly RSV hospitalizations have recently decreased, the number hospitalizations is still higher than normal for this time of year.

Daniel Ganjian, a pediatrician at Providence Saint John’s Health Center, told PopSci in October that RSV exposure early in life helps train the immune system and most RSV infections occur in babies whose immune systems are still developing. Beginning in early 2020, children did not attend as many in-person activities, which lowered their chance of infection and the creation of an appropriate immune defense. “They have zero antibodies because these kids, who were 1 and 2 during the pandemic, were not exposed to RSV,” Ganjian said. “Now they’re getting it for the first time and they’re getting severe reactions,” he said. Infected infants may cough and wheeze for about two weeks, but most babies make a full recovery. A 2022 study in The Lancet estimates that RSV caused 7 percent of infant deaths, with most occurring in children under 3.

Wearing a face mask, staying up to date with flu and COVID-19 vaccination, good hand-washing, and other general health practices can help prevent infection from respiratory infections.

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This story has been updated.

This week, the Food and Drug Administration (FDA) changed their emergency use authorizations (EUAs) for the bivalent Moderna and Pfizer-BioNTech COVID-19 vaccines to now include children from 5 years to six months old. The Centers for Disease Control and Prevention (CDC) followed up with its own announcement to expand use of the vaccine to the same age group.

The bivalent vaccines were first authorized by the FDA in August for adults and in some teens. Both the Moderna and Pfizer-BioNTech bivalent COVID-19 vaccines have mRNA components that correspond with the original COVID-19 strain and the Omicron variant (specifically the BA.4 and BA.5 lineages). The formula provides better protection against COVID-19 caused by the now year-old Omicron variant, according to the FDA.

[Related: FDA green lights Omicron-targeting mRNA vaccine boosters.]

“More children now have the opportunity to update their protection against COVID-19 with a bivalent COVID-19 vaccine, and we encourage parents and caregivers of those eligible to consider doing so—especially as we head into the holidays and winter months where more time will be spent indoors,” said FDA Commissioner Robert M. Califf in a press release. “As this virus has changed, and immunity from previous COVID-19 vaccination wanes, the more people who keep up to date on COVID-19 vaccinations, the more benefit there will be for individuals, families and public health by helping prevent severe illnesses, hospitalizations, and deaths.”

Here is what parents and caregivers of children from six months to five years old need to know:

• Children can receive the updated bivalent booster two months after completing their primary series of the monovalent (or original) Moderna COVID-19 Vaccine.
• Children that haven’t begun their three-dose primary series of the Pfizer-BioNTech COVID-19 vaccine or haven’t gotten the third dose of their primary series, will now get the bivalent Pfizer-BioNTech vaccine as that third booster dose after two doses of the original vaccine.
• Children who have already completed their three-dose primary series with the original Pfizer-BioNTech COVID-19 vaccine are not currently eligible for a booster dose of an updated bivalent vaccine at this time. The FDA expects that children in this age group who have already completed their primary vaccination series still have strong protection against the most serious outcomes of the virus, even from the Omicron variant. The agency also expects more data on giving an updated bivalent booster dose for these children in January 2023.

[Related: Omicron boosters are the future of COVID vaccines in the US.]

Patients who get the bivalent vaccines may see similar side effects that followed previous doses mRNA COVID-19 vaccines. The updated fact sheets for both bivalent COVID-19 vaccines provides more information about the potential side effects, as well as the risks of myocarditis and pericarditis. 

“Vaccines remain the best defense against the most devastating consequences of disease caused by the currently circulating omicron variant, such as hospitalization and death. Based on available data, the updated, bivalent vaccines are expected to provide increased protection against COVID-19,” said Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, in a statement. “Parents and caregivers can be assured that the FDA has taken a great deal of care in our review, and we encourage parents of children of any age who are eligible for primary vaccination or a bivalent COVID-19 vaccine booster dose to consider seeking vaccination now as it can potentially help protect them from COVID-19 during a time when cases are increasing.”

The news comes as hospital systems around the US continue to be stretched thin by a “tripledemic” of flu, COVID-19, and respiratory syncytial virus (RSV). According to the CDC, 14 children have died from the flu nationwide.

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On Friday, the Centers for Disease Control and Prevention (CDC) released its weekly flu activity map. The newest map shows that the 2022-2023 flu season is already bad and ramping up especially early. The cumulative hospitalization rate for this past week of the year is currently higher than it was at this point in flu season over the past decade.

Between common colds, the flu, respiratory syncytial virus (RSV), and COVID-19, it’s that the sneezy time of year where people are getting sick left and right. Some of the factors that influence the spread and rise of upper respiratory infections are still puzzling scientists. In fact, it wasn’t too long ago that miasma theory, or the idea that “bad air” caused disease was much more popular. While some diseases are certainly spread through the air, it’s airborne viruses or bacteria, and not the air itself, that makes us sick.

[Related: Masks can work—even if you’re the only one wearing them.]

A new study from Massachusetts Eye and Ear Hospital and Northeastern University published today in The Journal of Allergy and Clinical Immunology found that a specific immune response inside the nose that fights off infection-causing upper respiratory viruses, is inhibited by colder temperatures. This then makes infections more likely to occur as temperatures drop.

“Conventionally, it was thought that cold and flu season occurred in cooler months because people are stuck indoors more where airborne viruses could spread more easily,” Benjamin S. Bleier, director of Otolaryngology Translational Research at Mass. Eye and Ear and a co-author of the study, said in a statement. “Our study however points to a biological root cause for the seasonal variation in upper respiratory viral infections we see each year, most recently demonstrated throughout the COVID-19 pandemic.”

Part of what makes wearing a mask so effective is that it protects and covers the nose. Our nostrils are a likely entry point for germs, since the nose one of the first points of contact between the outside environment and inside the body. If pathogens are inhaled or we place them onto the front of our nose using our hands, they can work their way backwards through the airway and into the body. Once inside, they can infect cells and lead to an upper respiratory infection.

In 2018, a study sought to better understand the mystery of how the airway protects itself from this onslaught of pathogens. It found that an innate immune response was triggered when bacteria is inhaled through the nose. The cells located in the front of the nose detected the bacteria and then released billions of extracellular vesicles (EVs) into the mucus. These tiny fluid-filled sacs surround and attack the bacteria. According to Bleier, the release of this EV swam is similar to “kicking a hornets’ nest.”

The study from 2018 also showed that EV’s can move around protective antibacterial proteins through the mucus from the front of the nose to the back of it along the airway. This mechanism protects other cells against the bacteria before it has a chance to get too far into the body. This research helped set the stage for a closer look into what factors influence this response in the nose.

Other studies have found that EVs are present in the nasal passages of infants infected with RSV and other respiratory infections.

[Related: Is it flu or RSV? It can be tough to tell.]

In this new study, the team examined how the cells and nasal tissue samples responded to three different viruses: a single coronavirus and two of the rhinoviruses that cause the common cold. The samples were collected from the noses of healthy volunteers as well as patients undergoing surgery.

The team found that each virus triggered this EV swam response from nasal cells using a signaling pathway that is different from the one that is used to fight off bacteria. When the EV swarm was released, they acted a bit like decoys, bringing with them receptors that the virus could bind itself to instead of bringing along nasal cells to be infected.

“The more decoys, the more the EVs can mop up the viruses in the mucus before the viruses have a chance to bind to the nasal cells, which suppresses the infection,” Di Huang, a research fellow at Mass Eye and Ear and Northeastern, and a co-author of the study, said in a statement.

Temperature is particularly relevant in nasal immunity because the internal temperature of the nose is dependent on the temperature of the air it is inhaling. To see how colder temperatures affected this EV swam response, the team took healthy volunteers from a room temperature environment and then exposed them temperatures of 39.9° F for 15 minutes. After exposure to the cold air, they found that the temperature inside the nose fell by about 9° F. They then performed the same reduction in temperature with the nasal tissue and found that the quantity of EVs secreted by the nasal cells decreased by close to 42 percent and the antiviral proteins in the EVs were also impaired.

According to the team, these findings provide an explanation for the mechanisms behind seasonal variation in upper respiratory infections.

In an interview with PopSci, Director of Pulmonary Research at the University of Kansas Navneet Dhillon also praises this study as a step in better understanding the mechanisms behind the spread.

“I think it’s a good study and one of the novelties in this study is cold exposure,” said Dhillon. “A great next step will be proving that EVs are therapeutic in an actual infection setting, with virus replication. But they have already done a very detailed study with all of their experiments.” Dhillion was not involved with the study.

[Related: What’s the difference between COVID, flu, and cold symptoms?]

Rhinologist Zara Patel, a professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California, told CNN “This is the first time that we have a biologic, molecular explanation regarding one factor of our innate immune response that appears to be limited by colder temperatures.”

She also added “It’s important to remember that these are in vitro studies, meaning that although it is using human tissue in the lab to study this immune response, it is not a study being carried out inside someone’s actual nose. Often the findings of in vitro studies are confirmed in vivo, but not always.” Patel also was not involved in this study.

Next steps include include trying to replicate these findings with other illnesses and also the team also believe that this process can help develop treatments that can induce and strengthen the nose’s innate immune response.

“We’ve uncovered a new immune mechanism in the nose that is constantly being bombarded, and have shown what compromises this protection,” said Mansoor M. Amiji, a professor of pharmaceutical sciences at Northeastern University and co-author, in a statement. “The question now changes to, ‘How can we exploit this natural phenomenon and recreate a defensive mechanism in the nose and boost this protection, especially in colder months?’”

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In a press briefing yesterday, Centers for Disease Control and Prevention (CDC) Director Rachelle Walensky announced that the United States is currently seeing the highest levels of hospitalization for influenza (flu) at this point in flu season than it has over the past decade. She encouraged individuals to take preventative action by wearing face masks that can help reduce the spread of most of the respiratory illnesses, not just COVID-19.

“We also encourage you to wear a high-quality, well-fitting mask to prevent the spread of respiratory illnesses,” said Walensky, adding that wearing a mask is one of several precautions that people can take to reduce their chances spreading or catching a respiratory virus over the holiday season.

Mask mandates began to lift around the country in late February and March, when the CDC suggested that 90 percent of the country no longer needed to wear them in public.

According to CDC estimates, there have been at least 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths so far from this flu this season. During the week of Thanksgiving, nearly 20,000 people in the US were admitted to the hospital for the flu, almost double the number of admissions from the previous week.

“Especially for RSV and flu, these levels are higher than we generally see this time of year,” Walensky said in a telephone news briefing. She also added that the flu season got off to an early start and that “hospitalizations for flu continue to be the highest we have seen at this time of year in a decade.”

US hospital systems continue to be stretched thin by a “tripledemic” of flu, COVID-19, and respiratory syncytial virus (RSV) and Welensky added that so far, 14 children have died from the flu nationwide.

COVID-19 cases have also risen since Thanksgiving and COVID-related hospitalizations have increased about 15 to 20 percent over the last week, according to Walensky.

The agency is also considering expanding its system of COVID community levels to factor in other respiratory viruses such as the flu. This system is the basis for when the CDC advises people to mask-up.

[Related: Check this CDC map to see if you live in a ‘high risk’ flu state.]

“One need not wait on CDC action in order to put a mask on,” Walensky said. “We would encourage all of those preventive measures — hand washing, staying home when you’re sick, masking, increased ventilation — during respiratory virus season, but especially in areas of high COVID-19 community levels.”

Another prevention method includes getting this year’s flu vaccine. The CDC says preliminary data suggests that this year’s vaccine is a good match for the dominant strains of flu. Walensky added that even during flu seasons when the shot doesn’t match the circulating flu strains as well, “We see a 35 percent decrease in rates of hospitalization … which really just emphasizes, when we do have a good match, how much more effective it will be.”

[Related: No, you can’t get the flu from a flu shot.]

If you do get sick, testing is important, added Sandra Fryhofer, board chair of the American Medical Association and an internal medicine physician in Atlanta. Testing helps medical professionals tell whether the illness is flu, COVID-19, RSV, or a common cold so that they can prescribe the best treatment option. Antivirals for COVID-19 and the flu are available, but COVID-19 antivirals do not work against the flu and vice versa.

Fryhofer also urged people to get flu shots as soon as possible, stressing that it’s not too late. “This year’s flu season’s off to a rough start,” she said. “It started early, and with COVID and RSV also circulating, it’s a perfect storm for a terrible holiday season.”

Additional prevention measures for respiratory illness are hand washing, staying home when sick, avoiding touching your nose and face, and eating a balanced diet.

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In early 2020 I developed a disabling case of long COVID, which sent me on a never-ending search for adequate care. Three of the most prominent long COVID clinics in Los Angeles turned me away because I wasn’t able to obtain a test for the virus when I fell ill, an experience shared by many patients who were infected early in the pandemic, when resources were still nonexistent or scarce. But in late 2021 I was able to make an appointment at Keck Medicine of USC’s COVID Recovery Clinic. I was hopeful that I would be seen by a doctor with experience treating complex chronic illnesses since some infectious diseases such as SARS, mono, and Lyme are known to result in long-term conditions.

The same December, I was seen by a family medicine physician and physical therapist. The clinicians met with me for an hour and later referred me to a neurologist—who I wouldn’t be able to see for four months—and prescribed me an antidepressant that the physician said may help my headaches. I was told to follow up in one to three months despite the severe side effects that fractionated my work hours, made my hobbies of rock climbing and running impossible, and altered every aspect of my life. Before my appointment wrapped, I asked about possible treatments based on up-to-date long COVID research, but was turned down because of my symptom profile. I left defeated and hopeless.

My experience is not unique. This summer, the US Census Bureau reported that close to 16 million American adults are living with long COVID, a debilitating condition that lasts at least four weeks beyond an initial coronavirus infection and affects multiple organ systems. It has been observed in all age groups, and has placed stress on the US healthcare model that relies on short doctor’s visits. Even though high-demand clinics, sometimes called post-COVID care centers, now offer services for the illness, many fail the very patients they have set out to help. Long COVID patients share anecdotes about how the clinics they are admitted to often turn a blind eye to the gravity of their needs and fail to incorporate knowledge learned from myalgic encephalomyelitis, or ME, and other infection-associated illnesses.

[Related: Long COVID can manifest in dozens of ways]

ME, which is sometimes called chronic fatigue syndrome, is a disease that often appears in the wake of an infection. In a small observational study recently done on long COVID patients, nearly half met the diagnostic criteria for ME, including substantial impairment in both physical and cognitive function alongside post-exertional malaise—a flare-up of symptoms that typically appear a day after cognitive or physical exertion—and fitful sleep. It also can cover cognitive impairment or orthostatic intolerance, meaning the inability to remain upright without extreme dizziness and other symptoms. While most people living with long COVID or ME developed their illness after infection, a very rare group of people are known as vaccine-injured, meaning they developed similar symptoms after getting the coronavirus jabs. 

Clinics informed by ME offer insight into managing long COVID with treatment and education, providing a rubric for how other recovery centers could operate. Their approach also exposes the structural neglect of complex chronic illnesses in the US. 

Lucinda Bateman, founder and medical director of the Bateman Horne Center in Salt Lake City, is one of a small number of ME specialists in the county. She has been treating and researching the illness for more than three decades. “I can tell you from our close assessments that many people with long COVID become severe enough and chronic enough to meet these criteria [for ME/CFS],” she says. “So I would consider them SARS-CoV-2 induced ME/CFS.”

Hard-to-find care

Inaccessibility is one of the most prominent barriers to post-COVID clinics. Most require a positive test and a referral from a patient’s primary care physician. With nearly 26 million people uninsured in the US and many more who are inadequately covered, seeing a primary care physician can be a financial burden, especially if patients are chronically ill and unable to work.

Distance is another factor. According to the COVID-19 Longhauler Advocacy Project, the US has more than 400 long COVID clinics and rehabilitation centers, but few exist in rural locations and only around a dozen focus on pediatric long COVID patients. Traveling long distances is an enormous burden on long COVID patients, who may be bed- or housebound. What’s more, many physicians continue to consider their patients’ symptoms (and sometimes even their colleagues’ symptoms) to be psychosomatic, or the result of stress or anxiety, which can make getting a referral to a clinic challenging.

If a patient is able to clear these barriers despite their extreme fatigue, cognitive impairment, and cluster of more than 100 other possible symptoms, they typically encounter months-long waiting lists to be admitted to clinics.

Desireé Parker, a 39-year-old from Pennsylvania, had to wait almost half of a year to be seen by the University of Pittsburgh Medical Center’s Post-COVID Recovery Clinic. When she had her first appointment this summer, she says the clinic ordered some lab work and gave her basic informational handouts. “It was just very generic,” she recounts from her experience. “It was like a packet of internet sources … I expected a lot more after waiting patiently for five months.”

Beyond these forms of inaccessibility, patients say some doctors at long COVID clinics aren’t aware of recent studies of the disease, which link it to markers of complex chronic illnesses like microclots and autoimmune responses, reactivated viruses like Epstein-Barr, and common concurrent diagnoses like postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and others.

One of the least-acknowledged, but most-critical-to-address questions of long COVID is how it overlaps with ME. Before the COVID pandemic began, as many as 2.5 million Americans were already living with ME. Because the disorder has been stigmatized and underfunded for decades, few physicians are are able to diagnose and treat it. In fact, less than one-third of medical school curricula in the US include education about ME.

These systemic issues are now having a resounding impact on people seeking comprehensive long COVID care. Sara, a 30 year-old who wished to omit her last name, says that in the fall of 2021, when she had a virtual appointment with MedStar Health COVID Recovery Program in Maryland, her doctor told her that her symptoms were due to untreated anxiety and depression—a common experience for patients with chronic illness, particularly women and people of color. She worked with a lawyer to attempt to get the psychosomatic note off her record because she said it might put the private long-term disability insurance that she was applying for in jeopardy.

“At best, he was ignorant,” Sara says about her doctor at the clinic. “And at worst, he was actively being harmful.” Her concerns inspire a larger question of how post-COVID care centers are screening patients for the complex list of markers for the disease. When I reached out to a representative of MedStar to ask if their clinic believed long COVID and its concurrent diagnoses were psychosomatic despite vast scientific literature showing the disease affecting multiple organ systems, I didn’t receive a response. Sara left MedStar’s clinic and later went to George Washington Medical Faculty Associates COVID-19 Recovery Clinic in the D.C. metro area. There she had a promising initial visit where they diagnosed her with dysautonomia—an umbrella term for disorders of the autonomic nervous system including syndromes like POTS—and referred her to a cardiologist for further care. But the facility closed this summer and transitioned their patients to primary care providers, an emerging trend in the US and abroad.

Outdated therapies

Because so many physicians are uninformed about ME, some at long COVID clinics prescribe therapies that have been proven to be harmful to patients who experience post-exertional malaise (PEM). Graded exercise therapy (GET)—a controversial form of physical therapy for ME and long COVID which slowly increases exercise over time— worsens patients’ symptoms who experience PEM. “Graded exercise therapy implies that you can exercise yourself into fitness and resolve the illness,” Bateman says. “When in reality, that’s not the case.”

Jordan, a 23-year-old who wished to omit his last name, says he was referred for pulmonary rehabilitation after two visits to Houston Methodist’s COVID-19 Recovery Clinic in the spring of 2022. He followed a program of increased aerobic exercise resembling GET for about a month. “24 hours after I finished each session I’d get a flare-up of symptoms,” he says.

Jordan says he has been living with long COVID symptoms since getting his second COVID-19 vaccination dose in May 2021. Before that, he had two prior SARS-CoV-2 infections. Though there are few studies on post-vaccine side effects, some immunologists believe it may provide clues on the biology of long COVID.

His symptoms got progressively worse as he followed the GET-like program, leading to lightheadedness and “burning” headaches. When Jordan mentioned this to a nurse practitioner at the Houston Methodist clinic, he says he was told to continue exercising, do cognitive behavioral therapy, and come back in six months.

A spokesperson for Houston Methodist wrote to me that they do not prescribe GET at their post-COVID clinic, but that if a patient at the clinic requires pulmonary rehabilitation a respiratory therapist may recommend a “gradual exercise regimen” based on that individual’s needs. Jordan says his therapy included an increase in the length of the time of the exercises, which is a feature of GET. I asked by email if and how the clinic—or any medical professionals the clinic refers to—prescribes the therapy to patients with PEM, but didn’t receive a response.

Jordan left the clinic in summer and was recently admitted to Baylor’s Post COVID Care Clinic in Texas after a five-month wait. He says he feels heard at the clinic and that his primary provider is much better informed about ME and its ties to long COVID.

“The issue is that for most clinicians the disease is incredibly complex,” says Jaime Seltzer, the director of scientific and medical outreach at the advocacy group #MEAction. Clinicians who are faced with this level of complexity, she says, may turn to treatments like GET because they are based on simple hypotheses. 

The most prominent study used to employ GET is the 2004-2011 PACE Trial, which has been debunked as an outdated standard of care in a recent ME consensus recommendation written by Bateman and 22 other co-authors. The CDC even removed recommendations for GET from its website in 2017. The therapy is also not recommended for people with ME by the National Institute for Health and Care Excellence, which offers guidelines for health and care in England, nor is it recommended for long COVID patients who experience PEM by the World Health Organization.

“There is a lot you can do for ME/CFS,” Seltzer says. “There’s no cure, but that’s not the same thing as saying it cannot be managed.” She points out that many people with ME have grown frustrated with the narrative that long COVID is a new and mysterious illness, and says that it perpetuates an excuse for clinicians to not be blamed for failing to help. “It is absurd that they are turning away good information because of stigma.”

Akiko Iwasaki, an immunologist at Yale School of Medicine and a leading long COVID researcher, agrees with Seltzer: Had there been more research and funding devoted to studying ME, she says, we would have been much better prepared to deal with long COVID. “I’m hoping that any insights we gain from long COVID will also apply to [ME].”

Managing ME

In preliminary research posted online this August, Iwasaki and her colleagues found altered immune cell activity, blood abnormalities, low cortisol levels, and signs of reactivated Epstein-Barr virus in long COVID patients. She says that their findings warrant an immediate need for randomized clinical trials to target these syndromes. Long COVID clinics would be a natural place for them to begin. “As a scientist I’d like to know all the pieces of the puzzle first,” she explains, “But we don’t have that luxury, we have to start trialing to find something that works now.”

Iwasaki’s top candidates for potential therapies to study include antivirals, like the drug Paxlovid, which will undergo its first clinical trial to alleviate inflammation and other long COVID symptoms in January. Early results from a widescale study on veterans found that the treatment with nirmatrelvir—one of the two pills used in the treatment—can slightly decrease the risk of long COVID if taken during the acute phase. Iwasaki also hopes to investigate other therapies that target the reactivated Epstein-Barr virus and inflammation associated with long COVID, as well as cortisol supplementation therapies.

But until more long COVID clinics begin testing potential therapies, Iwasaki says that at the very least there should be “open communication” between these clinics so that they can share insights about what works for patients and what doesn’t. Programs should standardize their training for physicians, too, which may be helped by the Biden administration’s proposed Centers of Excellence, so long as the model prioritizes infection-associated illnesses like ME. 

Iwasaki underscores that each clinic should be set up so that patients can see many specialists in one visit. “That would be very helpful because people with long COVID often have brain fog that makes it very difficult to maneuver 12 different appointments,” she says.

One emerging model hoping to lead in this space is RTHM, Seltzer says. The new virtual long COVID clinic was co-founded by clinicians and researchers whose care is informed by their own patient experience with ME and other infection-associated illnesses. It sees patients virtually in five states, and targets ME, POTS, MCAS, and other conditions that often accompany long COVID. Seltzer is helping to shape the program’s educational resources.

Long COVID patients have begun visiting clinics and practices like RTHM that specialize in ME, even though the programs may be out of network with major health insurance carriers for some of their services. The nonprofit research advocacy group Solve M.E. shares a list of 17 doctors specializing in ME on their website; #MEAction has similarly compiled an international list of providers and allies. But many of these specialists are nearing retirement age at a time when their expertise is required by millions of survivors.

[Related: Getting COVID more than once might be even worse than we thought]

At Bateman’s ME clinic in Utah, she hired and trained two advanced practice clinicians to see long COVID patients, after she noticed a surge in need in late 2020. Like other medical experts I spoke with, she says the best way to address the growing need for ME and long COVID clinicians is to educate all healthcare workers about the illness. She also emphasizes that it’s necessary to put pressure on powerful agents like health insurance companies and academic institutions to recognize ME. “We need skilled chronic illness managers to coordinate the care of people with long COVID and other post-viral conditions,” she explains, far beyond those working in a few clinics.

In the meantime, Bateman recommends long COVID patients do the same thing she has been telling ME patients for years. “Become very well-informed yourself,” she says, advising individuals to read broadly about their own condition from ME non-profits, patient-led research groups, and papers written by ME specialists. “Secondly, work with a provider that you can communicate with and learn about long COVID together. It’s easier to train up a trusted doctor than to go searching for [ME specialists] when the numbers are still so low.” 

At some point, long COVID will become enough of an issue that it will demand change, Bateman says, but she worries about how many people will have to suffer until then. “I’m hopeful that the response to long COVID will improve. But I would like to see it move more quickly and include all of the people with post-viral syndromes who are in need.”

The post What patients find at long COVID clinics: rejection, outdated therapies, and unanswered questions appeared first on Popular Science.

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Almost three years into the pandemic, the spotlight isn’t just on COVID medicine anymore. While booster shots and take-home antiviral pills gave us new tools to fight the infectious disease, health researchers and drug makers regained momentum in other crucial areas, like organ transplants, STI prevention, and white-whale therapies for alopecia and HIV. At the same time, AI deepened its role as a diagnostic aid, while mental health services got an accessibility boost across the US. We know the pandemic isn’t over—and other pathogens and illnesses are likely lurking undetected—but the progress we make in medical labs, factories, and care centers can help nurse societies back to health before the next storm hits.

Looking for the complete list of 100 winners? Find it here.

Grand Award Winner

AuriNova by 3DBio Therapeutics: A replacement ear that’s made from ear cells

3DBio

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About 1,500 people in the US are born each year with absent or underdeveloped external ears. Traditional reconstruction techniques might fix the cosmetic issue, but a new 3D-printed ear transplant, called AuriNovo, offers a living substitute. The implant is made with proteins, hydrogel, and a patient’s own cells, giving it far more flexibility than any constructed with synthetic materials; plus, the procedure is less invasive than, say, transplanting tissue from a patient’s ribs. To build the replacement, a surgeon first takes a sample of an individual’s ear tissue to separate and culture the cartilage-making cells. Then, based on a 3D scan of the fully formed ear on the patient, the part is printed with collagen-based “bio ink” and surgically inserted above the jaw. A 20-year-old woman from Mexico was the first to get the implant this June. 3DBio Therapeutics, the New York-based regenerative medicine company behind AuriNovo, hopes to use the technology to one day create other replacement body parts, like noses, spinal discs, and larger organs. 

Paxlovid by Pfizer: The first take-home treatment for COVID-19

Pfizer

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COVID therapies have come a long way since the start of the pandemic, and now include several antiviral drugs and monoclonal antibodies. But Pfizer’s Paxlovid was the first oral treatment for the disease to receive emergency authorization from the FDA, meaning it can be obtained with a prescription. It’s also highly effective: Clinical trials show it reduces hospitalization and death from the virus up to 90 percent more than a placebo. The remedy is a combination of two pills: nirmatrelvir, which prevents the novel coronavirus from replicating, and ritonavir, which causes the body to metabolize nirmatrelvir more slowly. The drug does have downsides—it can interact with other medications and sometimes causes a foul aftertaste. Plus, rare cases of rebound COVID symptoms and positive tests have occurred in people following Paxlovid treatment, although research indicates that the latter might be related to the immune system responding to residual viral RNA. Still, it represents a crucial new safeguard for healthcare providers and the public.

EVO Visian Implantable Collamer Lenses by STAAR Surgical: Combining the perks of contacts and laser surgery

STAAR Surgical

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Most cases of nearsightedness and astigmatism, which is blurred vision caused by an irregularly shaped cornea, can be fixed with laser eye surgery. But the procedure requires some corneal tissue to be removed and often leaves recipients with lingering dry eyes. EVO ICL provides an alternative with a minimally invasive new way to correct or reduce both conditions. During the approximately hour-long procedure, a flexible collagen-containing lens is implanted between the iris and natural lens. The implant is meant to sit in the eye permanently, but can also be plucked out by an ophthalmologist if needed. In published clinical trial results, close to 88 percent of patients reported 20/20 or better and nearly all achieved 20/32 or better distance vision after six months. The lenses also block some UV rays for added protection.

Olumiant by Eli Lilly and Incyte: Long-term relief for severe alopecia

Eli Lilly and Incyte

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More than 300,000 people of all ages in the US live with severe alopecia areata, a condition that causes the immune system to attack hair follicles, leading to patchy baldness on the scalp and elsewhere. Hair loss in the nose and ears can affect patients’ hearing and allergies, and a lack of eyelashes can leave people vulnerable to eye irritation from dust. Olumiant, the first medication to secure the FDA’s approval for severe alopecia, can help hair grow back over the entire body. It belongs to a group of drugs called JAK inhibitors, which block certain inflammation-promoting enzymes. It was originally greenlit by the agency in 2018 to treat some forms of rheumatoid arthritis, but in clinical trials for alopecia, it helped roughly a third of participants to regrow up to 80 percent of their hair by 36 weeks, and nearly half after a year. Other JAK inhibitors in development could provide alternatives for patients who don’t fully respond to Olumiant.

AIR Recon DL by GE Healthcare: Sharper MRIs in half the time

GE Healthcare

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Laying motionless for an hour or longer in a magnetic scanner can be a claustrophobic and sometimes nauseating experience. A next-level neural network by GE Healthcare reduces the stress on patients, while filtering out visual noise from movement or faulty processing. The software combs through raw radio-wave data from MRI machines and turns the most accurate bits into high-resolution 3D images. Originally, the AI-reconstructed images had to be stitched together—but the updated tech, which received FDA approval this September, delivers in one go. The speedy precision can cut exam times in half, help hospitals and clinics serve more patients, and possibly improve the rate of diagnosis by giving radiologists a much cleaner view of tissues, bones, masses, and more.

ONE Male Condom by ONE: Latex that works for anal sex

ONE

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At first glance this condom isn’t all that different from those by other brands. It’s made from natural latex, comes in three thicknesses, and has a wide range of sizes for best fit. But the contraceptive is the first to also be clinically tested for STI protection during anal sex—and has proven to be extremely effective. In studies involving 252 male-male couples and 252 male-female couples, the condoms had a less than 2-percent chance of breakage, slippage, discomfort, and adverse events (which included urinary tract infections and bacteria and viruses spread during sex). With such a healthy showing, the company earned the FDA nod to label the product as “safe for anal sex.” With widespread availability, there’s hope that the condom can help beat back a record rise in chlamydia, gonorrhea, syphilis, and other STIs.

Bivalent COVID-19 vaccines by Moderna and Pfizer-BioNTech: A one-shot-fits-all approach

Ringo Chiu, AFP via Getty Images

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One of the niftiest features of mRNA vaccines such as Moderna and Pfizer-BioNTech’s COVID shots is that they can be tweaked and scaled up quickly to keep up with an ever-changing virus. This August, the FDA authorized the first bivalent COVID boosters, modified with new genetic data to target both the original version of SARS-CoV-2 and the Omicron sub-variants BA.4 and BA.5. Just how much added protection the bivalent shots offer against the latest versions of COVID remains to be seen, although in early results, the Pfizer-BioNTech booster increased antibodies against the BA.4 and BA.5 sub-variants by up to 11 times, while the Moderna booster did so by up to 15 times. Experts anticipate that the bivalent COVID vaccines, which are available to all adults and children ages 5 and older in the US, could save thousands of lives if the virus surges again this winter. 

Umbilical cord blood transplant for HIV by Fred Hutchinson Cancer Research Center and Weill Cornell Medicine: The right cells for viral resistance

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There are now three official cases of patients in long-term HIV remission—but this one might be the most promising for the millions around the world living with the virus. In 2017, an unidentified American received a blood transplant packed with genes that were resistant to the pathogen behind AIDS. More than four years later, her doctors at Weill Cornell Medicine confirmed that the procedure at Fred Hutchinson Cancer Research Center had indeed made her free of the disease. The miraculous sample was specifically taken from a relative’s umbilical cord blood cells, which were still in the process of maturing and specializing, making it easier for the transplant to take. Previous attempts to cure the disease depended on bone marrow donations that carry a mutated gene only known in Northern Europeans. This alternative treatment makes transplants more accessible for patients from other ethnic backgrounds, so their bodies can fight HIV in the long run as well.

988 Suicide and Crisis Lifeline by SAMSHA: Streamlining the call for help 

SAMHSA

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When you have a general emergency, you might call 911. But for people experiencing a mental crisis, the number has been a lot less intuitive. This July, however, the Suicide and Crisis Lifeline, run by the US Department of Health and Human Services since 2005, fully switched over to a three-digit code that’s easy to punch in: 988. The shortcut was years in the making, but required major collaboration with the Federal Communication Commission to connect every phone service provider to the alternative number. Since it went live, officials have reported shorter hold times and a 45-percent increase in use compared to August 2021, including on a specialized veteran hotline. The service shakeup also came with $177 million for states and tribes to support the transition in different ways, like alleviating surcharges, setting up call centers, and integrating crisis relief with existing or new emergency responses.

eCoin Peripheral Neurostimulator by Valencia Technologies: A discreet implant for bladder control 

Valencia Technologies

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Pads, vaginal seals, and skin patches can be a burden for anyone who has to deal with urinary incontinence on a daily basis. A new electrode device, about as small as a nickel and implanted above the ankle, nips the issue in the bud in a more private and convenient way. Incontinence typically occurs when the muscles in and around the bladder contract too often or too much. To prevent leaks and constant trips to the toilet, the eCoin sends low-key shocks through the tibial nerve, targeting the pelvic organs and relaxing the bladder wall. A doctor can control the intensity of the pulses with a remote, making the device more customizable for a broad range of patients. Neurostimulators have become a vanguard treatment for different nervous system conditions, including chronic back pain and even paralysis—but few are so adaptable as this.

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Between lockdowns, missing milestone events such as prom or graduation, and general worry over the state of the world in the past few years, times have been particularly tough on adolescents.

Reports of anxiety and depression in adults increased by more than 25 percent in 2020, and some new research suggests that mental health and the neurological effects of the pandemic on adolescents could be even worse than in their adult counterparts.

[Related: Neuroscientists are mapping all 100 billion cells in the human brain.]

Scientists are beginning to look at how the past two and a half years of pandemic life is affecting the brains of teens. A new study published today in the journal Biological Psychiatry: Global Open Science, suggests that stressors related to the COVID-19 pandemic have physically changed teen brains, causing their brain structures to appear multiple years older than the brains of comparable peers before the pandemic.

“We already know from global research that the pandemic has adversely affected mental health in youth, but we didn’t know what, if anything, it was doing physically to their brains,” said Ian Gotlib, study author and psychology professor at Stanford University’s School of Humanities & Sciences, in a statement.

Changes in brain structure occur naturally as we age. During early teenage years and in puberty, the hippocampus (which controls access to certain memories) and the amygdala (which helps moderate emotions), go through growth spurts like the rest of the body. The tissues in the cortex, which controls executive functioning, becomes thinner at the same time.

To get a closer look, Gotlib and his team compared the MRI scans of 163 children that were taken before and during the pandemic. The study showed that during the COVID-19 lockdowns, this developmental process in the brain sped up in adolescents. According to Gotlib, an accelerated change in “brain age” has typically appeared only in children and adolescents who have experienced chronic adversity (family neglect, violence, family dysfunction, etc.). These kinds of early adverse experiences can be linked to worse mental health outcomes later in life.

However, it is still unclear whether the changes in brain structure that this study observed will be linked to changes in mental health later on in life.

“It’s also not clear if the changes are permanent,” said Gotlib. “Will their chronological age eventually catch up to their ‘brain age’? If their brain remains permanently older than their chronological age, it’s unclear what the outcomes will be in the future. For a 70- or 80-year-old, you’d expect some cognitive and memory problems based on changes in the brain, but what does it mean for a 16-year-old if their brains are aging prematurely?”

The results of this study could have implications for some of the longitudinal studies that have spanned the course of the pandemic. Scientists will have to account for abnormal rates of growth in the brain for any research down the road involving this generation, if those who experienced the pandemic generally show this rapid brain change.

“The pandemic is a global phenomenon—there’s no one who hasn’t experienced it,” said Gotlib. “There’s no real control group.”

[Related: We shouldn’t disregard the ideas that come from teens’ developing brains.]

Co-author Jonas Miller, an assistant professor of psychological sciences at the University of Connecticut, added that results like this may have serious consequences for this generation later in life.

“Adolescence is already a period of rapid reorganization in the brain, and it’s already linked to increased rates of mental health problems, depression, and risk-taking behavior,” Miller said. “Now you have this global event that’s happening, where everyone is experiencing some kind of adversity in the form of disruption to their daily routines – so it might be the case that the brains of kids who are 16 or 17 today are not comparable to those of their counterparts just a few years ago.”

Gotlib plans to follow the same cohort of teens from this study through later adolescence and into young adulthood, looking to see if the pandemic changed the trajectory of brain development long term, alongside their mental health. He also plans to compare the brain structures of those who were infected with COVID-19 and those who weren’t infected with the virus, with the goal of identifying any differences in the brain potentially caused by infection.

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On June 5, 1981, the Centers for Disease Control and Prevention (CDC) released a report on a rare pneumonia and lung infection. One month later, a story in The New York Times with the headline “RARE CANCER SEEN IN 41 HOMOSEXUALS” detailed an illness striking gay men in New York and California.

Three years later, this “rare cancer” was officially diagnosed as Acquired Immunodeficiency Syndrome, a disease caused by a retrovirus that interferes with the body’s ability to fight off infections and disease. Panic was felt the world over as scientists raced to understand how the new infection, better known as HIV/AIDS, was spread and who was most at risk.

That same year, Anthony Fauci, a doctor and head of the Laboratory of Immunoregulation, was appointed as National Institute of Allergy and Infectious Disease (NIAID) director.

“In 1984, the virus was discovered, which set off a series of extraordinary research to determine the pathogenic mechanisms of HIV. But importantly, it allowed us to do the critical research to start developing effective drugs for HIV,” Fauci tells PopSci in a recent interview.

By the end of the 1980s, almost 700,000 people of all sexes and sexualities were estimated to be living with HIV. While knowledge on the virus and the disease has steadily progressed over the past 40 years, the fight against the epidemic continues globally.

According to World AIDS Day, an international awareness event celebrated annually on December 1, an estimated 38 million people now live with the virus worldwide. More than 35 million people have died of HIV/AIDS related illnesses since it was identified.

But Fauci, who has studied HIV/AIDS since the first cases emerged, finds hope in the treatments and advances over the last four decades that help patients to live longer lives. In 2003, he played an important role in developing the President’s Emergency Plan for AIDS Relief (PEPFAR), marking a pivotal point in government funding towards the global epidemic and a program he is proud to have been part of.

“That program has now been shown to be responsible for saving literally 20 million lives worldwide,” Fauci says.

[Related: Rare transplant cells have cured another HIV patient]

Despite scientific progress, unequal access to HIV/AIDS treatment has been difficult to solve, along with another obstacle that is less scientific and more social: the stigma that accompanies new diseases. As cases emerged, people with HIV/AIDS were often alienated, overlooked, and even loathed by the public. Discussions around sexual orientation, promiscuity, and individual behavior often centered the blame on the gay community and later, drug users, as these groups made up a large proportion of cases in the 1980s and 1990s. This negative connotation still prevents some people from seeking treatment.

“Stigma is the enemy of public health,” says Fauci. “There is no place [for] the stigma when you’re dealing with a disease, because it’s the disease [that] is the problem, not the people who are afflicted.” He and the National Institute of Health were even the direct targets of protests by AIDS Coalition to Unleash Power in 1990. The organization formally called for Fauci to include their members in the development of HIV drugs.

The stigma of disease—often attributed to minority groups—persists today. For those who remember the early days of the HIV/AIDS crisis, this year’s global monkeypox outbreak seemed to mirror the prejudice toward the gay community in the late 20th century. Notably, during the COVID-19 pandemic, Asian communities were blamed for bringing the coronavirus to the US. Black, Indigenous, and Latinx Americans have also been disproportionately affected by the sickness. 

As the infection took hold everywhere, Fauci needed to address stigma, while simultaneously sharing medical knowledge and pivoting to his role as the country’s most prominent health communicator.

“Given the circumstances of a historic pandemic, as a scientist and as a public health official, I felt [it] was necessary to step up to the level of trying to create policy that would get the best of the science available to the American public, as well as the messaging that [was] necessary to get the right public health interventions implement it,” he says.

Now, nearly three years after the first coronavirus cases, the stigma is being felt by those who suffer from long COVID. An estimated 16 million Americans—a number that could grow—are currently experiencing the debilitating condition.

[Related: The 5 phases of COVID’s endgame]

“I think from the beginning of the COVID pandemic, there’s been an ableist undertone,” Marija Pantelic, a lecturer at Brighton and Sussex Medical School in the UK, who studies stigma and disease, tells PopSci. “We were hearing so many testimonies [of long COVID], but there had been no work that I could find really, that empirically looked at the extent of this problem.”

Pantelic led a study published on November 23 in the journal PLOS One that found that the majority of people living with long COVID experience some form of stigma directly related to their condition. She and her colleagues surveyed more than 1,100 patients about their experiences of enacted stigma, internalized stigma, and anticipated stigma. They found that 95 percent of the adults in the UK who were surveyed experienced at least one type of stigma at least “sometimes,” and 76 percent experienced it “often” or “always.” Those numbers shocked Pantelic.

“I think a notable difference in the stigma is that long COVID is really psychologized, meaning that people are told that it’s all in their head,” she says. “Even a lot of healthcare providers dismiss it.”

According to Pantelic, raising awareness of diseases like HIV/AIDS and long COVID is often an important first step. Numerous groups like Long COVID Support and the Long COVID Alliance have emerged since the beginning of the pandemic, and have used platforms like social media to help mobilize efforts. 

“It’s really essential to acknowledge the role of communities. And mobilizing, I think that is a key similarity between HIV and COVID,” Pantelic notes. “It would be lovely for us to learn from the HIV movement.”

But it can’t end with raising awareness: Keeping people safe requires hard, long-lasting work. Currently, public health organizations are working to correct the errors of the past, and the World Health Organization announced on Monday that it would change the name monkeypox to mpox in an effort to fight stigma and stereotypes.

For HIV/AIDS, action has led to treatments such as the daily antiretroviral therapy and the HIV prevention drug PrEP, which helps keep the virus at bay. Current treatments are primarily long-term “forever” pills, which may make the disease less deadly, but still allow it to persist as a chronic illness in patients. 

[Related: The first people have received an experimental mRNA HIV vaccine]

“I think we’re going to get more user-friendly methodologies of treatments and long acting antivirals that can be given maybe every six months,” says Fauci. “That’s an amazing improvement rather than a single pill.” Further into the future is the hope that an HIV vaccine could change the course of the disease—and hopefully eradicate stigma. 

After 54 years with the National Institute of Health, 38 years at NIAID, and seven presidential administrations, Fauci has faced stigma and scientific challenges head on—from HIV/AIDS, to Ebola, to Zika, to COVID. While he is stepping down from government service at the end of December, he plans to continue writing, lecturing, and working.

“I might be able to help the effort of public and global health,” he says, “and perhaps inspire and encourage young people to pursue a career in science, medicine, public health, and hopefully in a public service.”

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Since January 2020, Twitter’s internal statistics cite over 11,000 accounts suspensions and nearly 100,000 post removals for spreading COVID-19 misinformation. Examples included erroneously promoting ivermectin as a viable alternative COVID-19 treatment and spreading conspiracy theories such as claims that vaccines contained 5G microchips. Last week, Twitter quietly ended its pandemic misinformation moderation policy.

Although the policy update is dated November 23, Twitter has yet to make an explicit public announcement regarding the reversal. News of the change has trickled down to the public via users, reporters, and media outlets.

[Related: Twitter overwhelmed by NSFW spam during protests in China.]

“… [A]s the distribution of COVID-19 vaccines expands around the world at varying degrees of pace and scale, people continue to turn to Twitter to discuss what’s happening and find the latest authoritative public health information. As such, we continue to prioritize removing or annotating potentially harmful and misleading information to ensure that users can readily find credible information during this critical phase,” the platform’s COVID-19 policy page still reads. At the top of the page, a statement now says the platform “is no longer enforcing the COVID-19 misleading information policy.”

Twitter’s new CEO Elon Musk has previously expressed strong opposition to pandemic lockdown procedures, vaccine mandates, and masking—procedures which are repeatedly proven to slow the deadly virus that has already claimed an estimated 6.6 million lives, per World Health Organization data.

The company’s swift change comes as Musk continues his campaign of reinventing the social media platform to reflect his interpretation of a totally “free speech” environment. Musk recently reinstated the personal accounts of Ye (formerly Kanye West), Jordan Peterson, and Rep. Marjorie Taylor-Greene following past suspensions for antisemitic, transphobic, and misleading pandemic-related statements, respectively.

[Related: Elon Musk Twitter layoffs have begun.]

Upon taking control of the social media company following his $44 billion acquisition, Musk almost immediately conducted massive layoffs. This led to the dissolution of entire teams dedicated to areas such as human rights, accessibility, news curation, and moderation. Earlier today, reports surfaced indicating the downsizing also decimated Twitter’s department focused on child sexual abuse materials, reducing it to a “skeleton crew” of less than 10 people for the entire website. Musk has previously stated eliminating CSAM was his “Priority #1” for the platform.

Both former employees and security experts warn that Twitter’s current team of around 2,000 people (down from 7,500 pre-Musk’s takeover) will not be able to handle engineering and content problems as they arise. Over the weekend, NSFW spam from China inundated the site in what some perceived to be a coordinated attack to obfuscate realtime coverage of the country’s ongoing protests. Around the same time, re-uploaded video clips of the deadly 2019 Christchurch, New Zealand, mosque mass shooting proliferated due to a lack of moderation teams.

Yesterday, Musk began tweeting a series of messages alleging that Apple had threatened to remove Twitter from its App Store, “but won’t tell [Musk] why.”

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The US is battling rising cases of flu, COVID-19, and respiratory syncytial virus (RSV) this winter, and the holiday season could make it worse. Experts predicted the 2022 flu outbreak, which has already caused the highest rate of hospitalizations in the last decade, but there are growing concerns that abandonment of precautions such as mask wearing and social distancing is leading us into a “tripledemic.”

According to the Centers for Disease Control and Prevention (CDC), as of November 18, there have been 38,000 hospitalizations and 2,100 deaths nationwide due to the flu. Meanwhile, cases of RSV, which were almost nonexistent during the 2020 season, are on the rise among children and older adults in several states. Meanwhile, despite weekly COVID counts trending downward in the last few weeks, the pandemic has by no means gone away. According to the CDC’s COVID tracker, there have been 2,222 deaths reported in the last week.

As all three respiratory viruses spread via droplets from the mouths and noses of infected individuals, epidemiologists who study disease outbreaks are now urging people to take extra precautions to avoid catching a potentially life-threatening illness ahead of the holidays.

How can you protect yourself against infection?

“First and foremost, vaccination is the best defense in the prevention of influenza and COVID-19,” Jose Romero, the director of CDC National Center for Immunization and Respiratory Diseases, told media at a telebriefing earlier this month. Though there is no RSV shot for the public, the CDC has confirmed there are immunizations and other prevention products under development.

“People should also practice everyday preventive measures,” said Romero. This means doing all the things we did in the height of the pandemic: washing hands regularly, using alcohol gels, staying away from people who are ill, and practicing good cough etiquette; covering your coughs and sneezes. “[And you] may also choose to wear a well fitting mask as an added precaution.”

[Related: Is it flu or RSV? It can be tough to tell.]

In advance of holiday travel and family gatherings, “it’s important to take steps now to prevent respiratory disease, especially in people who are at higher risk of developing severe complications,” CDC spokeswoman Kate Grusich told PopSci in an email. 

Should you wear a mask at your holiday dinner or party?

Mask wearing has been the subject of several studies since the COVID-19 outbreak. Initially, researchers found that the use of masks could lower the risk of COVID infection by up to 70 percent. More recent studies, though, have suggested their effectiveness is more likely around 19 percent, after controlling for other factors–in the beginning, the people who wore masks may also have been more vigilant when it came to social distancing and handwashing, for example, making their risk lower anyway. While new strains have emerged that have not been the focus of mask-wearing studies, Virginia Tech’s Linsey Marr says findings should still apply as the transmission method hasn’t changed from the original SARS-CoV-2 virus.

Marr, an influenza and aerosol-spread researcher, points out that other experts have found a 10- to 20-percent reduction in flu transmission when people wear masks. “However, it’s very likely that an individual can achieve much greater protection if they are vigilant about wearing a well-fitting, high-quality mask–these being the KN95, N95, and KF94 type masks,” she says.

[Related: Masks can work—even if you’re the only one wearing them]

Prior to the pandemic, the use of face masks and other PPE in hospitals with RSV patients was shown to greatly reduce transmission of the virus. The low levels of flu and RSV in the winter of 2020, Marr says, also points to the impact of safety measures on their spread, as pediatric doctors noted at the time. 

According to Marr, you should wear a mask if you’re in crowded indoor environments, where lots of people are sharing the air. “If you take it off to eat in a crowded restaurant, though, it won’t really help protect you.”

By Marr’s definition, a crowded indoor space can include a dining or living room, even if you have just 10 people gathered together. “If someone is sick with the flu or COVID, the poor ventilation in our homes makes it more likely that the virus can build up in the air and infect others,” she says. But there are other options when it comes to clearing the air of viruses. Cracking a window and turning on the exhaust fan in your kitchen or bathroom will help pull cleaner, virus-free outdoor air into your home. If you’re really concerned, a portable air cleaner with a HEPA filter can remove virus particles, too.

Do you need to cancel your holiday plans?

Marr intends to see loved ones this holiday season, but she explains that she and her family aren’t classified as vulnerable. For those who are, or for anyone sharing the holidays with people who might have a more severe reaction to infection with COVID, RSV or flu, putting protective measures in place is much more important.

Knowing who you’re interacting with may change your holiday plans. “Older and more vulnerable people are less likely to have already caught COVID,” says Paul Hunter, a professor at the Norwich School of Medicine of the UK’s University of East Anglia. “So personal precautions are still important if you’re spending time with such people, unless you know they have had a recent infection.”

[Related: Getting COVID more than once might be even worse than we thought]

Anyone who has had COVID could still be infectious up to 10 days from the first day of symptoms; RSV is likely to be transmissible for up to eight days; and the flu becomes contagious a day or so before symptoms appear and can hang around for five to seven days after that.

When finalizing your plans, talk to the people you’ll be spending the holidays with and make sure you are all on the same page. Pick up some COVID-19 tests before you travel—though remember not to put all your faith in their results—and pack a well-fitting mask if you’ll be in crowded environments.

“Ahead of our family gathering, I’m asking everyone to try to avoid crowded indoor spaces in the week leading up to it, and to wear a mask at the airport or on their journey,” says Marr. “This will reduce the chances that someone picks up COVID-19 or flu along the way and then spreads it to the rest of us.”

Correction (November 23, 2022): Linsey Marr said her family would be gathering for Christmas and New Year’s, not Thanksgiving. Her quotes have been corrected.

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Infection with COVID-19 brings with it the possibility of a high fever, dry hacking cough, and losing taste and smell. But, even months down the road, it carries the risk of developing long-COVID after infection, or getting sick with the virus all over again. The elusive virus is really good at evading the immune system, so it’s possible to be infected with COVID-19 multiple times per year, sometimes within only 90 days.

Those re-infections are proving to be risky, according to the results of a new study published today in the journal Nature Biology. The research from a team at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care system found that repeat infections with the virus contributes to significant additional risk to multiple organ systems in the body.

[Related: We’ve lost more than 1 million Americans to COVID.]

Some of the risks include hospitalization, problems with the lungs, heart, and brain; problems with the musculoskeletal and gastrointestinal systems, and even death. COVID-19 reinfection also contributes to chronic illnesses like diabetes and kidney disease and issues with mental health, according to the new research.

“During the past few months, there’s been an air of invincibility among people who have had COVID-19 or their vaccinations and boosters, and especially among people who have had an infection and also received vaccines; some people started to referring to these individuals as having a sort of superimmunity to the virus,” said senior author Ziyad Al-Aly, a clinical epidemiologist at the Washington University in St. Louis, in a statement. “Without ambiguity, our research showed that getting an infection a second, third or fourth time contributes to additional health risks in the acute phase, meaning the first 30 days after infection, and in the months beyond, meaning the long COVID phase.”

The study found that people with COVID-19 reinfections were twice as likely to die in the time period studied and three times more likely to be hospitalized than those with who haven’t been reinfected with the virus.

People with repeat infections were also three and a half times more likely to develop lung problems, three times more likely to suffer heart conditions, and 1.6 times more likely to experience brain conditions than patients who had been infected with the virus once.

The study also indicated that the risk seems to increase with each infection with the virus, so it’s better to avoid more infections, according to Al-Aly.

Limiting exposure to the virus is especially important as the US heads into the winter months, with new variants emerging, mutating and already causing an upswing in infections in some parts of the country, Al-Aly said. “People should do their best to prevent repeat infections by masking, for example, getting all of their eligible boosters, staying home when sick. Also, get a flu shot to prevent illness. We really need to do our best to reduce the chance we will have a twin-demic of both COVID-19 and the flu this winter season.”

[Related: Study shows Paxlovid may help prevent long COVID.]

The researches studied close to 5.8 million anonymized health records from a databased maintained by the United States Department of Veterans Affairs (VA). The VA is the country’s largest integrated health-care system and the patients in the sample represented multiple sexes, races, and ages.

To compare, they created a controlled data set of 5.3 million people who didn’t test positive for COVID-19 infection from March 1, 2020, (when the pandemic began in the US) through April 6, 2022.

Using the same time frame, the researchers compiled a control group of more than 443,000 people who had tested positive for one COVID-19 infection, and another group of close to 41,000 people who had two or more documented infections. Those who reported multiple infections primarily had two or three infections, with a small number showing had four infections. No one in the study experienced five or more infections with COVID-19.

The team used statistical modeling to examine the health risks of repeat infections within the first 30 days after contracting the virus and up to six months after infection. The study accounted for COVID-19 variants such as delta, omicron, and BA.5 and the negative outcomes occurred among the unvaccinated as well as those who had received shots of the vaccine prior to reinfection.

“Our findings have broad public health implications as they tell us that strategies to prevent or reduce the risk of reinfection should be implemented,” Al-Aly said. “Going into the winter season, people should be aware of the risks and practice vigilance to reduce their risk of infection or reinfection with SARS-CoV-2.”

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As the world enters yet another pandemic winter, as many as 4 million people are suffering from brain fog, headaches, chest pain, and other awful symptoms of long COVID. However, a new preprint study from the Veterans Health Administration (VA) is offering some hope for cutting the risk of developing the debilitating condition.

The study finds that the anti-viral medication Paxlovid, which is intended to treat and relieve the symptoms of COVID-19, may also reduce the risk of developing long COVID following the initial infection by 26 percent. The research is a preprint that was posted online over the weekend, so it still has to undergo peer review.

[Related: Long COVID could be keeping as many as 4 million Americans out of work.]

For the study, long COVID was defined as developing one or more symptoms (including heart issues, blood disorders, fatigue, and trouble breathing) one to three months after testing positive. The team analyzed the electronic medical records of 56,340 patients, all who had at least one risk factor for a severe response to COVID-19 infection. The analysis finds that 9,217 patients who took Paxlovid within five days of testing positive were 26 percent less likely to have a wide range of post-COVID-19 symptoms about 90 days later than the 47,123 patients who did not receive an antiviral or antibody treatment.

The patients in the study had all tested positive for the coronavirus between March 1 and June 30 of 2022 when the contagious Omicron variants were the dominant strains of COVID. The study also finds that the benefits of taking Paxlovid applied to patients who were unvaccinated, vaccinated, and had repeat COVID-19 infections. All groups has a similar reduction of developing long COVID with the antiviral drug.

For those who are medically eligible to take Paxlovid (older adults or those with certain medical conditions), it reduces the risk of hospitalization or death. It works by blocking receptors so that the virus can’t bind itself to healthy cells and make copies of itself.

“We know that one of the key factors that predict long COVID is detectable virus in the bloodstream at the time of infection,” Peter Chin-Hong, an infectious disease physician at the University of California, San Francisco, told NPR. “So it stands to reason that interventions that prevent the virus from making more copies of itself would therefore lead to a lower risk of long COVID.”

[Related: Long COVID can manifest in dozens of ways. Here’s what we know so far.]

The authors point to the study as another motivation for patients to take Paxlovid as soon as they can after getting sick. Some have become weary of using the anti-viral due to the “Paxlovid rebound,” a recurrence of symptoms or a positive test result. A small percentage of patients (about one to two percent based on Pfizer’s clinical trials) experience this, but high profile rebounds in President Joe Biden and Anthony Fauci as well as the need for more data on rebound cases, have added to the concern. A longer course of treatment of the drug is being investigated as a possible way to prevent the rebound.

“For people who are already qualified for Paxlovid use, to me, really the choice is clear,” Ziyad Al-Aly, the senior author of the study and chief of research and development at the VA Saint Louis Healthcare System, told The New York Times. “Do you get a metallic taste, do you get side effects from Paxlovid, can you get rebound? Yes. But we have proven data suggesting that Paxlovid in the acute phase reduces the risk of severe illness, meaning the risk of death and hospitalization. And now we’re showing in the post-acute phase, there’s also risk reduction.”

In addition to the study’s status as a preprint, it is also limited by the demographics in the sample size. It primarily surveyed white males, which means that Paxlovid’s benefits may change in other demographic groups. Medical experts told NPR that they would also like to see these results replicated in experimental, randomized control trials.

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From cities in the sky to robot butlers, futuristic visions fill the history of PopSci. In the Are we there yet? column we check in on progress towards our most ambitious promises. Read the series and explore all our 150th anniversary coverage here.

Feeling yucky? Runny nose, scratchy throat? Maybe a cough, with light chills and aches, possibly a low-grade fever? We’ve all been there. Statistically, everyone comes down with these symptoms multiple times a year. These past few years, it would be tempting to blame some variant of the COVID-19 coronavirus, or SARS-CoV-2, for such symptoms. However, there’s also a strong possibility that it’s a distant cousin on the human virus family tree, one that is responsible for more sick days and visits to the doctor each year than any other pathogen—rhinovirus. Common cold symptoms can be caused by many viruses, but the odds you’re fighting a rhinovirus are high: the virus accounts for as much as half of all common colds. 

Traditionally, there has been a certain seasonality to respiratory viruses in the US. Influenza tends to peak in fall and again in early spring, while common colds, such as respiratory syncytial viruses (RSVs), non-COVID coronaviruses, adenoviruses, and rhinoviruses pick up in mid-winter. But COVID-19 seems to have disrupted the normal pattern. “We typically see RSV at the peak of winter season,” says Richard Martinello, a respiratory virus specialist at Yale School of Medicine in Connecticut. “But our hospital’s already full. We’re trying to figure out where to put patients and how to care for them.” It’s not just RSV. “We’re actually seeing occasional kids with pretty severe rhinovirus infections,” Martinello adds, “and adults with severe rhinovirus infections in the hospital this year.” 

Every year, we’re encouraged to get our annual flu shot—and it seems COVID vaccinations are headed down a similar path. Yet, we don’t get one for the common cold. With more than a billion cases each year in the US alone—far more than any other virus, including COVID-19 and the flu combined—it’s hard to overstate the uplift a universal common cold vaccine would have. The hunt for such a vaccine began more than half a century ago, as Popular Science reported in November 1955.

Dating back to the 19th century, a slew of vaccines have been developed for many of humanity’s most pervasive pathogens, from the very first vaccine in 1798 for smallpox to cholera and typhoid in 1896 to the COVID-19 vaccines in 2020—but no common cold vaccine. 

In the 1950s, however, flush with the success of Jonas Salk’s polio vaccine, virologists were convinced it would be just a handful of years before the common cold would be eradicated by vaccine. In the 1955 Popular Science article, prolific virologist Robert Huebner estimated that a vaccine for the common cold might be available to the general public in as little as a year. While Huebner—who is credited with discovering oncogenes (genes with the propensity to cause cancer)—was successful in developing an adenovirus vaccine specifically for pharyngoconjunctival fever, he never fulfilled his quest for a common cold vaccine.

[Related: What’s the difference between COVID, flu, and cold symptoms?]

Although Popular Science’s story focused on Huebner’s 1953 discovery of adenovirus as a root cause for the common cold, it wasn’t until Winston Price’s 1956 discovery that virologists realized rhinovirus was the chief common-cold culprit. Since Price’s discovery, three species of rhinovirus have been discovered (A, B, and C), including more than 150 distinct strains. Plus, a majority of the known rhinovirus genomes have been sequenced in an effort to find commonalities that might serve as the basis for a universal vaccine.

“Considering there are more than 100 types of A and B rhinoviruses,” notes Yury Bochkov, a respiratory virus specialist at the University of Wisconsin School of Medicine and Public Health, “you would have to put all 100 types in one vial of vaccine in order to enable protection” against just A and B rhinoviruses. Add in all the C rhinovirus types (more than 50), then cram in RSV’s virus types (more than 40), and that same vaccine would have to be packed with more than 200 strains. Even then, it would only offer protection against about two-thirds of all common colds. “That was considered the major obstacle in development of those vaccines,” Bochkov says.

When it comes to manufacturing universal vaccines, scientists hunt for the lowest common denominator—a common trait that the vaccine can target—shared by all variants of a virus. Unfortunately, viruses aren’t that cooperative. Breaking them down to find common traits is not so easy. To trigger antibody production, human immune systems must be able to recognize those common viral traits as belonging to an intruder. That means the traits must be exposed, or on the surface of the virus. Traits locked inside the virus particle, or in its capsid structure, are not detectable until after the virus has begun to replicate, which is too late to avoid infection.

Antibodies, which are made of protein-based immunoglobulins such as IgM and IgG, are Y-shaped cells that continuously circulate through our blood, and latch onto invading pathogens, which are recognizable by certain sequences in their surface proteins. Antibodies are capable of disabling the invaders until the white blood cell, or leukocyte, troops can arrive to kill them. The goal of a universal vaccine is to not only find an antibody-triggering trait common across those many distinct types of the same virus, but also find a trait that is slow to mutate—or one that doesn’t mutate at all. In the cases of universal coronavirus and influenza vaccines currently under development, researchers have focused on more than just the surface protein, targeting other viral parts, such as the surface protein’s stalk, that are still detectable by our immune systems, but less likely to mutate from one variant to the next. 

Viruses travel light, in other words they don’t carry around the machinery to replicate on their own. Instead, they use their surface proteins to bind to our bodies’ cells, then trick them into replicating virus particles. Coronaviruses, for instance, are known for their distinctive spike surface proteins, which became the focus of COVID-19 vaccines. Similarly, rhinoviruses have their own distinguishing surface protein shaped like a cloverleaf, which plays an essential role in the virus’s ability to hijack cells and replicate. Unfortunately, surface proteins tend to mutate quickly, enabling viruses to shapeshift and evade detection by our immune systems. That’s a chief reason why flu vaccines, and now COVID-19 vaccines, must be updated at least annually.

Fortunately for RSV, scientists have identified such commonalities. RSV is considered among the most dangerous of common cold viruses, especially for infants and children who are susceptible to respiratory tract infections. After a failed human trial in the 1960s that led to the death of two infants, it took another half century before scientists identified an immutable common trait—RSV’s surface fusion protein, or F protein, that binds to cells. Now, four different vaccines are already in the final third phase of human trials. “And they’re working,” Martinello notes, “they’re working amazingly well. It’s a very exciting time for RSV right now.”

[Related: Is it flu or RSV? It can be tough to tell.]

But for a common cold vaccine to make a dent in annual infections, protection against rhinovirus must be developed, too. While progress has been made on RSV, the quest for a universal rhinovirus vaccine has received less attention. That may be changing.

Since the 1960s, there have been several human clinical trials of rhinovirus vaccine candidates, although none have been universal. Still, some results have been promising—one trial reduced symptomatic colds from 47 percent to 3.5 percent. However, the vaccines have only been effective on a few of the more than 150 strains. In the 2010s, researchers developed synthetic peptide immunogens capable of triggering immune responses in rabbits exposed to 48 different strains; peptides are the building blocks of proteins, which give cells their shape, and peptide immunogens attract antibodies, encouraging their production. In a 2019 study, researchers identified a way in mice to deprive rhinoviruses (and other viruses) of a specific enzyme they need to replicate. 

In 2016, a 50-valent rhinovirus vaccine, or 50 strains in one shot, was successfully trialed in rhesus macaques, and a vaccine with 25 strains in mice. But even if such vaccines make it into human trials, that leaves more than 100 unaccounted-for rhinovirus strains. 

“What if you could split [all the different strains] into several groups?” Bochkov says. “Then I think you would have higher chances of finding something that would be conserved within a group.” It’s like breaking fractions into similar groups and finding the least common denominator for each—or, in this case, separating out groups of strains with common traits and developing individual vaccines for each, which are all later combined into one super-packed vaccine. That’s precisely the direction research team’s like Bochkov’s are heading with rhinovirus species C. Once separate vaccines are developed for individual groups, they might be bundled into a single shot, which is called a polyvalent vaccine. This approach of targeting multiple strains in one shot has already been proven a successful way to control viral diseases. The annual flu vaccine, for instance, is a polyvalent vaccine designed to target three or four of the flu strains most likely to circulate in a given year. Similarly, the new bivalent COVID booster shots create an immune response to both the original strain of SARS-CoV-2, as well as recent Omicron strains.

[Related: New COVID Omicron boosters, explained]

Better tools for genome sequencing are also on the rise, including AI software that can be used to analyze surface proteins and predict possible mutations, like Google’s AlphaFold. This combined with mRNA platform technologies that expedite vaccine development makes Martinello and Bochkov optimistic that more respiratory virus vaccines will be developed in the coming years. “Maybe we’ll see a flu, COVID, RSV vaccine all combined in one,” Bochkov says, adding that “vaccination would be the way to go in fighting the common cold.”

Even as progress has been made on a universal flu vaccine and a universal coronavirus vaccine, the quest for a universal common cold vaccine has received less attention. That’s in part because public health efforts need to focus and allocate vaccine-development on the deadliest and most infectious pathogens first. As contagious as common cold viruses are—they spread through droplets that are airborne or left on surfaces—COVID-19 is at least 10 times deadlier than the flu, and the flu is deadlier than the common cold. Still, the common cold can lead to serious complications for people who are immunocompromised or have lung conditions, like asthma and chronic obstructive pulmonary disease. 

While the search for a universal common cold vaccine began several decades ago, it is not likely to be fulfilled anytime soon, despite recent advances like the RSV vaccine trials. So, keep those tissues handy and wash your hands frequently. Wearing face masks as a prevention tactic isn’t exclusive to fighting COVID—they also work against the spread of other respiratory illnesses, including the common cold. “We have to be cognizant of what the risks are and thoughtful about how we protect ourselves from getting sick,” Martinello notes. “If you are sick, stay home, keep your kids home, because you know when you’re out and about that’s how that’s how things further spread.” 

And when common cold vaccines do arrive, even if they’re virus-specific at first, don’t hesitate to get your jab.

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This article was originally featured on KHN.

As the covid-19 pandemic worsened a mental health crisis among America’s young people, a small group of states quietly withdrew from the nation’s largest public effort to track concerning behaviors in high school students.

Colorado, Florida, and Idaho will not participate in a key part of the Centers for Disease Control and Prevention’s Youth Risk Behavior surveys that reaches more than 80,000 students. Over the past 30 years, the state-level surveys, conducted anonymously during each odd-numbered year, have helped elucidate the mental health stressors and safety risks for high school students.

Each state has its own rationale for opting out, but their withdrawal — when suicides and feelings of hopelessness are up — has caught the attention of school psychologists and federal and state health officials.

Some questions on the state-level surveys — which can also ask students about their sexual orientation, gender identity, sexual activity, and drug use — clash with laws that have been passed in conservative states. The intense political attention on teachers and school curriculums has led to a reluctance among educators to have students participate in what were once considered routine mental and behavioral health assessments, some experts worry.

The reduction in the number of states that participate in the state-level CDC survey will make it harder for those states to track the conditions and behaviors that signal poor mental health, like depression, drug and alcohol misuse, and suicidal ideation, experts said.

“Having that kind of data allows us to say ‘do this, not that’ in really important ways,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, which oversees the series of health surveys known as the Youth Risk Behavior Surveillance System. “For any state to lose the ability to have that data and use that data to understand what’s happening with young people in their state is an enormous loss.”

The CDC developed the Youth Risk Behavior Surveillance System in 1990 to track the leading causes of death and injury among young people. It is made up of a nationally representative poll of students in grades nine through 12 and separate state and local school district-level questionnaires. The questions focus on behaviors that lead to unintentional injuries, violence, sexually transmitted infections, pregnancy, drug and alcohol misuse, physical inactivity, and more.

The decisions by Colorado, Florida, and Idaho not to participate in the state-level questionnaires will not affect the CDC’s national survey or the local school district surveys in the states that have them.

Part of what makes the survey a powerful tool is the diversity of information collected, said Norín Dollard, a senior analyst with the Florida Policy Institute, a nonprofit research and advocacy group. “It allows for the analysis of data by subgroups, including LGBTQ+ youth, so that the needs of these students, who are at a greater risk of depression, suicide, and substance abuse than their peers, are understood and can be supported by schools and community providers,” said Dollard, who is also director of Florida Kids Count, part of a national network of nonprofit programs focused on children in the United States.

The CDC is still processing the 2021 data and has not released the results because of pandemic-related delays, said Paul Fulton, an agency spokesperson. But trends from the 2009 to 2019 national surveys showed that the mental health of young people had deteriorated over the previous decade.

“So we started planning,” Ethier said. “When the pandemic hit, we were able to say, ‘Here are the things you should be looking out for.’”

The pandemic has further exacerbated the mental health problems young people face, said Angela Mann, president of the Florida Association of School Psychologists.

Nearly half of parents who responded to a recent KFF/CNN mental health survey said the pandemic had had a negative impact on their child’s mental health. Most said they were worried that issues like self-harm and loneliness stemming from the pandemic may affect teenagers.

But the CDC’s survey has shortcomings, said health officials from some states that pulled back from it. Not all high schools are included, for example. And the sample of students from each state is so small that some state officials said their schools received little actionable data despite decades of participation.

That was the case in Colorado, which decided not to participate next year, according to Emily Fine, school and youth survey manager at the Colorado health department. Instead, she said, the state will focus on improving a separate study called Healthy Kids Colorado, which includes questions similar to those in the CDC survey and Colorado-specific questions. The Colorado survey, which has been running for about a decade, covers about 100,000 students across the state — nearly 100 times the number that participated in the CDC’s state-level survey in 2019.

Minnesota, Oregon, Washington, and Wyoming, which also have their own youth surveys, either never participated or decided to skip the previous two CDC assessments. At least seven states will not participate in the 2023 state-level survey.

Fine said the state-run option is more beneficial because schools receive their own results.

In Leadville, a Colorado mountain town, a youth coalition used results from the Healthy Kids Colorado survey to conclude that the county had higher-than-average rates of substance use. They also learned that Hispanic students in particular didn’t feel comfortable sharing serious problems like suicidal thoughts with adults, suggesting that opportunities to flag issues early were being missed.

“I feel like most kids tell the truth on those surveys, so I feel like it’s a reliable source,” said high schooler Daisey Monge, who is part of the youth coalition, which proposed a policy to train adults in the community to make better connections with young people.

Education officials in Florida and Idaho said they plan to gather more state-specific data using newly created questionnaires. But neither state has designed a new survey, and what questions will be asked or what data will be captured is not clear.

Cassandra Palelis, a spokesperson for the Florida Department of Education, said in an email that Florida intends to assemble a “workgroup” to design its new system.

In recent years, Idaho officials cited the CDC survey data when they applied for and received $11 million in grants for a new youth suicide prevention program called the Idaho Lives Project. The data showed the share of high school students who had seriously considered attempting suicide increased from 15% in 2011 to 22% in 2019.

“That is concerning,” said Eric Studebaker, director of student engagement and safety coordination for the State Department of Education. Still, he said, the state is worried about taking up class time to survey students and about overstepping boundaries by asking questions that are not parent-approved.

Whatever the rationale, youth mental health advocates call opting out shortsighted and potentially harmful as the exodus erodes the national data collection. The pandemic exacerbated mental health stress for all high school students, especially those who are members of racial or ethnic minority groups and those who identify as LGBTQ+.

But since April, at least a dozen states have proposed bills that mirror Florida’s Parental Rights in Education law, which bans instruction about sexual orientation and gender identity in kindergarten through third grade.

The law, which critics call “Don’t Say Gay,” and the intense political attention it has focused on teachers and school curriculums are having a chilling effect on all age groups, said youth advocates like Mann, the Florida school psychologist. “Some of these discussions about schools indoctrinating kids has bled into discussions about mental health services in schools,” she said.

Since the law was adopted, some Florida school administrators have removed “safe space” stickers with the rainbow flag indicating support for LGBTQ+ students. Some teachers have resigned in protest of the law, while others have expressed confusion about what they’re allowed to discuss in the classroom.

With data showing that students need more mental health services, opting out of the state-level surveys now may do more harm than good, said Franci Crepeau-Hobson, a professor of school psychology at the University of Colorado-Denver, who has used the national youth risk behavior data to analyze trends.

“It’s going to make it more difficult to really get a handle on what’s happening nationally,” she said.

KHN Colorado correspondent Rae Ellen Bichell contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This post has been updated. It was originally published on 3/25/2020.

By now, almost everyone has experienced a COVID-19 case. The milder COVID symptoms—which are often the early signs of an infection, and sometimes the only signs you’ll get—are easy to confuse with the flu or a cold. Distinguishing those COVID symptoms is still important as the state of the virus continues to shift: While new cases and hospitalizations associated with the disease are declining in the US, public health experts are keeping a cautious eye out for another surge of cases this fall and winter. Some are already predicting that the mix of emerging strains of the Omicron variant, waning immunity from vaccines, and a potentially nasty flu season could place a toll on the country’s healthcare systems. 

People might experience no symptoms or severe symptoms with both COVID and the flu, so it’s important to know the differences to protect yourself and others. If you’re starting to feel under the weather, the Centers for Disease Control and Prevention (CDC) recommends getting tested for COVID. While you’re waiting on test results, you should do your best to social distance, avoid unnecessary outings and gatherings, wear a good mask, wash your hands frequently, and stay up-to-date with the most current COVID boosters (find out if you are eligible and when to get them). An updated flu vaccine is available now, too. 

If your COVID test is positive, stay put as much as possible and try not to have contact with people outside your household. The recommended isolation period can last around 10 days depending on the severity of your symptoms and subsequent test results. 

With all that advice in mind, you might still want to know if your symptoms are from COVID, the flu, or a cold—especially if you have a pre-existing condition that puts you at a high risk of developing severe coronavirus symptoms later on.

How do you know if your seasonal sniffles might actually be the novel coronavirus? Here’s a handy guide.

How to tell between COVID, flu, and cold symptoms

The main symptoms of COVID are fever, cough, shortness of breath, fatigue, muscle aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. Other possible COVID symptoms include chills or shivering, pink eye, and skin rashes. You can use this tool on the CDC’s website to see if what you’re experiencing lines up with what we know about the virus.

Because most COVID symptoms can overlap with those of a simple cold or flu, it is difficult to determine which you’re experiencing without taking a specific test. Some PCR tests can differentiate between flu and COVID to help determine diagnosis. Many testing locations also offer separate flu and COVID tests. However, some symptoms are much more common with one condition than with the other, which can provide clues. If you’re showing signs of having an upper respiratory infection, especially with one or more additional COVID symptoms like muscle ache or diarrhea, you should act as if you have the novel coronavirus. Additionally, COVID symptoms can appear between 2 to 14 days after exposure to the virus, while flu symptoms usually come about 1 to 4 days after exposure. It’s important to note that COVID seems to spread more easily and symptoms can last longer than the current flu strain, the CDC reports. 

The difference between Omicron symptoms and past COVID variant symptoms

Scientists are still learning about how the SARS-CoV-2 virus is evolving and how certain variants are more concerning than others. One of the most dominant strains is the Omicron subvariant BA.5, which makes up 62 percent of infections in October 2022. While initial reports suggested Omicron caused milder symptoms than previous strains, the BA.5 subvariant has reportedly been able to more easily evade immunity from vaccinations and previous infection, causing breakthrough infections.  

The symptoms of all the variants, including Omicron, are relatively the same, including runny nose, coughing, sore throat, fever, headaches, muscle pain, and fatigue. However, some early reports of cases of Omicron found that fewer people were experiencing a loss of taste or smell. While those who are fully vaccinated and boosted can still get Omicron, the symptoms are far less severe than those who are unvaccinated.  

What to do if you have COVID symptoms

If you have COVID symptoms but are not feeling particularly ill, there is no reason to panic. That being said, it’s important that people who have the means to stay home do so when they’re not feeling well. You should always wear a mask when you leave the house, wash your hands frequently, avoid spending time in enclosed spaces with people outside your household, and generally keep your distance from others. The CDC has a day-by-day guide on how long to isolate, and how to minimize the risk to other members of your household if you are isolating at home.

You should seek medical care if you start to have severe shortness of breath or chest pain, or a cough that keeps getting worse, as you may need help even if you don’t have COVID. If you’re feeling a lot of brain fog, having trouble staying awake in a way that’s unusual for you, or your skin, lips, or nail-beds are turning pale, grayish, or blue, you should call 911 immediately. These can all be signs that you’re not getting enough oxygen.

If your symptoms are mild and you do not have any conditions that put you at high risk, you should simply do whatever you’d usually do to treat a cold or flu. Rest, eat healthy foods, and drink plenty of fluids. Call your doctor if you have a persistent fever that doesn’t respond to medication, if your symptoms keep getting worse, or if your age or an existing health condition puts you at high risk of developing severe COVID-19 symptoms. You can also consult your doctor for a prescription for antiviral medications, like Paxlovid, or other treatments to help aid your recovery if symptoms are bad but don’t require hospitalization.  Most importantly, if you haven’t gotten vaccinated or the latest round of boosters, schedule an appointment a few months after coming down with symptoms or testing positive.

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Coded language is nothing new—but the scale at which it can be deployed via social media is essentially unprecedented. Observers often compare online content moderation to games of Whack-a-Mole, in which platforms can barely stem the influx of targeted misinformation, conspiracy theories, propaganda imagery, and hate speech.

As a report from Bloomberg last week detailed, antivaxxers in particular are becoming increasingly reliant on coded language, often using emojis to convey prohibited misinformation and propaganda on social media platforms such as Facebook. What’s more, a former Facebook exec overseeing public policy says it is becoming clear that current AI moderation programs aren’t up to challenge—and there’s reason to believe they may never be.

“All these systems that these platforms continue to build are frankly still very much in their infancy of being able to do some of the stuff that they would like them to be able to do,” Katie Harbath, CEO of the tech policy strategy group, Anchor Change and a Nonresident Senior Fellow for the Atlantic Council’s Digital Forensics Research Lab who previously served for ten years as Facebook’s head of public policy, tells PopSci.

[Related: The complex realm of misinformation intervention.]

Meeting and conversing within groups and pages with vague names like “Died Suddenly,” Bloomberg notes antivaxxers continue to peddle patently false COVID-19 misinformation using phrases like “eaten the cake” to refer to taking vaccines. “Sometimes, users claim that loved ones have taken four or five ‘slices’ of the Pfizer or Moderna vaccines, using emoji for pizza, cupcakes and various fruits to express their point,” adds the report.

Context is key for flagging and removing prohibited content, something that is made even more complicated for AI monitoring programs by the introduction of emoji code languages. AI content moderation utilizes machine learning algorithms to identify, flag, and if needed, remove content it identifies as problematic—typically sexually explicit or violent images and writing, but coded language and emojis are still often an Achilles’ Heel for them. “[M]achines can still miss some important nuances, like misinformation, bias, or hate speech. So achieving one hundred percent clear, safe, and user-friendly content on the Internet seems almost impossible,” explains a rundown from data annotation service Label Your Data.

Harbath says that the challenge for tackling both emojis and coded language is twofold, both for AI systems and human overseers. “One, you have to retrain your moderators to be able to try to understand that context, and to figure out if they are trying to use this emoji,” she says. “That can be challenging, based on how much [context and material] the content moderators do or do not get.” Harbath says that these moderators often only see a single post or message at a time, depriving them of potentially vital context for enforcement decisions.

[Related: It’s possible to inoculate yourself against misinformation.]

Trying to get ahead of these groups presents its own challenges, as well. Harbath explains that updating or broadening a moderator system’s classifiers and nomenclature can also lead to higher false positives, creating new headaches and complications while simultaneously doing more harm than good. “Most people use emojis in a relatively benign way,” she says, “… It’s a constant fight that all the platforms have to deal with.”

Facebook’s parent company, Meta, chose to cite its successes in this realm when reached for comment on the issue. “Attempts to evade detection or enforcement are a sign that we are effectively enforcing our policies against COVID misinformation,” Aaron Simpson, a policy communications manager at Facebook, writes via email. Simpson also notes that, since the pandemic’s onset, Facebook has removed “more than 27 million pieces of content” for violating polices regarding COVID-19 misinformation across both Facebook and Instagram. Facebook alone counts approximately 241 million Americans on its platform as of this year.

Despite these many issues, there are still silver linings. AI programs continue to improve their efficacy, and given its very nature, coded language is generally only used by people already “in the know,” and therefore isn’t necessarily pivotal for recruitment efforts or spreading propaganda. It may be small consolation, but people like Harvath are wary of the alternatives, urging for more digital literacy programs as opposed to such tactics as outright prohibiting emojis.

“You could go wholesale on banning that stuff altogether, but then they would just go [back] to coded words,” says Harvath. “You’re pretty much getting to the point of, like, ‘Just shut the internet down.'”

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This article was originally featured on High Country News.

Editor’s note: This story contains a graphic description relating to the loss of a child.

The heat was in the triple digits when Lea Bossler and her U.S. Forest Service engine crew reached the blaze unfurling in a canyon outside Nogales, Arizona. As she trekked up a hill with her shovel-like rhino tool, flaming barrel cacti tumbled down the slope, igniting more parched fuels along the way. Despite the heat, a 45-pound pack and little sleep, Bossler felt strong and capable, mopping up the edges of the fire, extinguishing collapsed cactuses that smoldered like burnt rubber. This was her third season as a wildland firefighter, and she was well on her way to fulfilling her goal of becoming an incident commander.

After the fire was contained, Bossler and her crew drove home to Missoula, Montana, concluding a two-week roll in the Southwest. It was early July 2020, the middle of a record-breaking fire season that would burn over 10 million acres across the country, and Bossler was resting before her next assignment. There was a coronavirus outbreak at her partner’s workplace, and just a couple of days after she came home, she caught a debilitating case of COVID-19. Now, more than two years later, the 32-year-old still hasn’t recovered. Long COVID has not only damaged her health, it has also forced her to give up her career in firefighting.

Currently, over 19 million people in the United States—1 in 13 adults—are living with long COVID, though some estimates place the number as high as 23 million. Long COVID is a complex condition that affects all age groups and can involve multiple organ systems. It’s diagnosed weeks or months after a COVID-19 infection. Some of the symptoms include cognitive dysfunction, respiratory and cardiovascular problems and extreme fatigue, though roughly 200 other symptoms are recognized, and some can linger for years. Many patients meet the diagnostic criteria for other diagnoses, as well. Those include postural orthostatic tachycardia syndrome, which causes extreme dizziness, headaches and rapid heart-rate; and myalgic encephalomyelitis (ME)—sometimes called chronic fatigue syndrome—a disabling neurological disease that has been underfunded for decades.

A World Health Organization official recently warned that repeated infections may increase the risk of long COVID. A recent US Census Bureau survey analyzed by the National Center for Health Statistics showed that as many as 1 in 5 adults who were infected with COVID-19 now have symptoms of long COVID. 

While the number of US wildland firefighters affected is unknown, the workforce is considered at high risk of contracting COVID-19: In 2021, the leading cause of line-of-duty deaths in wildland firefighters was COVID-19. Firefighters are already stretched thin due to the prolonged and intensified fire seasons caused by climate change. Long COVID is not only affecting firefighters’ health and livelihoods, it could also seriously hamper their response to the escalating crisis.

Firefighters are a strikingly transient workforce, making them more vulnerable to catching and spreading COVID-19. “You have firefighters and other fire personnel who are traveling from all over the country to arrive at one common location,” said Matthew Thompson, a research forester with the Forest Service.

The lack of sanitation and privacy in the camps, combined with fatigue, heat, physically demanding work and other factors add to that vulnerability, according to the National Wildfire Coordinating Group (NWCG), which provides leadership to wildland fire operations among federal, state, local, tribal and territorial partners. One of the largest COVID outbreaks at a fire camp occurred during the 2020 Cameron Peak Fire in northern Colorado, with 79 positive cases and 273 close contacts who were quarantined. A Forest Service press officer emailed that among nearly 11,000 permanent and temporary agency firefighters, there were 1,847 reported cases of COVID-19 within the past 12 months. 

In a recent modeling study, Thompson and his co-authors found that social distancing and vaccination reduced outbreaks in fire camps, though their study did not assess long COVID or the highly contagious omicron variant. (According to a 2022 study in the journal Nature Medicine, vaccination may only slightly reduce the risk of long COVID.) Thompson’s study also found that firefighters were infected even more often outside of fire camp than within it, meaning that they are continually at risk as the US eases preventative measures, allowing for dangerous peaks that can occur in the heart of fire season. 

The NWCG recommends COVID safety prevention practices for wildland firefighters based on guidance from the Centers for Disease Control. But a widely referenced CDC document about COVID and wildland firefighters doesn’t specifically mention long COVID.

In a review published last year, Kathleen Navarro, a researcher at the National Institute for Occupational Safety and Health, noted that particulate matter—including the hazardous mixture of small particles and droplets found in wildfire smoke—could contribute to a greater likelihood of COVID-19 infection in wildland firefighters, as well as more severe illness. “It’s not only the risk of transmission or getting COVID,” said Navarro. “It’s also the severity of outcomes.” 

But firefighters face a risk of long COVID, no matter the severity of their acute case: A 2022 white paper stated that nearly 76 percent of those diagnosed with long COVID have not been hospitalized.

Bossler returned to work after her 14-day quarantine despite not feeling fully recovered. “I went back hoping I would go back to normal,” she said. “But I really didn’t. I worked through it because you just don’t pass up opportunities as a female firefighter.” She often felt like she was drowning as she continued to fight fires across Montana the rest of the summer. 

“There’s an attitude in firefighters that you don’t quit for anything,” she said. “And there’s just no education, warning, or recognition of long COVID in fire.” 

Advocates for those with chronic illness warned of the possibility of complex chronic illness following COVID-19 in the beginning of the pandemic, but the federal government’s public health apparatus did not amplify these messages and still doesn’t consistently emphasize the risk of long-term health effects following an initial case. “I can only assume that I did more damage to myself,” she said. “I gave in to this notion that because I was young and healthy, I’d be fine, when I knew, deep down, there was something really wrong with me.”

A growing number of physicians warn that resuming activity while not yet fully recovered may increase a person’s likelihood of developing long COVID. But owing to financial hardship, inadequate sick leave and other pressures, many workers in the United States push on through their illnesses. 

Bossler continued to work on her crew through the summer, despite lingering symptoms. But then, in late August, she found out she was pregnant. She said she likely conceived around the time she first contracted COVID-19 in early July 2020.

In a joint decision with her superiors, Bossler transferred from the engine crew to a timber strike team for the rest of the season. Her due date was in May, and she planned to take a Forest Service office job that summer and resume working as a firefighter the following season—assuming she recovered from long COVID. But these plans were put on hold in January when she gave birth to her daughter, Maesyn, prematurely, at only 25 weeks. Her baby suffered fetal inflammatory response syndrome due to the maternal history of COVID, and Bossler’s placenta was filled with blood clots, which contributed to placental failure and abruption. “A COVID-affected placenta looks like you took a roadkill deer, took the liver out, and shot it with a shotgun a couple of times,” Bossler told me. 

When she first went into the hospital at 23 weeks with contractions from early labor, Bossler was told there was only a 30 percent chance of her baby surviving. Her daughter weighed just 1 pound and 6 ounces at birth when she arrived two weeks later and gained only 5 more pounds during her 115 days in the Neonatal Intensive Care Unit. She died on May 14, 2021, close to her original due date. In Maesyn’s final moments, Bossler was able to take her daughter out of the NICU to see the sky for the first time. Maesyn died outside in the spring sunlight, in the arms of Bossler and her partner, Marcus Cahoon.

Now, over two years since she first contracted COVID, Bossler continues to experience debilitating long COVID symptoms. She cannot walk more than half a mile without feeling fatigued and also struggles with headaches and memory loss, and has difficulty paying attention. She has chest pain that she says has worsened significantly since she was reinfected in June. Bossler believes her pregnancy complications made her more aware of her illness, which she might otherwise have been too stubborn to acknowledge. “I know of people that have long COVID that are still trying to be firefighters,” she said, “but I don’t think they have the same understanding or recognition of it that I might have. 

“I think all employers of wildland firefighters would be doing a huge disservice to their employees to not recognize long COVID and the mental health challenges that come from it,” Bossler said. When I reached out to the Forest Service in August about the agency’s approach to long COVID education and prevention, I was told to contact the United States Office of Personnel Management (OPM), which oversees all federal employees. The Interior Department, which employs over 5,000 temporary and permanent wildland fire personnel, wrote that it develops policy based on recommendations from the CDC and Safer Federal Workforce Task Force, which is led by the White House COVID-19 Response Team, the General Services Administration and the OPM—none of which offer publicly available guidelines on long COVID. The Office of Personnel Management sent a written statement in response to our request for comment but did not elaborate on its policies related to long COVID.

“(First responders’) careers depend on our health and us being able to respond to a fire or an emergency at any point of time, despite how we feel,” said Karyn Bishof, the founder of the COVID-19 Longhauler Advocacy Project, a nonprofit advocating for education, research and patient welfare. She said that many first responders, including wildland firefighters, are reluctant to speak about health issues for fear of losing their livelihoods. “The flip side of that is if they’re not seeking treatment and care, they’re not only risking their own lives, but possibly the lives of their crews.”

Bishof became infected with COVID after an outbreak at her firefighter paramedic training in the city of Palm Beach Gardens in South Florida. She told me she was later let go from her job on the Fire Rescue team without explanation. In late 2020, Bishof was also denied workers’ compensation after a doctor diagnosed her symptoms as psychosomatic, a common experience for many patients with complex chronic illness. She has since filed a discrimination lawsuit against the city of Palm Beach Gardens. The city did not respond to my request for comment.

Like other infectious diseases, including Lyme, mononucleosis and SARS-1, COVID-19 can develop into complex chronic illnesses. Researchers have consistently found a range of abnormalities in long COVID patients, including micro clots, persistent viral reservoirs, reactivated viruses and autoimmune responses. The US Department of Health and Human Services has recognized that the condition can be a disability, but in the fall of 2021, Bishof—like many long COVID patients—was denied Social Security disability benefits. She reapplied but was denied a second time and is now awaiting an appeal hearing.

Because there is no cure for long COVID, Bishof said that preventing COVID-19 and increasing public awareness of its long-term consequences are paramount, especially in protecting first responders. She’s concerned that if long COVID continues to affect one of every five infected people, it will inevitably effect public safety. “If we lose that percentage of that workforce, what does that mean for emergency response times?” she asked. “What does that mean for wildfire response?”

In testimony before a Senate Subcommittee on the Coronavirus Crisis this July, Katie Bach, a senior fellow at the Brookings Institution, said that policymakers need to support improved health care, sick leave, disability and workplace accommodations for workers. Given that as many as 4 million long COVID patients are unable to work, Bach estimates a cost of as much as $230 billion in lost earnings alone, not including other costs, such as health care or reduced productivity. 

The Forest Service and Interior Department offer sick leave for employees exposed to communicable diseases, like COVID-19, as well as disability accommodations that can include teleworking and more flexible work hours. Federal firefighters who can’t work at all due to long COVID contracted on the job may be eligible for workers’ compensation, according to an Interior spokesperson. But employees infected outside of work are not eligible for any benefits, according to guidelines by the Office of Personnel Management. 

Looking back at her experience over the past two years, Bossler says the Forest Service needs to develop policies that help protect firefighters from long COVID, as well as provide support for those affected by it. She was forced to leave her job at the Forest Service when she went into early labor. “It was a medically forced resignation,” she said. After her daughter’s birth, she considered returning to the agency, but at that point, she was still grieving and unable to work full-time due to her long COVID symptoms. 

In the fall of 2021, she began working part-time as a health unit coordinator in the same neonatal intensive care unit that treated Maesyn. A number of the nurses there, like other first responders, also suffer from long COVID. “I wanted to work somewhere that would understand me,” Bossler told me. 

“I learned how to handle all these traumatic situations by relying on the lessons from fire,” Bossler said. Maesyn’s brief life and death had such a profound impact that Bossler feels an obligation to continue telling her daughter’s story while educating people about this chronic illness. “I think about other firefighters that lost their ability to do their job.

“It’s not just your job. It’s your identity. The grief that comes with that is just not discussed enough.” 

This story was supported by the journalism nonprofit the Economic Hardship Reporting Project.

Miles W. Griffis is an independent journalist based in Los Angeles, California. We welcome reader letters. Email High Country News at editor@hcn.org or submit a letter to the editor. See our letters to the editor policy.

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The health implications of COVID-19 do not always go away when fevers break, coughs subside, and senses of smell and taste return. An estimated 4 million people suffer from long COVID, which has symptoms like brain fog, lingering cough, fatigue, and more. A new study out this week found that one out of 20 people who have had COVID-19 report that they still have symptoms six to 18 months after first getting sick.

Another risk after infection with COVID-19 is myocarditis, or an inflammation of the heart muscle. The inflammation can reduce the heart’s ability to pump blood and cause cause chest pain, shortness of breath, and rapid or irregular heart rhythms also called arrhythmias. A study published on Wednesday in the journal Frontiers in Cardiovascular Medicine found that risk of developing myocarditis is seven times higher with a COVID-19 infection than with the COVID-19 vaccine. It also finds that the risk of myocarditis was 15 times higher in COVID-19 patients, regardless of vaccination status.

[Related: How dangerous is myocarditis? The truth about the scary-sounding condition.]

“Our findings show that the risk of myocarditis from being infected by COVID-19 is far greater than from getting the vaccine,” Navya Voleti, a resident physician in the department of medicine at Penn State, said in a statement. “Moving forward, it will be important to monitor the potential long-term effects in those who develop myocarditis.”

A team from the Penn State College of Medicine reviewed an analyzed 22 international studies published between December 2019 and May 2022. The studies included nearly 58 million patients, all of whom reported cardiac issues.

The patients belonged to either the vaccination group or the COVID-19 group. The vaccination group included 55.5 million who were vaccinated against COVID-19 compared to those who were not vaccinated. The COVID-19 group included the 2.5 million who contracted the virus compared to those who did not contract the virus.

Within the vaccination group, the researchers separately compared the risk of myocarditis for various COVID-19 vaccines, including the mRNA vaccines (Pfizer, Moderna), Novavax, AstraZeneca, and Johnson and Johnson.

[Related: What you need to know about heart inflammation and COVID-19 vaccines.]

Among those diagnosed with myocarditis after receiving the vaccine or having COVID-19, the majority (61 percent) were male. Of patients diagnosed with myocarditis in both vaccination and COVID-19 groups, 1.07 percent were hospitalized and 0.015 percent died.

“COVID-19 infection and the related vaccines both pose a risk for myocarditis. However, the relative risk of heart inflammation induced by COVID-19 infection is substantially greater than the risk posed by the vaccines,” Paddy Ssentongo, a resident physician in the department of medicine at Penn State and the lead author of the study, said in a statement. “We hope our findings will help mitigate vaccine hesitancy and increase vaccine uptake.”

The findings come after claims on social media that the vaccine causes irreversible myocarditis cases. While heart complications following an mRNA vaccine are a rare side effect of the mRNA COVID-19 vaccination, the majority of medical professionals agree that the benefits of getting the vaccine outweigh the risks.

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Researchers at Oxford announced today that a nasal spray version of the COVID-19 vaccine they’ve developed with AstraZeneca failed in early stages of clinical trials. The underwhelming results in were published in eBioMedicine. Scientists have abandoned their plans to develop the spray in its current form, and will pivot to studying different vaccine formulations and other delivery devices. The trial didn’t report any serious side effects or safety concerns.

The nasal vaccine only produced an antibody response in the respiratory mucous membranes in minority of trial participants, according to the published findings. Additionally, the immune response measured in the blood was weaker than that from a shot (intramuscular) vaccination. The trial enrolled 30 previously unvaccinated participants and 12 volunteers who had previously received a standard two-dose vaccine course by injection.

[Related: China approves world’s first nasal COVID-19 vaccine booster.]

“The nasal spray did not perform as well in this study as we had hoped,” Sandy Douglas, chief investigator on the trial at Oxford’s Jenner Institute, said in a statement. “This was quite different from recent data from China, which has suggested good results can be achieved by delivery of a similar vaccine deep into the lungs with a more complex nebulizer device.”

In September, China became the first country to approve a COVID vaccine nasal booster, made by Chinese vaccine maker CanSino. The CanSino vaccine is delivered by a nebulizer device that turns the vaccine into a fine mist. India also approved an intranasal vaccine in September, with trial results awaiting publication.

A nasal spray version of the vaccine could be a game changer according to scientists, as it could stop the virus in the nose and mouth (where it enters the body) and keep it from spreading. Researchers believe that targeting the airways could more effectively prevent transmission, since it spreads in tiny droplets though the air. Nasal vaccinations are also typically less painful and appeal to those with a fear of needles.

According to Douglas, the spray used the same formula as the traditional intramuscular version of the vaccine, but still delivered less-than-ideal results. “We believe that delivery of vaccines to the nose and lungs remains a promising approach, but this study suggests there are likely to be challenges in making nasal sprays a reliable option,” Douglas said in the statement.

[Related: Inside the race to develop a safe COVID-19 vaccine.]

He added that the weaker result might be due to the majority the spray being swallowed and destroyed in the stomach, but targeting the delivery of the vaccine into the lungs could help keep the vaccine out of the digestive system and into the respiratory system where it belongs.

Nasal vaccines have been available for the H1N1 (aka swine flu) strain of influenza for over a decade. However, some evidence from past flu seasons has shown that the mist doesn’t always achieve the same level of efficacy as a shot. The data is not clear on whether or not that same efficacy gap will exist with new inhaled COVID boosters.

“We urgently need more research to develop vaccines which can block transmission of respiratory pandemic viruses using delivery routes which are safe and practical at large scale,” Douglas said in the statement.

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Clinicians and researchers continue to search for some of the long-term effects and risks patients face after having COVID-19. Three newly published studies are exploring whether infection increases the risk of developing type-1 diabetes, or T1D. Previously called juvenile diabetes, T1D is typically diagnosed in children and occurs when the pancreas fails to produce a hormone called insulin. The body uses insulin to allow sugar (glucose) to enter the cells and produce energy. According to the Centers for Disease Control and Prevention (CDC), roughly 187,000 children and adolescents under the age of 20 have T1D in the United States.

In a study published last week in JAMA Network Open, researchers analyzed the electronic health records of 571,256 international patients aged zero to 18 who tested positive for COVID-19 or other respiratory infections from March 2020 to December 2021.

Of the total participants who received a positive COVID test, 123 (0.04 percent) were newly diagnosed with T1D. Only 72 (0.03 percent) with a confirmed respiratory infection that wasn’t COVID-19 ended up with a T1D diagnosis. This represents a 72 percent increase in new diagnoses just based on COVID-19 status.

The risk of T1D was substantially higher for the COVID-19 survivors after one, three, and six months of infection when compared to those with other respiratory infections.

[Related: From the archives: How a medical ‘outsider’ discovered insulin.]

Despite the high numbers, the scientists still don’t know whether COVID-19 triggers the development of T1D.

“Type 1 diabetes is considered an autoimmune disease,” corresponding author Pamela Davis, professor of medicine at Case Western University, said in a news release. “It occurs mostly because the body’s immune defenses attack the cells that produce insulin, thereby stopping insulin production and causing the disease. COVID has been suggested to increase autoimmune responses, and our present finding reinforces that suggestion.”

Going forward, the team behind the study advises families with a high risk of T1D to look for diabetes symptoms after COVID-19 infection. Pediatricians also must be vigilant and prepared for a surge of new T1D cases. “We may see a substantial increase in this disease in the coming months to years,” Davis added. “Type 1 diabetes is a lifelong challenge for those who have it, and increased incidence represents substantial numbers of children afflicted.”

Additionally, a study presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden, used the national health registers of 1.2 million Norwegian children between March 1, 2020 (when COVID-19 was beginning to spread throughout Europe)and March 1, 2022. The study finds that 0.13 percent of children and teens were diagnosed with T1D one month or more after COVID-19 infection versus 0.08 percent in uninfected children. This is a 62 percent increase in relative risk.

[Related: Doctors add diabetes to the list of COVID-triggered conditions.]

The research was conducted by Norwegian Institute of Public Health investigators and colleagues and found that out of 424,354 children who tested positive for COVID-19, 990 were diagnosed with T1D during the period of study.

“The absolute risk of developing type 1 diabetes increased from 0.08 percent to 0.13 percent, and is still low,” lead author Hanne Løvdal Gulseth, a diabetes expert at the Norwegian Institute of Public Health, said in a press release. “The vast majority of young people who get COVID-19 will not go on to develop type 1 diabetes, but it is important that clinicians and parents are aware of the signs and symptoms of type 1 diabetes. Constant thirst, frequent urination, extreme fatigue and unexpected weight loss are tell-tale symptoms.”

The team noted that T1D is suspected of being an outsized immune response by the body. Some suspect viral infections like COVID-19 could create a similar reaction, but a link between the two hasn’t been established. Gulseth also speculated delays in seeking medical care because of the pandemic may explain some of the increase in cases. “However, several studies have shown that SARS-CoV-2 can attack the beta cells in the pancreas that produce insulin, which could lead to development of type 1 diabetes,” he explained in the release. “It’s also possible that inflammation caused by the virus may lead to exacerbation of already existing autoimmunity,”

Finally, a study published this summer in Diabetes Care that was presented at this year’s EASD meeting finds the risk of developing T1D after being infected with COVID-19 only exists for a short period of time. The team evaluated Scottish diabetes registry data on 1.8 million people under the age of 35 from March 2020 to November 2021. In that time, 365,080 children and young adults tested positive for COVID-19 at least once, and 1,074 were diagnosed with T1D. COVID-19 was associated with a rate of new-onset T1D over twice as many times compared to uninfected participants and three times as high in children younger than 16 years, but this association only lasted for one month.

The researchers speculate that the increase in T1D diagnosis after infection is possibly related to increased testing for COVID-19 at the time of the T1D diagnosis rather than from COVID itself. Also, because the average time from onset of T1D symptoms to diagnosis is about 25 days in patients younger than 16 in England, many of those who tested positive for COVID-19 within 30 days of a diabetes diagnosis probably already had T1D, they said in a release.

“Our findings call into question whether a direct association between COVID-19 and new-onset type 1 diabetes in adults and children exists,” corresponding author Helen Colhoun, an epidemiologist at Public Health Scotland and the University of Edinburgh, said in a news release. However, Calhoun reiterated that if scientists replicate these findings, “this is going to create a large number of people with newly diagnosed diabetes and might also alter the risk–benefit balance for COVID-19 vaccination in young children.”

While the picture on whether or not COVID-19 causes type-1 diabetes is still not fully clear, they point to the need for more vigilance and research into what long-term affects the novel virus may cause. According to the Mayo Clinic, some of the major symptoms of type-1 diabetes to look for in children are frequent thirst and urination, extreme hunger, unintentional weight loss, and a change in behavior or increase irritability.

The post Why we should be looking out for diabetes in young people with COVID appeared first on Popular Science.

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This story was originally published on October 7, 2020.

Fall is finally here, and the cooler weather is a welcome relief from the summer heat. Even as the seasons change, COVID cases continue to spread, with two new Omicron strains killing and infecting hundreds of people each week in the US. While the chillier temperatures may kickstart your craving for taking gatherings indoors, it’s still important to do what you can to stop the spread of the virus. So bundle up with a cozy scarf, stay outside when you can, and check out a few festivities that will keep you and your family and friends safe and in the fall spirit this season.

[Related: What you need to know about getting the new COVID-19 booster]

In general, the safest places to be are outdoor spaces where it’s easy to keep social distance, says Joshua Petrie, an epidemiology researcher at the University of Michigan.

“You would want to avoid big gatherings where there’s a lot of people, especially if they’re going to be in close contact for long periods of time,” says Petrie. “You would also want to assess how well you can do the risk-reduction techniques that we’re all used to now, like wearing masks and social distancing. And if it’s an outdoor activity, that’s going to be better.” The risk of any activity depends on the level of COVID in your area, he adds, so make sure to check how high your county’s cases are on this national tracker before you venture out.

Least risky: Hiking and apple picking

Since the beginning of the pandemic, the safest place to avoid catching or spreading COVID has been inside your own home with just your roommates or family. But the next best thing is to get outdoors, a safe distance from other people and with plenty of fresh air. Luckily, some of the best, most traditional fall activities—apple picking and hiking—line up perfectly with those guidelines.

Apple orchards hit every point for a safe fall activity. They are spacious, outdoor areas where it’s easy to maintain a safe social distance while scooping up some tasty autumn treats. Apple harvesting season started in early July, but there are still several varieties that are ripe for the picking well into October. Red Delicious apples are best picked early this month, and if you’re into baking, then look for some perfectly-ripe Cortlands—a favorite for apple pie. Look for orchards in your area that are following good sanitation practices and other health recommendations.

“It’s a good idea, especially if you’re going apple picking where you might run into a few more people, to bring your mask,” says Petrie. But overall, he says, as long as you’re able to maintain a safe social distance from others, apple-picking is pretty low-risk.

It’s also the perfect time of year to go on a fall hike and look at the changing autumn leaves, creating the gorgeous autumn landscape you know and love all across the US. If you live in the Northeast or Midwest, the best time to head outside and look for the best fall colors is in the first half of October. If you’re in the southern half of the country, the best is yet to come—Texas should be seeing the most colors for the region in early November.

Not too risky: Camping

If you’re craving a change of scenery, it’s probably still not wise to go jet setting. But camping in a nearby campground, or even your backyard, can still be a perfect nature getaway with your social bubble. But think twice about inviting people you haven’t seen in a while.

“Some people, when they go camping, tend to go in big groups, and they might not be people they live with, and they travel from all around to go camping together,” says Petrie. “That would be higher risk than just going out with your family or a smaller group. But in general, being outside and not being in contact with a lot of people should be pretty safe.”

If you’re exploring the wilderness outside of your backyard, be sure to check the local COVID rates where you’re coming from as well as where you’re headed.

Kind of risky: Tailgating

Tailgates, in general, may at first seem low risk—you’re in a large outdoor parking lot and you can just stay with your own group at your car. Still, when you’re eating and drinking you aren’t wearing a mask, and unless cars have a few spaces between them, you’re probably going to be less than six feet away from your neighbors. Shouting and singing also propel droplets that could contain the virus further than just talking quietly. Also, there’s a big difference between tailgating with your close family members or roommates and heading to a large college tailgate party—the latter poses a much bigger risk.

“[Tailgating has] being outside going for it, and if you’re doing mask-wearing and social distancing it’s going to be relatively low risk, especially if it’s one car with your family or the people you’re normally in contact with or a small group of close friends,” says Petrie. “But the more people you bring in, especially if they’re traveling from other areas, it’s going to be higher risk.”

[Related: How have non-alcoholic beers gotten so good?]

One solution early in the pandemic, developed by the architectural firm Populous for the Milwaukee Bucks, used stacked shipping containers converted into viewing boxes where four to six people could watch the game streamed to large LED displays. The Bucks also considered turning a parking garage into a giant ticketed drive-in theater with 360-degree screens.

If your team isn’t offering a safe tailgate option, there are still ways of enjoying the game with friends and family. You can host a virtual watch party and hang out on video chat while watching from home. If you’ve got a backyard, set up a mini-tailgate with a small guest list. After all, cornhole and cheering for your team isn’t limited to a parking lot.

Risky: Thanksgiving and Halloween parties

The holiday season is fast approaching, and some people are still planning on hosting Halloween parties or Thanksgiving dinners for their families and friends. Some things public health officials recommend for gauging how risky an indoor event might be are local COVID infection rates, the number of people at the gathering, the location, and the duration. Tighter spaces, high guest counts, and long hangouts all contribute to increased risk of spread.

The post How to enjoy fall festivities during the COVID pandemic appeared first on Popular Science.

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The change in season is coming with a change in COVID-19 vaccines. Last week, the Food and Drug Administration (FDA) authorized the use of another round of boosters, with the Pfizer-BioNTech shot green lit for people 12 years and older and the Moderna shot for people 18 and older. The shots can only be received after at least two months following the primary vaccination series.

Unlike previous doses, the new booster is a bivalent vaccine which includes an updated formula containing the mRNA of the original SARS-CoV-2 strain to broadly protect against COVID-19 infection, as well as the mRNA of the more recent Omicron BA.4 and BA.5 variants. As of September, the BA.5 variant is currently the dominant variant circulating in the United States, making up 88.6 percent of cases.

Infectious disease experts are bracing for another surge of cases in the fall and winter, but they are cautiously optimistic that the new COVID-19 boosters will provide immunity against severe disease and illness. These vaccinations will be available soon—here’s what you need to know before you get one.

When can I get the new boosters?

By the end of the week. The White House COVID-19 Response Team said in a September 6 press briefing that they have already shipped millions of doses once they received the FDA’s authorization on August 31. They announced that by Friday, September 9, “over 90 percent of Americans will live within five miles of these new updated vaccines.”

You can visit Vaccines.gov to find sites carrying the new boosters. Appointments at pharmacies such as CVS and Walgreens will become available this weekend with a majority of slots opening up next week. You can also contact your primary care provider or local health clinic to see if they are taking vaccine appointments and which booster they are carrying.

Should I go with the Moderna or the Pfizer-BioNTech booster?

Michael Chang, a pediatric infectious disease specialist at UTHealth Houston and Memorial Hermann Hospital, says there’s not much evidence to suggest one is better than the other. However, he says pre-clinical data showed little difference between the two and both were effective in preventing illness and hospitalization. 

Sharon Nachman, chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital, recommends trying for a mix-and-match strategy this time around. “If you’ve gotten Pfizer as your primary series, it’s a great idea to swap out and go for the Moderna booster and vice versa.” She says because the vaccines are formulated a little differently and there’s more research to suggest that mixing and matching gives you an extra boost of immunity, you’re likely to have a higher degree of protection.

I already had a COVID booster. Do I need this one?

Yes. The Centers for Disease Control and Prevention (CDC) says you’re not up to date with your vaccines until you’ve finished your primary series and the most recently authorized booster. Even if you received a booster earlier this year, Chang says these new shots are better at targeting Omicron strains. “It will better cover the currently circulating variants and potentially provide broader immunity against future variants,” he explains. Since the newer boosters are more effective, they will replace the previous boosters, which will not be offered anymore to people over the age of 12, Chang adds. 

[Related: Omicron boosters are the future of COVID vaccines in the US]

Chang says if you received your booster even three to four months ago, your antibody levels are probably falling. Both he and Nachman agree that getting the bivalent vaccine will raise the country’s collective immunity and provide as much protection as possible going forward. As the US transitions from pandemic to endemic mode, the priorities have shifted towards learning how to live with? and manage the virus. 

“COVID is here to stay,” adds Nachman. “It’s going to be part of our lives and I suspect we’ll have annual dosing like the flu vaccine every year.”

I just recovered from COVID. How long can I hold off on getting a booster?

Yes, you can wait, but not for too long. Fighting off a recent battle with COVID temporarily gives you antibodies to avoid catching another infection. The CDC advises delaying your booster shot for no more than three months from when your symptoms first emerged or when you received a positive test result. 

Studies measuring antibody levels after each strain of infection shows a lot of variation with naturally acquired protection, Nachman explains. In some cases, she says antibodies lasted a couple of months while others saw levels dropping sooner than that. “Would I run and get the booster a day [after testing negative]? No,” she says. “Would I wait six months? Absolutely not.”

When is the best time to get the bivalent booster?

If you recently recovered from infection and delay the dose for three to four months, Chang says you’ll likely have your highest antibody levels during the winter, a time when infectious disease experts expect to see a surge in cases after the holidays. “You will probably have peak antibodies within two weeks or so [after immunization].” Chang also recommends waiting three to four months for people who received a booster in the summer or in the last two weeks.

Nachman says that in an ideal world, people would wait until October or November to get the booster to prepare for a bad winter. But if you have underlying immune issues or are living with someone with multiple medical problems, she recommends getting the vaccine immediately. If you’re planning on traveling outside of the country, she says it’d be ideal to get your vaccine a month before to protect yourself against a potential outbreak in another country. “There’s no one right answer,” she cautions. When in doubt, Nachman highly recommends speaking with your doctor about the right timing for you to get the booster shot.

[Related: China approves world’s first nasal COVID-19 vaccine booster]

Will the booster have any side effects?

Yes. Both experts say you should expect to see similar side effects as your previous vaccines such as low-grade fever, muscle soreness around the injection site, and fatigue. Though Chang is hopeful that the side effects won’t be as severe as prior vaccinations. “In some cases with people who had vaccine side effects, we’re seeing a little less side effects with each booster.”

To prepare for the side effects, experts recommend getting a full night’s rest, gently moving your body to help with fatigue and muscle aches, and staying hydrated throughout the day. Nachman does not recommend taking pain relievers such as aspirin, Tylenol, or Motrin prior to vaccination. Instead, she says it’s better to take Tylenol a couple of hours after.

When will boosters be available for kids from 5 to 11?

There’s no clear timeline on when boosters will become available for kids between 5 to 11 years. Both experts say Moderna and Pfizer-BioNTech are already starting the groundwork to conduct studies on the appropriate dosage for this age group. 

Chang says the process toward authorizing boosters for kids should not take as long—he could even see more developments before the end of the year. Nachman’s prediction is a bit more grim. She says parents should not expect COVID booster eligibility for younger age groups until late winter 2023. The CDC recommends children 5 to 11 years old get a monovalent—containing only the original strain—booster dose in the meantime.

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Good news for those with trypanophobia, or fear of needles. Regulators in China have approved a COVID-19 vaccine booster nasal spray, providing those virus-fighting antibodies without the jab of a needle.

According to vaccine maker CanSino, one breath of their vaccine mist provides protection against COVID-19. The dose will be used as a booster and is the first approved alternative to injectable COVID-19 vaccines. The inhaled vaccine has the same ingredients as the intramuscular vaccine in China, but uses a nebulizer machine to turn it from a liquid into an easily inhaled aerosol spray.

Data from the World Health Organization (WHO) shows that a single-dose of the CanSino shot is about 92 percent effective at preventing severe disease and about 58 percent effective at preventing COVID-19 entirely. Clinical trials that used the mist as a booster (after a single injected dose of the vaccine) showed that the mist is about as effective as the two-dose vaccine that’s widely used elsewhere in Asia and in other countries.

[Related: Omicron boosters are the future of COVID vaccines in the US.]

CanSino’s formulation contains pieces of COVID-19’s genetic material so the body can recognize the virus, similar to how the vaccines in the United States work. However, this vaccine uses a benign version of the common cold virus to carry information about the virus, instead of introducing the material directly like the Moderna or Pfizer vaccines do. “It’s completely possible to determine efficacy,” said Sandy Douglas, a is chief investigator of an intranasal COVID-19 vaccines being developed by the University of Oxford, in an interview with Nature. “It’s just a bit trickier than testing first-generation intramuscular vaccines in an infection-naive population,” he added.

This nasal vaccine is one of more than 100 nasal (or mucosal) vaccines currently in development around the world, with 20 of them currently in clinical trials. In theory, inhaled vaccines could prime the immune cells in in the nose and mouth and quickly prevent the virus spread. According to CanSino’s press release, this is how their nasal mist works: by stopping the virus in its tracks where it typically enters the body.

[Related: How people die from the flu.]

FluMist intranasal vaccine is one of the more common mucosal vaccines that is typically available in pediatricians’ offices during flu season. These inhaled vaccines provide a needle-free alternative for both children and adults. Nasal vaccines have been available for the H1N1 (aka swine flu) strain of influenza for over a decade.

However, some evidence from past flu seasons has shown that the mist doesn’t always achieve the same level of efficacy as a shot. The data is not clear on whether or not that same efficacy gap will exist with new inhaled COVID boosters.

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Over Labor Day weekend, pharmacies across the country began receiving shipments of new Omicron-specific mRNA booster shots against COVID-19, after the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) signed off on their use last week.

The updated formulas, which will become the standard booster for almost everyone in the US, were developed by Pfizer/BioNtech and Moderna in the 10 months since Omicron first emerged. Although the boosters are almost identical to the original shots, they’re bivalent, which means they can induce an immune response to both the original strain of SARS-CoV-2, as well as the BA.4/BA.5 Omicron strains that currently cause about 90 percent of the country’s COVID cases.

[Related: Long COVID recovery is finally getting the attention it deserves in the US]

Moderna’s bivalent booster will be available to anyone 18 and up who has finished their primary vaccination series, and hasn’t had a shot for at least two months. Pfizer’s will be available to anyone 12 and up who meets those same timing conditions. However, the CDC recommends waiting at least three months after a COVID infection before being boosted.

“We hope this is the start of moving [COVID boosters] toward a more usual type of vaccine recommendation and process,” said Melinda Wharton, associate director for vaccine policy at the CDC, at a meeting last week on the updated shots. “I’m sure there’ll be some bumps in the road, but it’s an important move toward simpler recommendations, as well as an updated vaccine that we expect to provide broader protection.”

What is a bivalent vaccine?

Let’s start with a refresher: The mRNA vaccines for COVID work by injecting small sequences of quickly degrading genetic material based on SARS-CoV-2 into the body. Your cells read that mRNA like an instruction manual, and build the virus’s signature spike protein. After seeing those home-grown spikes, your body develops antibodies and other immune responses to target the pathogen’s primary weapon during future infections.

The original Pfizer/BioNtech and Moderna vaccines contained instructions for the spike protein of the first strain of SARS-CoV-2, and have remained remarkably effective at preventing severe illness and death from evolving variants and subvariants. But one of the reasons that Omicron has been so able to infect vaccinated people is that it carries a heavily modified spike— roughly 30 mutations away from the original—that resists the antibodies triggered by earlier shots. So, the bivalent vaccines contain a 50/50 mix of mRNA that replicate the original spike protein and the identical spikes of BA.4 and BA.5.

[Related: A deep dive on the evolution of COVID and its variants]

This is generally how vaccines for other quickly mutating viruses are built as well. Most prominently, the annual flu vaccine is a tetravalent formula, designed to train the immune system to recognize four strains of influenza most likely to circulate in a coming year.

How well does it work?

The ability to quickly update mRNA shots is one aspect of the new technology that has excited vaccine researchers. But the data used to consider the clinical trial results and approve the updated shots differs from any previously used for COVID.

The CDC and FDA said that they recommended the bivalent boosters based on the “totality of evidence.” In translation, the decision was made using a combination of safety and efficacy data from trials of slightly different bivalent Omicron vaccines, and mouse trials involving the newly authorized updates.

Part of this is because the Omicron variant mutates rapidly. Just weeks after the variant emerged last November, Pfizer, Moderna, and other vaccine manufacturers began developing strain-specific shots. But by the time the companies began to submit data to federal regulators for approval, Omicron had changed shape. When an independent panel of FDA advisors convened in April, it largely agreed that updated boosters should target the most recent BA.4 and BA.5 strains. That forced pharmaceutical companies to begin work on a second Omicron formulation of which human trials are still ongoing.

On September 1, the CDC presented its argument for distributing the shots with the safety and efficacy data collected so far. First, officials from Pfizer and Moderna presented results from human clinical trials on the original bivalent booster that showed it made recipients produce significantly higher levels of antibodies against the Omicron variant—and that those antibodies appeared to last longer, and were better tailored to suit all COVID variants. They then explained that the new BA.4/BA.5 shot produced similar patterns of immune response in mice that had been genetically modified to make human-like cell receptors. 

Those results build on several years’ worth of data on variant-specific shots, points out Pei-Yong Shi, an expert in vaccine development and virology at the University of Texas Medical Branch. “The companies have tried multiple modified sequences before,” he says. Moderna and Pfizer made shots for both the Beta and Delta variants that went through human trials.

“I’m totally in support of this recommendation of bivalent boosters,” Shi adds. “I think we can always say we want more clinical data, but if that’s the case, we’re always playing the catch up game.”

Govind Persad, a bioethicist at the University of Denver’s Sturm College of Law, says it’s important not to confuse uncertainty about efficacy with that about safety. “I think there’s reason to be uncertain about whether there’ll be big bumps in efficacy from these BA.5 boosters,” he explains. “But I don’t think there’s much, if any, reason to be worried about there being any new scary side effects.”

Wharton, of the CDC, told the expert panel that similar data is used to roll out flu vaccines. “Every year, we approve new influenza vaccines with new strains without clinical data,” she said. The CDC also warned that delaying a variant-specific booster would result in a human toll. Agency scientists presented COVID transmission models that estimated 37,000 additional hospitalizations and 9,000 more deaths from the virus in the US, if the bivalent boosters weren’t made available for another two months.

Despite widespread reservations about the lack of updated clinical data, the independent advisory panel voted 13-1 to recommend the shots. Sarah Long, a pediatric infectious disease expert at Drexel University College of Medicine, said she was ultimately swayed by the fact that the BA.1 and BA.4/BA.5 vaccines both targeted relatively similar strains of Omicron. “It’s the same scaffolding, the same roof,” she explained. “We’re just putting in new dormers and windows.”

What does this mean for boosters going forward?

At last week’s hearing, CDC and FDA officials said that they hoped the updated vaccine would simplify the confusing process for COVID boosters approval and eligibility. Going forward, it doesn’t matter how many shots a person has received in the past, or what risk group they’re in: Almost all boosters will be bivalent, and almost anyone who is two months out from their most recent vaccine will be eligible.

The exceptions are children between ages 6 months and 5 years, who aren’t yet eligible for any booster, and those ages 5 to 11. Last week Pfizer told CDC advisors that it would apply for FDA authorization of the bivalent booster for that second age group in early October.

[Related: How do vaccines affect periods? A big COVID survey lays out some clues.]

According to a presentation by the CDC’s internal COVID vaccine working group, one effective strategy moving forward may be to follow the flu vaccine’s example and issue annual updates to the boosters.

“I think there’s a lot to be learned from the flu,” says Shi. “But of course, we have to be cautious. This is not the flu.” Countries will need to monitor for new mutations every week or every month, and track real-world outcomes of COVID patients, he notes, to understand how future variants interact with the bivalent vaccine.

Persad adds two other elements he’d like to see from future booster updates. “People keep insisting that you had to do this based on mouse data because the human trial would have taken too long. I really challenge whether it has to take so long,” he says. He wonders if either federal incentives for human trials, or accelerated screening for vaccines with safety data could be possible. He also stresses that the CDC and FDA should “really understand what the obstacles are among people who got their initial vaccine, but haven’t gotten a booster.” Only half of eligible Americans are boosted, and getting the new shot to individuals who need it will be an ongoing challenge.

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The Food and Drug Administration (FDA) has authorize Pfizer-BioNTech and Moderna’s new bivalent COVID-19 booster shots. The new vaccines, which the FDA will also call “updated boosters,” contain two messenger RNA (mRNA) components: one targets the original strain of the virus and the other targets omicron’s extremely contagious BA.5 subvariant that is currently responsible for the majority of COVID-19 infections.

The Pfizer-BioNTech vaccine booster is available to anyone 12 and older at least two months after a completed primary vaccination or those who received the third booster shot that only targets the original strain, like the previous boosters from 2021.

[Related: Omicron-specific COVID vaccine approved in the UK.]

The Moderna vaccine is available to anyone over 18 at least two months after the first two doses or if you received a third shot without the booster.

It is important to check vaccination records or with a healthcare provider with any questions about when to receive a booster.

The move comes before the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) meeting, amidst concerns over waning immunity and a potential fall and winter surge of the virus.

“The COVID-19 vaccines, including boosters, continue to save countless lives and prevent the most serious outcomes (hospitalization and death) of COVID-19,” said FDA Commissioner Robert M. Califf in a press release. “As we head into fall and begin to spend more time indoors, we strongly encourage anyone who is eligible to consider receiving a booster dose with a bivalent COVID-19 vaccine to provide better protection against currently circulating variants.”

Last week, federal health officials noted to The New York Times that they are eager to deliver updated boosters as quickly as possible, pointing to a death toll that averages about 450 Americans per day. That number could rise in the coming months when the weather gets colder and people spend more time inside.

On August 15, Great Britain became the first country to authorize a bivalent vaccine, where half of a dose targets the original COVID-19 strain and the other half targets BA.5. The vaccine is updated version of Moderna’s original COVID vaccine and generated a good immune response to these two variants, as well as the BA.4 and BA.5 subvariants in adults, in clinical trials.

The FDA asked vaccine manufacturers to tailor new shots that target the two dominant subvariants (BA.4 and BA.5) this past June, adding that the regulatory group would not require studies testing the shots in humans for the vaccines to be authorized. This process is similar to how how annual changes to flu vaccines are handled, as the influenza virus is constantly mutating.

The Biden administration is currently planning a vaccine campaign roll out set to begin after Labor Day.

[Related: If you’re unsure about getting the COVID-19 vaccine, read this.]

According to the FDA, The mRNA in these boosters is a specific piece of genetic material that instructs cells in the body to make the distinctive “spike” protein of the original virus strain and the omicron variant lineages BA.4 and BA.5. The spike proteins of BA.4 and BA.5 are identical.

“We are confident in the evidence supporting these authorizations,” said Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research in a press release. “The public can be assured that a great deal of care has been taken by the FDA to ensure that these bivalent COVID-19 vaccines meet our rigorous safety, effectiveness and manufacturing quality standards for emergency use authorization.”

Correction: A previous version of this post said the FDA decision followed the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP). The CDC committee will be held on September 1.

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At-home tests have been a critical tool in humanity’s efforts to stop the spread of COVID-19. You may have purchased some at your local drugstore, or ordered them for free through the program the US government launched in January. But they may expire by the time you show symptoms.

The good news is that the Food and Drug Administration—the agency responsible for authorizing COVID tests—is constantly using new data to extend the shelf life of these useful products. This means the ones you have at home may be good for up to 14 months beyond the expiration date on their packaging. All of this information is on the FDA’s website, but you’ll need some guidance to navigate it. 

If the expiration date on your test is long gone, go to the FDA’s list of authorized at-home COVID tests and check the database at the bottom of the page. You can use the search bar by entering your test’s make and model, or you can display all the entries on the list by clicking the dropdown menu on the right and selecting Show all entries. At the time of writing, the FDA has authorized only 22 tests in the US, so displaying the entire list won’t force you to scroll ad nauseam.

[Related: This week is the last chance to order free at-home COVID tests]

Next, find your test. A previous version of this database only had the names of the tests in the first column, but the FDA has since included some visual aids in the form of thumbnails showing the packaging for each test. This makes it easy to see which entry corresponds to what you’ve got at home, and you can scroll down the list until you find the right box. When you do, confirm the make and model of your test match the entry.

On each entry, you’ll find all sorts of useful information for each test, including who can use it, what kind of sample it requires, and how long it takes to get results. The information you’ll need to find out when a COVID test expires is in the last column, all the way to the right, under Expiration date. There, you’ll see the shelf life of the test, and whether it has been extended. If it has, you’ll see the word (extended) right next to it, and a link to a PDF with a list of all the updated expiration dates. 

If your test’s shelf life has been extended, you’ll need to confirm that extension applies to the specific group of tests (the lot) yours comes from. Open the PDF to find a list with three columns: from left to right, you’ll see lot numbers, original expiration dates, and extended expiration dates. To find your test’s lot number, you’ll need to look at the box—you’ll most likely find this six-digit number on the back or one of the sides, usually on a sticker next to the word LOT. 

Go back to the PDF and use your browser’s “find” function to locate the lot number: if you’re using a Mac computer, hit Cmd+F, and if you’re a Windows user, press Ctrl+F at the same time. On the emerging search bar in the top right corner of the browser screen, type in your test’s lot number. Your browser should automatically scroll down to where the number is and highlight it. Note that the original date (middle column) matches the date printed on the box, and then look at the third and last column to see the real expiration date. If that hasn’t passed yet, you’re good to swab away—hopefully, the test comes out negative. 

If your lot number is not on the list, you should abide by the expiration date printed on the box. And if that’s already in the past, the FDA says the test may provide inaccurate or invalid results, so you should throw the test away and get a new one. 

With the first testing method, manufacturers just let a batch of tests sit for a period of time (seven, 13, or 19 months), and then see if the tests still perform as well as they did when they were fresh out of the factory. This method is the most reliable way of ensuring tests work properly, but it’s slow because it requires actual time to pass before manufacturers can, well, test the tests. 

[Related: You can, and should, order more free COVID tests from the US government]

But back at the peak of the COVID-19 pandemic, we couldn’t wait nearly two years to be sure tests were up to standard, so manufacturers used accelerated stability testing. This method consists of storing a batch of tests for a shorter period of time at a high temperature and then checking whether they’re still performing accurately. Tests are made to work ideally between 59 and 86 degrees Fahrenheit (15 and 30 degrees Celsius, approximately). Extreme temperatures can degrade them more rapidly, mimicking the effect that sitting on a shelf for a long time would have. 

This method was useful early on because it allowed the FDA to approve tests and get them into our homes quickly to help us curb the spread. But because accelerated stability testing is not as accurate as just letting time pass, the agency only gave tests a four- to six-month shelf life that could be updated once manufacturers provided more data on stability. 

That is what’s happening right now, and we may continue to see extended expiration dates for at-home COVID tests as more time goes by. For now, though, make sure you check the FDA website before you toss your tests, and take precautions to protect others if you need to go to a public space to get a new test. 

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The federal government is pausing its free COVID-19 test kit program citing a lack of funding. According to the government’s website, “Ordering through this program will be suspended on Friday, September 2 because Congress hasn’t provided additional funding to replenish the nation’s stockpile of tests.”

Free tests can still be obtained at several federally-funded community sites (libraries, museums, pharmacies, etc.), community health clinics, and both public and private health insurance plans will reimburse the cost.

A senior Biden administration official spoke with USA Today on condition of anonymity, as this update has not been publicly announced. The official said that the administration would work “within its limited existing resources” to secure as many additional tests as possible. However, he official did not say how many tests were left in the government’s stockpile, but did tell USA Today that testing distribution could “expeditiously resume” if Congress provides funding. Up to 600 million free tests have been delivered, according to the official.

[Related: Why aren’t daycares testing kids for COVID?]

The free home testing program first began in January, as the Omicron strain tore through the country. Households could order up to 16 tests, with the most recent ordering period in May. COVID-19 funding from the $1.9 trillion American Rescue Plan signed by President Biden in 2021 were used to help fund it and the tests were delivered via the US Postal Service. In March, the White House asked for up to $22.5 billion in new funding to pay for COVID-19 research, therapeutics, tests, and updated vaccines. Senate Republicans would not authorize any new money until the government could account for previous COVID relief money.

The lack of congressional funding could also thwart the rollout of new COVID vaccine boosters that target Omicron, expected to begin as soon as next week. This puts the country at risk if a feared fall and winter COVID surge hits in the coming months. It also comes as other federal efforts to cover free COVID-19 testing are winding down and federal guidance is shifting. The Centers for Disease Control and Prevention’s Operation Expanded Testing will stop offering free lab tests to places like schools and shelters at the end of 2022.

[Related: With COVID-19 ‘here to stay,’ CDC loosens most guidelines.]

Before the program launched, the United States lagged well behind other countries as far as free testing. By January, Britain’s National Health Service had already distributed 1.7 billion free rapid home tests (in a country of 67 million). Additionally, in Singapore, six antigen tests were mailed to every household in in late summer 2021, tests were readily available in pharmacies, and at a low cost. In India, rapid tests cost as little as $3, compared to about $20 in the United States.

Tests can be ordered through Friday September 2 or until supplies run out. For even more details on how to get those last tests, when to expect them in your mailbox, and how to properly administer a self-test, check out this guide.

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As the world heads into another COVID-19 fall and winter, new data from the Brookings Institution sheds some insight on the effects of long COVID. According to the Centers for Disease Control and Prevention (CDC), long COVID covers a wide range of symptoms that persist for weeks to even years after initial COVID infection, such as headaches, “brain fog,” chest pain, and more.  The World Health Organization (WHO) defines long COVID as a condition in those who had a probable or confirmed COVID-19 diagnosis within three months, symptoms that last at least two months, and can’t be explained by another diagnosis.

An estimated 10 to 50 percent of those infected with COVID-19 will experience long COVID. A new Brookings report released on August 24 finds that anywhere between two and four million Americans are currently not working due to the effects of the mysterious disease. The new report builds on one from January that estimated long COVID is contributing to the country’s labor shortage by 15 percent. 

Brookings used new data from The United States Census Bureau’s Household Pulse Survey (HPS), a survey that is designed to gather and implement data quickly and efficiently. In June, the bureau added four questions about long COVID to the questionnaire, which gave researchers up to date date on the condition’s prevalence. A recent study from the Federal Reserve Bank of Minneapolis also corroborates numbers gathered by the HPS.

[Related: Long COVID can manifest in dozens of ways. Here’s what we know so far.]

“Critically, this number does not represent the full economic burden of long COVID, because it does not include impacts such as the lower productivity of people working while ill, the significant health care costs patients incur, or the lost productivity of caretakers,” wrote Brookings senior fellow Katie Bach. Including those factors, long COVID could cost an additional $544 billion annually, according to calculations from Harvard University economist David Cutler who reviewed to the report.

Brookings also finds that this experience is consistent with those of comparable economies. They cite a speech in May from a former Bank of England representative who stated that labor force participation has dropped by around 1.3 percent across the entire 16 to 64 year-old population and that long-term illness is causing the greatest impact.

[Related: The long road back to fitness after COVID.]

“If long COVID patients don’t begin recovering at greater rates, the economic burden will continue to rise,” added Bach. They estimate that if the number of Americans infected long COVID increases by just 10 percent each year, the annual cost of lost wages will amount to half a trillion dollars in 10 years. “These impacts stand to worsen over time if the US does not take the necessary policy actions,” the Brookings authors said.

At the end of the report, it highlights the five “critical interventions” that should be taken to best mitigate the macro and microeconomic effects of long COVID, including: better prevention and treatment, expanding paid sick leave, improving workplace accommodations, widening access to disability insurance, and enhancing data collection. 

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Just one year after the coronavirus pandemic began, vaccine researchers finished the first formulas that could protect people against SARS-CoV-2. Since then, more than 12 billion doses of various COVID vaccines have been administered around the world, largely in adults from 18 to 65 years old.

Now, the global COVID vaccination rollout is shifting as several countries turn their attention to immunizing children. In October 2021, the US Food and Drug Administration authorized the Pfizer and Moderna shots for Americans between the ages of 5 and 1; it then green-lit vaccines for kids younger than 5 after considering new clinical trial results this June. About 862,000 individuals in that last category got at least one dose of a COVID vaccine this summer.  

Other governments, including the UK, Canada, France, and Germany, have opened up COVID vaccinations to children in the past year. India, for instance, moved Bharat Biotech’s homegrown Covaxin vaccine forward for restricted emergency use in children aged 6 to 12 years this April.

[Related: Just had COVID? Here’s when you should get a booster.]

Even though studies suggest that risk of death or severe disease from COVID is low among young people, inoculating them against SARS-CoV-2 could significantly reduce the spread of the virus and any new variants. And while children’s COVID vaccination rates are rising globally, health experts say there should be more campaigns targeting Africa, where the world’s youngest population lives. The mean age across the continent is 19.7 years; more than 540 million of the children are younger than 14.

So far, 23 out of 54 African nations have vaccinated some youth against SARS-CoV-2. Africa’s most populous country, Nigeria, has only authorized the shots for children who are 16 and 17 years old, specifically for educational and international travel purposes. “That allowance is very small, so essentially, it’s still 18 and above,” Nadia Sam-Agudu, a pediatrician who works in Nigeria, says. Meanwhile, South Africa, which has a population of more than 60 million people, was among the first to begin vaccinating kids between ages 12 to 17 years last October. Smaller governments like Burkina Faso, Eswatini, Rwanda, and Togo have found traction as well—in all, nearly 18 million young people have been immunized on the continent, the World Health Organization (WHO) Regional Office for Africa reports.

Sam-Agudu, who is part of the Institute of Human Virology at the University of Maryland School of Medicine, emphasizes that it’s crucial to vaccinate children in Africa before they’re seriously ill and need medical attention. “It’s important to have a good COVID-19 vaccination coverage in the light that it’s a pandemic and newly emerging pathogen. We don’t know what it’s coming down the line—we’ve seen enough of what it can do,” she adds.

In a study published this January in the Journal of the American Medical Association Pediatrics, scientists from the African Forum for Research and Education in Health COVID-19 Research Collaboration on Children and Adolescents found that hospitalized youth across the continent are at higher risk of death and severe disease from the virus than those in high-income countries. The authors identified the lack of access to intensive care units, testing, and treatments as a major reason.

COVID vaccines could make a difference. Sam-Agudu says African countries that have not immunized children yet should consider “scaling and approving” the shots. “This is the time that we need to mobilize and make sure that children, including pregnant women, are vaccinated. We should not be complacent,” she notes.

[Related: It’s harder for kids with food allergies to catch COVID]

Although nations like the US have donated vaccines to Africa through the COVAX initiative, if the formulas are not widely approved for children on the local level, they will not reach the scale of the continent’s population. When developing COVID vaccination programs for adolescents, WHO recommends each country consider the benefits in their specific epidemiological and social context. But disease researchers and COVID policy advisers say this puts the responsibility on African governments to conduct their own resource-intensive research to guide decision-making.

Phionah Atuhebwe, the vaccines introduction medical officer at the WHO Regional Office for Africa, backs the individual approach. “Although severe COVID-19 is rare in children, it does occasionally occur. In some cases, vaccinating them is particularly important,” she says. She notes that the WHO Strategic Advisory Group of Experts on Immunization states that kids older than 12 who are at higher risk for severe COVID should be offered an mRNA vaccine, along with other priority groups.

While scientists and public health experts look for better ways to protect people against COVID in the long term, their plans and protocols will need to focus on boosting immunity in all ages, in as many parts of the world as possible. It’s the only way to beat a global disease.

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Health officials in the UK have just made the country the first to approve a new bivalent COVID-19 vaccine that targets both the omicron variant and original virus. The Biden administration is currently working on its own booster campaign for next month and the Food and Dug Administration (FDA) has received assurances from both Modern, Pfizer, and BioNTech that doses of the re-tooled vaccine will be available by September. 

Massachusetts-based pharmaceutical company Moderna developed the booster, which was approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) after it was found to meet regulator’s standards of safety, quality, and effectiveness. As of late July, Moderna said that it has secured 66 million doses of a vaccine that targets both the 2020 strain of the virus and the new sub-variants.

“The first generation of COVID-19 vaccines being used in the UK continue to provide important protection against the disease and save lives. What this bivalent vaccine gives us is a sharpened tool in our armory to help protect us against this disease as the virus continues to evolve,” said June Raine, MHRA Chief Executive, in a press release. “We have in place a comprehensive safety surveillance strategy for monitoring the safety of all UK-approved COVID-19 vaccines and this will include the vaccine approved today.”

[Related: Moderna is testing an Omicron-specific COVID vaccine. Here’s how it’s faring.]

Half of each dose targets the original virus with the other half targeting the highly contagious omicron variant.  According to the MHRA, the new formula was effective against omicron sub-variants BA.4 and BA.5 in clinical trials. BA.4 and BA.5 are currently the dominant strains of the virus and a study published in the June 2022 issue of Cell shows that the two have a strong ability to escape the antibodies built from previous vaccination.

While worldwide case numbers are not as high as winter 2021-2022, the World Health Organization (WHO) has been reporting huge numbers of fresh cases throughout the summer, due in large part to these highly contagious sub-variants and waning immunity from vaccination or previous infection. The new bivalent vaccines could help stem a possible fall and winter surge that could potentially lead to 100 million infections. 

According to data complied by The Washington Post, about 330 million Americans have been fully vaccinated and the infection rate stands at around 266 new infections per 100,000 people over the past week. In Britain, close to three quarters of the population have been fully vaccinated.

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Yesterday, The Centers for Disease Control and Prevention (CDC) announced a loosening of its COVID-19 guidelines. The new guidance moves further away from the nationwide lockdown strategies of the past and focuses more on individual actions. 

“We know that Covid-19 is here to stay,” CDC epidemiologist Greta Massetti said in a news briefing on Thursday. “High levels of population immunity due to vaccination and previous infection, and the many tools that we have available to protect people from severe illness and death, have put us in a different place.”

One of the biggest changes in this update is that schools and businesses no longer have to sceen non-symptomatic students and employees. This can end the controversial test-to-stay policies implemented by school districts nationwide. Instead, the CDC recommends that students exposed to COVID-19 could test regularly, as opposed to quarantining at home, to keep attending school in person. 

Additionally, early COVID prevention and social distancing standards like the six-feet apart rule is no longer required.

[Related: The ultimate guide to reusing and buying N95 masks.]

Quarantine rules for adults have also changed—those exposed COVID-19 are no longer expected to quarantine. Instead, it is recommended that they wear a high-quality mask around others for 10 days.

Unvaccinated individuals who test positive for COVID-19 are recommended to follow the same quarantining procedures as those who are up to date on vaccines (quarantining for five days and wearing a high-quality mask around others for 10).

The revised guidance follows the update from December 2021 that shortened the quarantine guidelines from 10 days to five. The agency is still recommending that individuals who test positive for the virus stay home for five days, keep away from others, and wear a high-quality mask for five days after leaving isolation.

These new guidelines underline the CDC’s emphasis on vaccination and treatment options, instead of preventing individual cases. 

“We’re in a stronger place today as a nation, with more tools—like vaccination, boosters, and treatments—to protect ourselves, and our communities, from severe illness from COVID-19,” said Massetti in a press release. “We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation.  This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”

Since arriving in the United States in 2020, COVID-19 has killed more than one million people. 42,000 people are hospitalized with the virus and the daily death toll is close to 500 currently, according to numbers from the Washington Post. These new rules may be troublesome for future outbreaks. Another surge of cases this fall and winter is entirely possible, a new variant could emerge at any time, which could call these new guidelines into question. 

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Two years into the pandemic, and political leaders are finally taking strides towards understanding the complexities of long COVID. The Biden administration released two reports last week on August 3 that address the government’s plan to advance research towards the prevention, diagnosis, and treatment services of long COVID. But for the estimated 7.7 to 23 million people currently living with longer-term symptoms and health complications from COVID, the time it takes to recover fully is still unclear. 

“The short answer is it’s a bit up in the air,” says Scott Roberts, an infectious disease specialist at Yale Medicine. 

In 2020, the Centers for Disease Control and Prevention (CDC) initially reported that nearly 35 percent of people infected with COVID-19 take 2-3 weeks for symptoms to go away after testing positive. But new data now estimates that 13.3 percent—nearly one in ten people—who recuperate from illness will take a month to resolve their symptoms. For people with more severe infections, such as those needing hospitalization, the CDC says that 2.5 percent are predicted to have lingering side-effects, including but not limited to difficulty breathing, muscle pain, and trouble concentrating, for three months or more. 

Some scientists argue that certain individual cases will take longer to become healthy again. Over three-fourths of hospitalized COVID-19 patients in Wuhan, China showed prolonged symptoms of fatigue, muscle weakness, and sleep problems six months after discharge. A 2022 study found that one in four people took a year to fully recover from long COVID. A number of grim scenarios suggest that some people may live with long COVID for the rest of their lives. A July 2022 review of past studies of people with long COVID symptoms suggests nearly six percent of people will never recover their sense of smell and taste.

[Related: Long COVID can manifest in dozens of ways. Here’s what we know so far.]

One reason ‌why recovery times are so difficult to estimate is because COVID-19 infections affect multiple organs in the body. “When a virus damages the body in multiple ways, you’re going to have different timelines for recovery,” says Shruti Gohil, an assistant professor of infectious diseases and associate medical director at the University of California, Irvine. For example, she says an injured nerve is going to take more time to repair than an upper respiratory tract that’s causing congestion.

Another issue is that we still don’t know what’s causing long COVID in the first place. Infectious disease experts, however, have identified some possible leads: Gohil says long COVID symptoms may be the result of the body’s overactive immune response when fighting the virus. Widespread inflammation from such a response may cause collateral damage to nearby organs and tissues. 

Another prominent theory is that small, undetectable numbers of the virus are able to survive, says Sritha Rajupet, the primary care lead for the Post-COVID Clinic at Stony Brook Medicine. Rajupet explains that these persistently low viral particles might hide within nerves and tissues, causing the body to maintain a chronic inflammatory response. Another explanation is that the body could be exhibiting an abnormal immune response where it still thinks it’s fighting the initial infection. Roberts says one less popular but plausible cause is that an infection creates a hypercoagulable state, a condition that leads to increased micro blood clots from blood vessel damage, which could explain shortness of breath in people with long COVID.

[Related: The long road back to fitness after COVID]

The data is also unclear on who is more likely to endure long COVID for weeks versus months. Rajupet explains that recovery rates could depend on a person’s symptoms, age, and overall health. For instance, she says individuals with severe COVID-19 symptoms or multiorgan problems during infection are susceptible to developing other conditions involving the heart, brain, or even diabetes. People who are older or immunocompromised may also have a hard time recovering from any damage to the body, which could lead to persistent symptoms after infection. 

One thing all experts are sure about: vaccination helps. Research suggests vaccinated individuals with breakthrough infections were nearly half as likely than infected unvaccinated individuals to report long COVID symptoms at least four weeks after infection. However, the role of vaccines in long COVID is still up for debate. There’s other preliminary research to suggest that vaccines only help long COVID symptoms somewhat or not at all. A May 2022 study in Nature Medicine reported the vaccines only reduced the longer-term risk by 15 percent. 

Infectious disease experts are still trying to unpack if vaccination, even during long COVID, can help with symptoms, says Roberts. “There’s just a lot of unknowns,” he says. “It’s an ongoing science that I imagine over time, we’ll get more data about what is going on and hopefully how to prevent and treat it.”

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When the first round of COVID vaccines were authorized in December of 2020, they were developed in record time, due in large part to a flood of public funding that sped up the clinical trial process. They also far exceeded expectations for preventing disease and death—the White House estimates that two million lives have been saved by vaccines so far. But as SARS-CoV-2 has adapted to a population with widespread immunity, the vaccines have proven poorly equipped to stop transmission of variants like BA.5, and their efficacy has waned among the elderly, requiring repeated boosters.

At a White House summit on July 26, called “The Future of COVID-19 vaccines,” the Biden administration brought together pharmaceutical leaders, disease researchers, and federal public health officials to figure out next steps. The aim of the summit, top White House advisors said, was to chart a roadmap to vaccines that could resist variants and halt, rather than blunt, coronavirus transmission.

“That’s the holy grail,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, and the White House Chief Medical Advisor. “Durability, breadth, acquisition, transmission.”

However, the summit didn’t come with concrete proposals on how to accelerate the development of those tools. “In order to make that a reality, there’s a tremendous amount of work,” said Ashish Jha, the White House COVID-19 Response Coordinator. “This administration is fully committed to doing that work.”

“I hope that they invest the resources that are needed for Operation Warp Speed 2.0,” says Michal Tal, an immunologist at Stanford University who has studied variation in COVID-vaccine responses. “We’ve needed to launch that as soon as Operation Warp Speed 1.0 was rolling.”

A vaccine for many viruses

The US vaccine strategy at present involves requesting that vaccine manufacturers like Pfizer and Moderna tweak their mRNA formulas to more closely resemble the mutated spike proteins of the BA.4/BA.5 variant. But because those updated shots need to go through the clinical approval process, they likely won’t be ready until this fall.

However, because the latest Omicron variants emerged just a few months apart, it’s very possible that BA.4 and BA.5 will no longer be dominant by then. “I feel like we’re chasing a ghost,” Tal says.

One strategy discussed at the summit involves developing a pan-coronavirus vaccine. The idea is that a vaccine could spark an immune response that would target a common feature of all SARS-CoV-2 variants, or even all SARS-like viruses. One approach to that, outlined by Sandeep Reddy, the chief medical officer of the pharmaceutical company ImmunityBio, which is entering Phase 3 trials for a vaccine in South Africa, is to train immune cells to recognize not just the spikes of a coronavirus, but the internal machinery that lets the virus reproduce.

From shots to sprays and pills

So far, existing vaccines have been durable at preventing severe illness and death in the face of new variants. That means a pan-coronavirus vaccine might be useful against a radically different variant or a novel virus, but it won’t necessarily stop the spread of existing variants.

To do that, immunologists have increasingly pointed towards the need for vaccines that provoke an immune response in the mucosal linings of the throat, mouth, and nose. “This is where the actual battle rages day to day,” Tal says.

While injected vaccines have been very successful at triggering antibodies in the blood and protecting vital organs, mucosal tissues are defended by an entirely different type of antibody. Research co-authored by Tal shows that injected COVID vaccines did produce fleeting mucosal antibodies in some people, and the presence of those antibodies made a person less likely to experience a breakthrough infection. The results suggest that a vaccine specifically designed to hit mucosal tissue might be particularly effective at stopping SARS-CoV-2 transmission.

Pharmaceutical companies are pursuing that goal in a number of ways, the most common being a nasal spray vaccine. Akiko Iwasaki, a professor of immunology at Yale University and a panelist at the summit, founded a firm that’s specifically investigating whether mRNA boosters can be given through the nose. A team led by NIAID scientists also investigated delivering the AstraZeneca vaccine nasally, which reduced viral shedding in hamsters and monkeys. But another biotech group, the US-based Vaxart, is running clinical trials on a vaccine pill aimed at activating mucosal immunity in the lining of the gut.

A number of immunologists pointed to success with the AstraZeneca nasal FluMist vaccine. In the early 2010s, federal regulators actually recommended it over flu shots for children, Marty Moore, chief scientific officer of Meissa Vaccines, pointed out during a panel. “It was more durable, it could reduce transmission—these are the principles of mucosal immunization that we’re aiming for.” It did decline in popularity and use after manufacturing problems, but Tal says that had to do with the challenges specific to a key ingredient: live, weakened flu virus.

“Every year that it’s been available, I have found out where it’s being sold and driven my whole family to get FluMist because we know that when it works, it works,” she says.

How to approve new shots

During the summit, Fauci and the other panels flagged the challenge of testing any new vaccines in the context of widespread exposure to COVID. It’s much harder to know how effective any vaccine candidate is when most potential trial subjects have already been sick or immunized.

The National Institutes of Health, among others, are working on determining what are called “correlates of protection,” or markers of a renewed immune response in blood, saliva, or elsewhere, to measure how strongly a person responds to a vaccine. The correlates are already used to select each year’s flu vaccine.

“I think one of the most important and really pressing issues is identifying correlates of protection that regulatory agencies would be willing to accept for approval,” said Reddy. “What’s the goalpost we need to hit? If that was known, that would make it very easy to design those trials.” That’s a point that Food and Drug Administration advisors have raised in recent meetings as well, and will likely come up again as these COVID vaccine discussions continue through 2022.

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Since the COVID-19 vaccines first began rolling out last winter, some recipients have noticed unexpected menstrual bleeding after getting the shots. A survey of tens of thousands of adults published today in the journal Science Advances confirms that this experience is relatively common.

“We think it’s really important to be clear and honest and responsive when something like this does come to the forefront, and so we want to reassure people that this is something that might happen, it should be transitory, it should be a short-term effect,” says Katharine Lee, a biological anthropologist at Tulane University. “The main takeaway is that this is a real factor, and it shouldn’t scare people away from the vaccine.”  

She and her collaborators surveyed a gender-diverse group of more than 39,000 pre- and post-menopausal people around the world. Forty-two percent of participants with regular periods bled more heavily than usual after vaccination, while 44 percent reported no change. 

These numbers aren’t meant to be indicative of how prevalent such irregularities are in the general population, the authors note. “But the information we have about the characteristics of folks within that sample being more or less likely to experience this are still very, very useful and valuable,” Lee says.

[Related: COVID deaths in pregnant people in the US are flying under the radar]

She and her collaborators became curious about the COVID-19 shots’ effect on menstruation after several of them experienced unexpected bleeding. “We decided to look into this a little bit more because so many people were starting to talk about it on social media, and we thought it was important to capture and start to understand what was happening,” Lee says.

“This is in fact a real lived experience, there are real biological mechanisms that would underpin and predict a finding like this, and we shouldn’t be surprised that the uterus, which is an immune organ, is going to be impacted by an immune treatment like the vaccine,” says Kathryn Clancy, a biological anthropologist at the University of Illinois at Urbana-Champaign and another coauthor of the findings.

“The uterus as an organ is already very closely tied to the immune system,” she explains. The uterus must be able to contend with pathogens from outside the body while also allowing sperm and embryos to survive. “It’s not quite ‘open for business,’ but the cervix is not like a full barrier; there has to be some way in which the uterus is doing something to fight infection,” Clancy notes. 

Menstruation itself is also an inflammatory process. “Any system in the body that … has to repair itself many times or that is in any way connected to the immune system has a chance of having some kind of transient side effect associated with something like a vaccine,” Clancy says.

[Related: How to track your period—without an app]

The team released a web survey in April 2021 as vaccines were reaching widespread distribution in the US, hoping for 500 to 1,000 responses. “We had more than that within the first hour or two of the survey being open,” Lee says. “I think there was really a huge need for people to want to share these experiences, because people don’t normally get to talk about their periods; it’s sort of a taboo subject to bring up.”

The researchers ultimately focused their analysis on 39,129 respondents who were adults, fully vaccinated, and hadn’t caught COVID-19. Among participants who regularly menstruated, the proportion who experienced unusual bleeding was similar to those who noticed no change. A small minority also reported lighter periods. Among those who don’t typically menstruate, 71 percent of people on long-acting reversible contraceptives such as the IUD, 39 percent of people on gender-affirming hormones, and 66 percent of postmenopausal people reported breakthrough bleeding. 

Respondents who were Hispanic or Latinx, had a diagnosed reproductive condition such as endometriosis, had been pregnant or given birth in the past, or experienced fever or fatigue after vaccination were all more likely to report heavier menstrual flow than their peers. The type of vaccine didn’t seem to have an effect either way.

“I’m glad this innovative research on menstrual health is being conducted,” Leslie Farland, an epidemiologist at the the University of Arizona Mel and Enid Zuckerman College of Public Health who has studied how SARS-CoV-2 infection can influence menstruation, said in an email. “Traditionally, the emphasis in vaccine surveillance has been on pregnancy and fertility with little emphasis on gynecologic or menstrual health.” 

Clancy suspects that menstrual irregularities following vaccination are much less prevalent in the population at large than in the researchers’ sample. Individuals who noticed some kind of menstrual change following vaccination were probably more likely to take the survey than those who didn’t. Had pharmaceutical companies conducting vaccine trials recorded data on menstruation, Clancy notes, they might have been able to capture the effect across a broader swath of people than was possible with a survey. 

Changes to menstrual bleeding generally aren’t uncommon, dangerous, or indicative of changes to fertility, the researchers emphasized in the paper. COVID-19 vaccines are safe to receive while pregnant or breastfeeding and there is no evidence that vaccines of any kind harm a person’s fertility, according to the Centers for Disease Control and Prevention. Infection with the novel coronavirus itself, however, can cause fertility problems.

[Related: The truth about COVID, vaccines, ED, and fertility]

Nonetheless, it’s important to understand how vaccines might affect menstruation so that people aren’t caught unaware. 

“This unexpected bleeding runs the risk of psychological distress for those who experience gender dysphoria with menstruation and physical harm for people for whom managing menstruation in public is dangerous,” the researchers wrote in the paper. Breakthrough bleeding among postmenopausal people can also be an early sign of cancer, they said. “When possible side effects to a medical treatment are not shared with the clinical or patient population, it may lead to unnecessary, painful, and expensive diagnostic procedures.”

Many people who filled out the questionnaire felt that their healthcare providers brushed off their concerns. “One of the things we found really compelling as we started reading the free responses in our study was the number of people who felt betrayed, whose trust was reduced, who were really hurt by they kinds of experiences they had when they tried to tell people they had this increased bleeding and then people dismissed their experience,” Clancy says. 

Recognizing the impacts of vaccines on periods will help bolster trust between people who’ve experienced them and healthcare providers, she and her colleagues concluded. The team is now conducting a follow-up survey to determine how long changes persisted after vaccination.

The COVID jabs aren’t the first immunization to be linked to anomalies in menstruation, Farland wrote in her email. “It is my hope that in the future, information on changes to the gynecologic and menstrual health should be collected regularly as part of vaccine surveillance.” 

Amelia Wesselink, an epidemiologist at the Boston University School of Public Health whose work has indicated that COVID-19 shots and other vaccines don’t impair fertility, described the new study as an important first step. 

“Because menstrual health is not evaluated in vaccine trials, we lack any systematic data on post-vaccine change,” she said in an email. “This type of survey, designed to listen to the experience of menstruating people, is essential in developing hypotheses for future research.”

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The US is adding a new COVID vaccine to its pandemic toolbox. On July 13, the Food and Drug Administration gave emergency use authorization to Novavax’s COVID-19 shot, making it the fourth brand of vaccine cleared for use. The two-dose vaccine, which was already available in 170 countries, is only authorized for Americans 18 years and older who need their first immunization series.

Novavax’s COVID-19 vaccine is coming at a time when the US faces a lag in vaccination. As of July, 78.4 percent of the population has received at least one dose, and only 67 percent is fully vaccinated. What’s more, the rapid spread of multiple Omicron variants— BA.5 now makes up nearly 70 percent of coronavirus cases—has accelerated interest in variant-specific vaccines. On June 30, the FDA voted to change the formulation of the next set of COVID-19 boosters to include components of Omicron BA.4/5 for extra protection.

Novavax’s vaccine, though it arrives more than two years into the pandemic, is expected to boost vaccination rates among Americans wary of mRNA technology. In contrast with Pfizer-BioNTech and Moderna, Novavax uses a decades-old vaccine method, widely found in protections against other viruses such as influenza and hepatitis B.

The Novavax COVID-19 vaccine is a protein-based shot. It delivers copies of protein fragments of the virus for the immune system to recognize and destroy. Those protein copies are made in insect cells and packaged into nanoparticles that give off the appearance of a virus. Other ingredients, such as the bark of a South American tree, are included in the nanoparticles to serve as red flags—alerting the immune system to a suspicious character in the body. 

[Related: Omicron variants keep getting better at dodging our immune systems]

Each faux-virus particle is “basically a soap bubble. It’s made of stuff that you find in root beer,” Gregory Glenn, Novavax research chief told NBC Chicago.  “When an immune cell sees that, it becomes quite activated. … We supercharge the immune response.” 

In clinical trials, the Novavax vaccine was 90.4 percent effective in preventing mild, moderate, or severe COVID-19 infections. In people 65 years and older, the vaccine was 78.6 effective. It’s important to note, though, that the data was collected before Delta and Omicron appeared, and the vaccine is based on the genetic sequence from the first coronavirus strain.  

Still, US officials say this immunization will be helpful because it may be an appealing alternative to those who are holding off on getting vaccinated with mRNA vaccines. “Authorizing an additional COVID-19 vaccine expands the available vaccine options for the prevention of COVID-19, including the most severe outcomes that can occur such as hospitalization and death,” FDA commissioner Robert M. Califf said in a statement. 

The Biden-Harris Administration secured 3.2 million doses of Novavax’s COVID-19 vaccines, and like all other COVID-19 vaccines available in the US, the shots will be free of charge. You won’t see a Novavax vaccine offered at your local pharmacy just yet. The director of the Centers for Disease Control and Prevention will need to officially sign off on a recommendation for the two-dose shots, which is expected to happen after a CDC meeting on July 19. 

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In 2020 and 2021, COVID-19 became the third leading cause of death in the US. This May, the country passed the grim milestone of 1 million known COVID deaths. Although fewer people are dying from the virus now than during the height of the Omicron surge this winter or previous waves, new strains have continued to take lives.

As the pandemic drags on, understanding how many people are dying and who is most vulnerable remains crucial for efforts to avert further deaths. To that end, the Centers for Disease Control and Prevention (CDC) recently updated the software it uses to process all of the country’s mortality data. The change, powered by advanced computing techniques like machine learning, could supply health officials and the public with more up-to-date information about the disease. 

“Civil registration of births and deaths and understanding causes of death are really key to a functioning health system,” says Emily Smith, an assistant professor of global health at George Washington University. “There are a lot of ways to use this information.” 

Tracking the leading causes of death in a community and identifying where those deaths are concentrated helps public health officials direct resources, she adds. During a crisis like the COVID pandemic, having prompt information is particularly crucial. But the national statistics system has been slow to process and post mortality figures. When the US passed a million deaths from the virus earlier this year, the CDC’s tracker was still weeks behind.

“Effective epidemic response is getting the right resources—whether that’s drugs or vaccines or prevention programs—to the right people at the right time,” Smith says. “Data helps us do that.” 

The CDC upgrade represents an important step forward. “It’s great to see the US moving ahead with this,” Smith notes. “More transparent, faster data is a great advance.”

Coding COVID-19

For decades, the CDC has relied on computers to analyze death certificates and assign four-digit codes to each report based on the underlying cause so they can be tracked by the National Vital Statistics System. 

However, only about 70 to 75 percent of the country’s death certificates could be coded automatically; the rest were flagged for review, which means a staff member would have to input the cause of death into the system by hand. “When you’re dealing with 2 to 3 million deaths [every year], 25 to 30 percent of records is quite a substantial number and requires quite a lot of resources,” says Robert Anderson, chief of the Mortality Statistics Branch at the National Center for Health Statistics.

The updated cause of death coding system, known as MedCoder, can handle a greater proportion of these records: It currently codes 85 percent of records automatically, and with continued improvements, “has the potential to code better than 90 percent of records,” Anderson says. “These records can be autocoded in minutes, whereas manual review might take a couple of weeks,” he adds. “It just means more information is available in a more timely fashion.”

MedCoder is more adept than past systems at dealing with variations in the terms that physicians, medical examiners, and coroners use to describe mortalities, Anderson explains.  The computer assigns one of 10,000 possible codes for causes of death to a record. For example, when COVID is mentioned on a death certificate, it chooses U07.1. To improve the results, Anderson and his team used machine learning techniques that drew upon a decade’s worth of national death certificate data to train MedCoder to recognize mistakes and other aberrations. So, when a doctor fills out the death certificate with “Coronavirus 2019,” “SARS-CoV-2,” “Delta variant,” or another name for the disease, the computer still codes it as U07.1. “The old system would say, ‘I don’t find that term in the dictionary,’ and kick it out for somebody to look at,” Anderson explains. “[Now] the computer says, ‘Okay, I know what to do with this and what code to assign.”

[Related: AI confirms the pandemic bummed people out]

While installing the upgrades between June 6 to 24, the National Center for Health Statistics paused its processing of death data reported by states and didn’t refresh the COVID surveillance datasets on the National Vital Statistics System’s public page. Counts from weeks earlier in 2022 may temporarily seem low while the system catches up and reprocesses these records, the agency’s website notes. 

“Once we get over this backlog here the system is going to function pretty much the way the old system did,” Anderson says. “I don’t want people to worry that the data that we’re putting out now is not comparable to the data we were putting out before. It is comparable; it’s just going to be a little more timely.”

Mortality numbers matter

It’s unusual for death certificates to mention which variant of SARS-CoV-2 afflicted the deceased person. But looking for patterns in more precise mortality data can help health experts understand how dangerous a new strain might be—and whether extra precautions are needed.

“If deaths are rising it increases the urgency,” Anderson says. “If the data aren’t as timely, then our situational awareness degrades by a week or two or maybe three.” 

[Related: Omicron variants keep getting better at dodging our immune systems]

It’s also possible that having speedier data would have allowed the US to recognize that it had reached 1 million COVID-19 deaths sooner. “Having better real-time data hypothetically should matter on a lot of different fronts,” Smith says. “It matters for public perception; it matters for political will.”

Reported deaths tend to lag behind other warning signs such as a rise in positive COVID tests or hospitalizations. However, these measures can be difficult to interpret. An uptick in hospitalizations can indicate that more people are becoming seriously ill, but might not capture the full scope of the problem because not everybody with severe disease has access to hospitals.

“Those are softer outcomes that incorporate both the severity of the disease and other social and economic factors, whereas death is a hard outcome.” Smith says. “Mortality is the ultimate indicator—it’s black and white.”

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It’s happening again. BA.5, one of close to a half dozen strains of the Omicron variant, now accounts for about half of all COVID infections in the United States. Both confirmed cases and hospitalizations are on the rise, and more than half of all US counties are at medium or high levels of COVID, according to the Centers for Disease Control and Prevention. Could its ability to evade our immune systems drive yet another summer surge?

Forgive yourself for feeling some deja vu. The first strains of Omicron, including BA.1 and BA.2, were discovered in southern Africa in late November 2021. BA.1 had a slight head start in its global spread, and drove the winter wave in the United States; BA.1  drove a minor bump; and BA.2.12.1 followed shortly after that. Although 73 percent of Americans ended up protected against the OG Omicron after the first wave, those following Omicron strains carried slightly different spikes that antibodies, the body’s first-line immune response couldn’t always recognize.

Each of those other Omicron sublineages have caused local outbreaks in the US. And those waves have meant that deaths remain persistently high, with around 300 people dying every day since mid-April.

BA.5, and the closely related BA.4 emerged, in South Africa, before spreading internationally. BA.5 appears to have a transmission advantage in the US, though case counts have become increasingly unreliable diagnostics. Even so, CDC wastewater data show a steady rise in COVID levels since the last week of June. “The US is in a surge, and the question is how much BA.5 will exacerbate that,” says Spencer Fox, associate director of the UT COVID-19 Modeling Consortium at the University of Texas at Austin.

What makes a BA.5 surge different?

While BA.5 is spreading widely, it’s doing so in the context of widespread immunity, making it challenging to predict its course.

“The immunological landscape is getting so complex at this point,” says Fox. “We have people with different combinations of natural infections, vaccine types, and vaccine doses, and timings.” As of February, two-thirds of Americans had caught COVID at least once, and currently, two-thirds have finished a primary vaccine series.

That said, a recent 27-person trial published in The New England Journal of Medicine found that the antibodies of vaccinated individuals are less effective against BA.5 than earlier Omicron strains. “Our data show that BA.5 escapes antibody responses approximately three times more effectively than BA.1 and BA.2, and about 20 times more effectively than the original strain of SARS-CoV-2,” Dan Barouch, an immunologist at Beth Israel Deaconess Medical Center and an author on the study, told PopSci in an email. So even if most of the country has had COVID, it’s reasonable to expect BA.5 is equipped to spread, though perhaps less widely. In South Africa, which experienced the first BA.4/BA.5 wave, daily case totals peaked at one-third the level of the initial Omicron wave.

By evading existing immunity, BA.5 can spread in a larger population. “Think of someone’s immune system as a door with a whole bunch of locks,” says Jeremy Kamil, a virologist who has led sequencing work at LSU-Health Shreveport. “You know that the virus can pick seven out of nine locks, and then all of a sudden, BA.5 comes up with a key that can pick an eighth lock.” For some people, even some who were previously infected, that will be enough for the virus to get inside. 

How dangerous is BA.5?

Fortunately, reinfections are less likely to kill or hospitalize. Unreviewed research from a team in Qatar found that Qataris who’d been infected once were 20 times less likely to experience severe symptoms during a reinfection. That was true even when the second infection was caused by an Omicron strain, and if the patient was older than  50. It’s important to note, however, that BA.4 and BA.5 entered Qatar at the very tail end of the study, so it’s possible that they’ll cause slightly more severe illness.

A study in hamsters suggested that BA.5 could be more likely to cause severe illness. But that doesn’t seem to be playing out in people. In South Africa, the risk of hospitalization and death was the same as in the initial Omicron wave. And, according to a late June technical briefing from the UK Health Security Agency, there’s currently little data to suggest that vaccines are less effective at preventing serious illness from BA.5.

The reason that a variant like BA.5 can be so well-equipped to dodge antibodies, but still not cause severe disease, has to do with the complexity of the immune system. Antibodies stop the coronavirus from infecting cells, while other immune cells, called T-cells, are key in stopping that initial infection from exploding into serious illness. T-cells can recognize more parts of a SARS-CoV-2 virus than an antibody, and so they aren’t easily thrown off by mutations. Although there haven’t been any studies on how T-cells in vaccinated or previously infected people respond to BA.5, previous work has found that T-cells respond strongly to new variants in young, healthy people.

What happens next

Still, in the US, hospitalizations have climbed steadily since mid-April, with the sharpest summer increases in the Pacific Northwest and Southeast. Most of that spike is among people 70 or older, who are more likely to have waning immune responses that make them particularly vulnerable without boosters. More than 90 percent of people over 65 have had their primary two shots, while 63 percent have had a first booster, and just 21 percent have had a second booster.

The BA.5 wave may not overwhelm hospitals to the degree seen last winter, although emergency rooms and ICUs are already stretched thin. “But there’s definitely going to be an increase to some degree,” says Kamil.

Death rates, even outside a peak, are still high. “The current daily death toll, projected over the course of a year, roughly equates to two to three times our normal flu epidemic mortality,” says Fox. “In some ways, the overall goal is to get to a place where we can handle surges in a manageable way, but I worry that means that vulnerable people will take the brunt of a surge. And most people in the general public won’t really feel it, which will exacerbate disparities.”

The positive news on the horizon is that the Food and Drug Administration has asked vaccine manufacturers to include BA.5-specific shots in new boosters, and intends to roll them out this fall. “We might be entering a phase where these boosters really are looking like seasonal flu vaccinations,” says Fox, “where we’re updating them alongside the pandemic as new variants emerge.”

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Pregnancy puts an immense medical strain on the human body—American mothers can attest to that. The US has the highest rates of maternal mortality among high-income countries, and studies show that COVID-19 made those rates worse. 

A report from the National Center for Health Statistics (NCHS) released earlier this year showed that the virus disproportionately impacted pregnant people across the country, with an 18 percent increase in maternal mortality in 2020 from 2019. The increase in overall US mortality in 2020 was 16 percent, meaning that pregnant people saw a higher increase in death rate. But a new analysis from the University of Maryland and Boston University, published in the journal JAMA Network Open on June 28, finds that the rise in the maternal death rate was actually closer to double the initial rate that NCHS shared. The analysis also showed that Black and non-white Hispanic mothers may have been more critically impacted than originally thought. 

Marie Thoma, an assistant professor in the UM School of Public Health, and Eugene Declercq, a professor in the BU School of Public Health, compared maternal mortality data from 2018 to March 2020—the pre pandemic period—against records from April and December 2020, after the pandemic began. This was a more finely partitioned analysis of maternal deaths than the NCHS report, which compared the entire year of 2020 against the entire year of 2019, despite the major shift in public health resources and risk due to COVID. 

The researchers combined the first three months of 2020 with other years to make the data more stable, and found that the rates of maternal death during those pre-pandemic months were more similar to the earlier, pre-COVID years. 

“We wanted to separate the first three months of 2020, since it wasn’t during the pandemic, because they could potentially dilute the rate for maternal mortality, which is what we showed,” Thoma says. “The increase that happened in 2020 was concentrated in those nine months after the start of the pandemic.”

[Related: What 1 million COVID deaths looks like from the frontlines]

Overall, Thoma and Declercq found a 33 percent increase in maternal deaths from the pre-pandemic period to during the pandemic, and a 41 percent increase in late maternal deaths over the same period of time. They also found that COVID-19 exacerbated existing disparities and created new disparities, too. They recorded a 40 percent increase in already high maternal mortality rates among non-Hispanic Black women, and a 74 percent increase in rates among Hispanic women. The change in rates among Hispanic women is notable, Declercq says, because this marks the first time in more than a decade that the maternal mortality rate for Hispanic women is higher than for non-Hispanic white women. Typically, it’s the other way around. 

Thoma and Declercq also analyzed the causes of maternal death, which were not included in the NCHS report. The largest increases were because of respiratory illnesses or viral infections—conditions directly related to COVID—and diabetes or cardiovascular disease—conditions made worse by COVID. Thoma is careful to note that interruptions in the healthcare system might have also played a role by delaying prenatal care or failing to detect pregnancy complications.

Racial disparities were also made evident in the data, with COVID listed as a secondary cause of death (maternal death is typically mentioned as the first) for 32 percent of Hispanic, 12.9 percent of Black, and 7 percent of non-Hispanic white women giving birth. This is compared to 15 percent of all maternal deaths that listed COVID as a contributing factor. This pattern is also reflective of COVID death rates across the US population: In 2020, Hispanic people had some of the highest mortality rates from the virus. 

Parsing through the data was difficult in certain cases, especially when trying to understand the role COVID played. For some mothers, it was listed as the contributing factor to death; for others, COVID-related symptoms, like respiratory illnesses, were listed as the cause of death. 

“Clarifying whether COVID-19 was an underlying or contributing cause in the cases could help [healthcare workers] think about the treatments they provide, and whether it should more directly address COVID or not,” Thoma says. 

Thoma notes that she and Declercq plan to do further analysis with the research, especially given that this was written as a descriptive analysis of the data and published as a research letter. While their conclusions describe the patterns in maternal deaths during the early months of the pandemic, Thoma intends to dive deeper to more clearly describe some of the connections in the underlying causes. 

“We wanted to get it out because we wanted to show how this was important,” Thoma says. “We had many questions with the NCHS report and when we did our analysis and saw this increase, we felt like it needed to be further explored.”

[Related: Black mothers face high death rates. Now they have to contend with climate change, too.]

As 2021 data on maternal death comes in, Thoma says she will be curious to see how public access to COVID vaccines may have impacted mortality rates. Though some pregnant people may have been hesitant to get vaccinated, they still likely saw an impact from increasing resiliency against the virus in the general population. What’s more, Thoma points out that the American Rescue Act in 2021 gave states the option to extend Medicaid postpartum coverage from 60 days after birth to one year. The additional coverage, she says, can play a crucial role in helping new mothers stay healthy. Congress is still debating over extending funding for the act through 2022.

“We can only see how [this kind of program] worked in 2021,” Thoma says. “But we would hypothesize it would lead to improvement.”

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On Thursday, the Biden Administration announced the introduction of free at-home COVID-19 tests for individuals who are blind or visually impaired. The rapid tests, which White House COVID-19 response coordinator Ashish Jha said were developed in close collaboration with members of the disability community, are available to order now through the covidtests.gov portal via a dedicated request form. 

Details on how the test itself will work have not yet been provided, but the request portal notes that it will require a Bluetooth-enabled smartphone and a companion iOS or Android app. Individuals can order a single set of two tests.  

Ever since the mass rollout of at-home COVID tests began in early this year, disability communities have been vocal about the inaccessibility of at-home tests, whose instructions feature small typefaces and whose results require a sighted person to read. “An issue raised consistently was that individuals who are blind or low vision are often unable to utilize rapid self-tests on their own,” Jha said in yesterday’s COVID-19 news conference. 

[Related: How to order free COVID tests]

In the interim, workarounds have emerged. Apps like Be My Eyes match people with visual impairments with a sighted partner who guides them through the testing process. Though a January 2022 report in The New York Times pointed out that some blind or visually impaired people aren’t smartphone users, and a go-between can also erode an individual’s agency and compromise privacy. “You should be the first to know,” Martin Wingfield of the Royal National Institute of Blind People in the UK told the Times. 

It remains to be seen if or how the government-issued accessible tests will avoid these shortfalls, but community collaboration on their development is a hopeful sign. CNN reports that, in February, the Rapid Acceleration of Diagnostics Tech program at the National Institute of Health said it would work to create accessible at-home tests. 

Visual disability is among the most common in the US, especially among adults. According to the Centers for Disease Control and Prevention, some 12 million Americans over 40 have a visual impairment, including 1 million individuals who are blind and 3 million who still experience impairment with the use of corrective lenses. 

Accessible tests are, however, only one facet of the disability conversation surrounding COVID-19. Advocates and doctors, for example, have noted that the increased prevalence of telemedicine has presented barriers. And in-person testing has also presented challenges; in fact, the American Council of the Blind sued major testers over the accessibility of touch screen-based check-ins at testing sites. 

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In 2018, a deadly outbreak was underway at Sarasota Military Academy Preparatory School in Florida. Groups of middle schoolers congregated with hazmat suits and masks, distributing medicine, checking one another’s health statuses, and occasionally carrying the infected into isolation on a stretcher. 

Looking back, the situation was prescient, even if not quite real. The students running around were part of an app-based educational simulation, and the pathogen they were dealing with was a virtual one spread through proximity-sensing Bluetooth communications. Every other element was no more than a stage prop.  

This experiential education platform, called Operation Outbreak, started as a simple lesson plan by Todd Brown, a former teacher from southwest Florida. It began in 2015, he recalls, with a single question by a seventh grader. From there, it “has blown up to what we’re doing now,” Brown says. 

The question was: What if an Ebola-like virus came to the US? A discussion and a subsequent two-week lesson plan spawned from that inquiry, delving into details on who would be in charge of what, where funding comes from, what things would be like on the ground, and how different groups reported to one another. From there, they launched an early analog version of the simulation, where the virus was spread through a close-contact sticker system. They broke students into groups of doctors, triage personnel, epidemiologists, the media, the government, and the general population.

Then, that same year, on a whim, Brown reached out to Pardis Sabeti, a computational geneticist and a professor at Harvard University. 

Sabeti had previously researched infectious diseases such as the Ebola virus. And from 2014 to 2016, she and Andrés Colubri, a computational researcher in her lab, had been working on apps that could support diagnosis, prognosis prediction, and digital contact tracing. “It’s something that anyone who’s been in an outbreak recognized as needed,” Sabeti says. “The whole world came to it during COVID, [but] we came to it before and during Ebola and during the mumps outbreak because it became clear to us that it was spreading through contacts.” 

At the time Sabeti was learning about Brown’s work, she and Colubri were discussing ways to get good data and model the different facets of an outbreak. They were drawn to the schoolyard project that they heard about from Brown because they saw it as an opportunity to make the students’ experience as engaging and hyper-realistic as possible, and also gain high-quality insights into how actual humans would respond to mitigation methods like vaccination or quarantine. “At that point, those pieces kind of came together, and it was like wait, the best thing to do is simulate an outbreak,” she says. “And it’s best simulated on the phone [via an app] where you can make all of those pieces that would make the simulation more realistic and gather the data.”

In late 2017, Colubri, Sabeti, and Brown introduced the first version of the Operation Outbreak smartphone app and accompanying web platform.

Here’s how it works 

Operation Outbreak is a project geared towards schools and educational facilities. All participants must download the Operation Outbreak app (available in iOS and Android app stores) to set up the simulation. 

While Operation Outbreak mainly partners with the schools (which can reach out to the team to receive a code to activate the app), they are working toward a more decentralized approach where any school or organization can create a simulation and use the app. “We’re working through that right now in terms of what’s the best level of supervision that may or may not be needed,” says Kian Sani, program manager for Operation Outbreak, now an outreach project run by The Broad Institute of Harvard and MIT. 

The virtual pathogen flows across phones through Bluetooth. Each user’s app will show an avatar that displays their health status (depicted as a happy face emoji or sick face emoji). The app uses software like p2pkit, Herald, and Estimote to detect proximity and contact with nearby devices. It records all interactions between users that are less than 10 feet apart at a resolution of one second. 

The virtual pathogen can be transmitted if a phone is close to an infectious participant, and the probability of transmission over a certain time period is preset in the parameters of the simulation ahead of time. The app can also model the effects of interventions such as diagnostic tests, vaccines, masks, or personal protective equipment. Students get these by scanning QR codes that decrease their probability of catching the virus. For example, in the versions where asymptomatic spread is activated, users can have avatars that appear healthy when they’re carrying the virus and they can only discover that they’re infected by scanning the diagnostic test QR code, says Sani.

Every interaction and contact that happens during the simulation is recorded into a web server that can be used to observe what’s happening in real-time or analyze patterns post-simulation (like the ‘God View’ feature in video games). The web portal also allows organizers to get data on the number of cases, and the health status of each participant, as well as tweak different parameters for the outbreak including number of users, duration, symptoms, recovery time, viral transmissibility, money and resource allotments, and more. It creates a microcosm where public policies, economics, and personal decisions play out within the bounds of the technology. 

“Every outbreak [simulation], there were more insights that were being generated in real-world response,” Sabeti says. “Essentially these outbreaks could emulate everything you could experience from police tensions to government mistrust to vaccine passports and people cheating the system.” 

Though the team is still running simulations during the COVID pandemic, some of the shockingly relevant insights they’ve noticed stemmed from trials that were run in 2018 and early 2019. For example, in one of these pre-COVID setups, the participants that were assigned government roles decided to lie to the general population in order to get them to do certain things. Then a whistleblower leaked it to the media who reported it to the general population. 

“Everything went haywire,” says Brown. “These were young kids in which we were seeing these kinds of behaviors.” 

In another run, kids were restricted from going places based on their health status. “There are always people that don’t want to abide by rules so they can get what they want as an individual. So they would screenshot the healthy emoji to fake the passport to then get through to certain areas.”

There is also a financial system built into the simulation that can randomize the amount of money that families received to help them, and the wealth was not evenly distributed. In these scenarios, although some with “grotesque” amounts of money decided to help those without, there were also people who used their extra capital to buy up supplies like masks and try to resell them at a higher price even though “you didn’t get anything for being wealthy at the end,” Brown notes. 

“To watch some of these things, watch people protest the government’s decisions, watch people get angry with one another… It was surreal,” Brown says. He sees some “cosmic strangeness” in how things have since aligned between the simulations and real life. One year to the date before the US declared a state of emergency, the team penned an 2019 op-ed in Wired about why they shouldn’t wait for a pandemic to happen to prepare people for how things might go down. That same year, they started running a version of the SARS-inspired virus that spread asymptomatically, to make it challenging for participants. Former students even emailed him during the COVID pandemic saying how it was bizarre that the adults were acting almost exactly like they had in middle school. “It was very Twilight Zone,” says Brown.

Initially, the goal for the students in the simulation was to survive. But they’ve been testing other metrics for winning as a group, such as specific percentage of survival. “I think it changes with some of the new additions to the app with vaccination strategies and masking,” says Brown. In a recent 2021 run with Brigham Young University, they even used the simulation to explore ideas for incentivizing more vaccinations.   

Models for real pandemics

In addition to using this technology to create a more immersive setting for students, the Operation Outbreak team hopes that their simulation data could help create better predictive models on how real-life pandemics play out. The team has already published some preliminary findings on this subject in a Cell commentary and a preprint article on medRxiv. 

One benefit is that these mock pandemics can allow the team’s researchers to completely map out everything that is happening—who infected who—which is hard to keep track of in a real outbreak. “We always have a partial view of things during a real outbreak. We need to test everybody—that’s something that’s not possible to do,” says Colubri. “With the data from this simulation, we have the advantage of getting the ground source data, kind of the answer of what happened.” 

They can then use this data to infer how groups of people might interact with each other and spread the pathogen through the community and construct exposure risk models or new algorithms that might predict what happens in a real outbreak. 

Another feature is that Operation Outbreak’s simulations benefit from human input. “There’s a whole method of running outbreak simulations with agent-based models, which is essentially like running a Sim City simulation where the computer simulates each agent,” Colubri says. “But here, the individuals are real people who might do things you did not anticipate. That element of unpredictable behavior that we have in this simulation is something that sets it apart from these other models where everything is already programmed into the system.” 

From here, there are many attractive possibilities for this type of research, although much of it remains speculative at the moment. For one, Operation Outbreak could be used as a testing ground for trying out public policies or intervention techniques. Alternatively, they could use the simulation-derived models as a foundation for constructing a real-time risk calculator that can take data from real-world Bluetooth contacts (it could look something like the system Apple and Google partnered up to create in April 2020). 

They’re not the only group thinking about incorporating social relationships into models of pandemics. Several research groups have looked into how the dynamics of social contacts, cultural influences on behavior, and factors like restrictions and speed of vaccine rollout can impact the way populations respond at-large to such emerging public health threats.  

Ran Xu, an applied statistician and an assistant professor at the University of Connecticut who is not involved in Operation Outbreak, says that he sees value in such simulation exercises. 

“Disease simulations have been used widely in policy planning and for education purposes,” he says. “This one seems particularly interesting as the users can play a part during a disease outbreak and see how their behaviors affect the disease transmission. Many articles have pointed out the important role of human behavior in epidemiology.” He and his colleagues published a paper last month in PLOS Computational Biology that showed that detailing how disease affects behavior and vice versa is important for building better pandemic forecasting models. But any behavioral insights should be tested more rigorously afterwards with real-world data as well, he says. 

There are some limitations to consider, too. “This may not fully represent what will happen in the next disease outbreak depending on how seriously people play this,” Xu notes. “But this applies to any simulation.”

An outlook on outbreaks

Outside of Operation Outbreak, Sabeti is working on a number of other pandemic-related projects, most converging at the intersection of genetics, epidemiology, and technology. Separately, Sabeti and her colleagues have been working on a symptom-tracking app for COVID infections called Scout, which they have tested at Colorado Mesa University. 

Sabeti believes digital platforms that enable contact tracing, health status monitoring and virus tracking are going to be critical for containing and managing the spread of novel infections. But privacy concerns remain a hurdle. “What is fascinating to me is that everyone is so freaked out about their privacy in these outbreaks,” she says. “We’re on TikTok sharing every one of our personal thoughts. But somehow, the data that might save you from a deadly virus is one thing you want to protect.” 

“The lack of trust is so high and it’s gotten so much worse over the course of this,” Sabeti adds. “It’s insane how much we have to overcome to get to a point where this will work and these technologies [such as contact tracing and health-monitoring apps] won’t be scary to people.” 

Sabeti estimates that she spends more time on Operation Outbreak than any other project in the lab. This time is broken down into periods of tweaking the app and coming up with simulation plans, but also editing a textbook on outbreak science (expected to come out sometime next year). “It’s probably the most important thing I could be doing—educate a generation of people who understand these technologies and get the point,” she says.

Education, in fact, remains the core mission of Operation Outbreak. “You might argue that people have been living through the pandemic for over two years, why would we want to play it with an app. The answer is, the information that we have received through the news and social media is often conflicting, [with] lots of misinformation, which really doesn’t help,” Colubri says. “By creating these immersive simulation scenarios, we could help make sense of what happened.” 

The goal for the project is that in addition to raising compelling questions about human behavior in the event of a disaster, it can also prepare the next generation of scientists, public health officials, and health responders to think about their positions in these situations, understand how their roles work in conjunction to other parts of society, and grasp how what they do as an individual or a collective might impact other people.

“I’ve asked a group of teachers: How many people are happy with how the United States as a whole has responded to this? And virtually no one raises their hand,” Brown adds. “How would this pandemic have been different if the general person walking on the street would’ve had a little better understanding of outbreak science, awareness, and response? What would the results have been at this point compared to what they have been in reality?” 

The ‘empathy’ factor

A key component of this simulation is the post-outbreak exercise, which Brown included at the start of the program to provide students with an opportunity to reflect on why they or others acted one way or another, and discuss whether their decisions worked best for themselves or for everyone in the group.

“We were having situations in which communication, government trust, belief or understanding of basic science principles, those things we see are always on the bottom of the decision chain. Because of that, it changed the way people behaved,” says Brown. “But kids learn. They realize that that’s probably not the best way to do something.” 

Often through repeated runs, the students become more considerate, they learn to cooperate, they learn to convey their needs, and eventually, they get better at beating the pathogen.  

“What’s interesting about it is in a way it gives the students empathy for what the circumstances are for somebody else, in a situation that’s not very high stakes and volatile,” Sabeti adds.  

The researchers behind the Operation Outbreak project stress the present urgency of properly informing the younger generations about how to navigate and respond to these stressful and chaotic global health emergencies, an item that’s lacking in most school curriculums, especially as statistics show that COVID-like outbreaks are only expected to become more common and more severe. 

COVID, for which there are effective vaccines, has already killed over one million people in the US. But surprisingly, it is still not the virus that Sabeti considers “the big one.” 

“It’s a very scary time,” Sabeti says. “What are we doing if we actually get something that is the ‘big one’ that could kill any one of us instantly in all ages? How would this all go down?”

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This week many families with young kids can breathe a sigh of relief. For the first time in two years since the pandemic began, two COVID-19 vaccines will be available for children between the ages of 6 months and 5 years living in the US. The announcement comes after the Food and Drug Administration (FDA) unanimously voted last week to recommend emergency use authorization for two mRNA vaccines produced by Pfizer-BioNTech and Moderna. The vaccines could increase protection against the virus for 20 million more children nationwide.

The Biden administration plans to ship 10 million vaccine doses to multiple states who preordered the vaccines with millions more to come in the coming weeks. Deliveries will first go to top-priority sites like pediatric hospitals where there are many high-risk kids. Every state except for Florida has ordered vaccine doses in preparation for the approval, meaning almost the entire country will have vaccines available as early as June 21. The Florida government only allowed doctors to order COVID vaccines for children under 5 starting last Friday, though the state’s Department of Health says it “has always been available to providers.” Florida officials also noted that they won’t help distribute the shots or encourage parents to get the treatments to their children. As such, the vaccines are expected to be delayed by a few days in the state.

Parents elsewhere in the US can set up appointments at pediatrician offices, community health centers, hospitals, or at local pharmacies. “As doses arrive in places throughout the country, more sites will have vaccines and more appointments will become available. Our expectation is that within weeks, every parent who wants their child to get vaccinated will be able to get an appointment,” said Ashish Jha, the White House COVID-19 response coordinator, in a press briefing earlier this month.

[Related: How to talk with your kids about the COVID vaccine]

While vaccines will be sent to pharmacies, a federal law prohibits many states from allowing a pharmacist to vaccine children younger than 3. Walgreens said it will vaccinate children older than 3; CVS will offer vaccines for children between 18 months and 4 years at 1,100 MinuteClinic locations, according to Yahoo News. 

But for the large part, family doctors will be the ones to vaccinate young children against COVID. “The first place that I’d encourage eager parents to consult is their pediatrician’s office. Parents are used to getting kids vaccinated there, and the pediatrician will know when and if they plan on giving the COVID-19 vaccine,” Leana Wen, an emergency physician and CNN medical analyst said in a broadcast.

Guardians might also wonder which vaccine they should choose for their children. Like the COVID-19 vaccines for adults, pharmacies and doctor’s offices will carry either the Moderna or Pfizer-BioNTech option. But individuals can call ahead or look on a pharmacy’s website to see which place has their preferred vaccine. 

As for which formulation works better, clinical trial data shows both are safe and effective. Pfizer-BioNTech’s three-dose vaccine is meant for children 6 months to 4 years and Moderna is expected to receive authorization for children between 6 months and 5 years. 

For parents who want to get children fully vaccinated right away, the two-dose Moderna vaccine may be the way to go. “If a child starts the series next week, they could be fully vaccinated by mid-August and in time for the next school year,” Wen also told CNN. The Pfizer-BioNTech three-dose regimen will take longer but offers 80.3-percent effectiveness in preventing symptomatic cases. 

Timing is also important as new waves of COVID spread across the country. Omicron caused a high number of pediatric cases, and children under 5 were five times more likely to be hospitalized than with the previously dominant Delta variant. While children are at low risk for severe COVID-19 infections, they can still carry the virus and spread it to others. Vaccinations can help slow the spread of the virus, prevent hospitals from being overwhelmed with cases, and give families greater confidence when sending kids to school in this new normal.  

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On June 16, a panel of Food and Drug Administration (FDA) advisors unanimously recommended two COVID vaccines for children between the ages of 6 months and 5 years. The vote, which sets the stage for an emergency use authorization that will allow doctors and pharmacies to dole out the shots, should bring relief to millions of parents of young children who have waited a year and a half since the first adult vaccines were authorized.

The vaccines, made by Moderna and Pfizer, will go through three more steps before becoming available to the public: They need to be officially authorized by the FDA; reviewed by an independent panel convened by the Centers for Disease Control and Prevention (CDC); and finally approved by the CDC. The CDC panel meets on Friday and Saturday, so it’s likely that the shots will be distributed beginning next week.

Pfizer’s vaccine will involve three shots. The first two will be three weeks apart, while the third will follow eight weeks later. Moderna’s will consist of two shots administered a month apart. Clinical trials on the vaccines found that they reduce symptomatic illness by about 50 to 80 percent—but because children so rarely get sick from COVID, the exact efficacy is still fairly uncertain. Still, the advisors felt that the benefits outweighed the risks observed in the trial, which resembled those seen in other age groups.

Although the second Omicron wave has largely peaked in the US, FDA officials began the meeting by stressing the continued need to protect young children. As of May 28, 442 children under the age of four have died of COVID, according to those officials. While that’s a relatively low fatality rate from the virus compared to other age groups, it’s a toll that “compares quite terribly to what we’ve seen with influenza in the past,” said Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, in opening remarks. He noted that a bad flu season in 2009 to 2010 killed 78 young kids.

It’s important, he said, that “we don’t become numb to the number of pediatric deaths because of the overwhelming number of older deaths. … Each loss fractures a family.”

In spite of that urgency, it’s been about eight months since vaccines were authorized for children over the age of five, leaving out the next youngest group. The authorization has been delayed in part because children’s immune systems work differently than those of adults, which made it challenging to find an optimal dose.

But federal regulators have also drawn criticism for how they’ve approached the early clinical trial data. In February, after Pfizer presented the results from a relatively lackluster two-shot series to the FDA, the agency chose to wait and see if a third jab would make the entire treatment more effective. And in April, regulators decided to “postpone” a decision on Moderna’s emergency use authorization application to shepherd both vaccines through the approval process at once, with the rationale that it would confuse parents less.

Data presented at the June 16 panel clarified the February Pfizer decision. Two doses of the vaccine only reduced symptomatic illness in the younger population by 14 percent—a weak result, even ignoring the extremely high bar of 90-plus percent efficacy set by the adult mRNA vaccines. But with three doses, Pfizer has now increased the efficacy against symptomatic illness to 80 percent. Meanwhile, Moderna’s two-dose regimen showed a 40 percent reduction in kids’ chances of falling ill.

Side effects included headaches, rashes, and fevers—similar to those seen in adults. A few children ran fevers over 104 degrees Fahrenheit, though all cases passed within days. Still, high fevers in toddlers can cause symptoms—including convulsions—that don’t occur in adults. The trials didn’t detect any cases of myocarditis or pericarditis, the heart inflammation that has been occasionally spotted in adolescents, but the sample sizes were small enough that these conditions are not ruled out entirely.

Both of the efficacy findings are bracketed by huge amounts of uncertainty. While the companies included tens of thousands of participants in clinical trials for adults’ vaccines, they only had several thousand for each of the kids’ vaccines. At the same time, the trials only tested for COVID in kids who exhibited symptoms, even though 75 percent of COVID infections in children  are asymptomatic. Because efficacy is based on the number of observed COVID cases, investigators simply had fewer data points to work with, leading to less certain estimates.

Efficacy measurements in the Pfizer trial, for instance, were made based on seven COVID cases in the placebo group and three cases in the vaccinated group. Neither trial could estimate efficacy against severe illness, because no participants got severely sick.

But the FDA advisors were convinced of the vaccines’ efficacies, in part, because of the antibody levels in vaccinated children that participated in the trials. Those antibodies roughly corresponded to what’s seen in adults, and representatives for the companies said they believed the pediatric vaccines would confer similar real-world protection against severe illness.

The unknowns don’t mean the vaccines aren’t effective—it just means that until more data is collected, there’s no way to know if one brand is more protective than the other, or exactly how many COVID cases they’ll prevent in the general population.

[Related: Here’s why it’s hard to study a COVID vaccine once most people have been infected.]

The FDA panel was also explicit that they saw the data as preliminary, but that the need to make a pediatric vaccine available was too high to wait for more precise data again. Hayley Gans, a pediatric infectious disease specialist at Stanford University, said she anticipated a third shot being added to Moderna’s pediatric series as Moderna conducts further trials.

Both the panelists and company representatives talked through a series of follow-up questions being addressed by ongoing research, from whether additional shots will be needed, including Omicron-specific formulations, to the efficacy of the vaccines in immunocompromised children.

They also discussed one specific case from the Moderna trial in which a toddler experienced a high fever that led to a “febrile seizure,” a type of convulsion that some kids experience when their temperature goes above about 100 degrees Fahrenheit. Febrile seizures aren’t necessarily dangerous during the course of a regular viral infection, but investigators suspect the event was related to her first vaccination. Still, she recovered and completed the trial, and didn’t have a similar reaction to the second shot.

Given the missteps public health officials have already made in communicating the uncertainties of vaccines throughout the pandemic, the next challenge will be getting vaccines to kids who need them. According to polling by the Kaiser Family Foundation, one in five parents of a child under five says they’ll get them vaccinated right away. Nearly 40 percent say they’ll “wait and see.”

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Two and a half years after the coronavirus pandemic began, there’s growing evidence that allergies—which were once suspected to put patients at risk for serious COVID-19—instead protect against the illness. Children with allergies are significantly less likely to catch COVID-19, for reasons that may have to do with the idiosyncrasies of the virus, according to a long-term, National Institutes of Health-funded study published earlier this month.

“Historically, those with asthma and allergic disease are susceptible for poor outcomes due to viral infections,” says Max Seibold, a pediatrician and genomics researcher at the National Jewish Health hospital in Denver who led the research. “There was a real fear there about whether this was a risk group.”

Asthma, atopic dermatitis—the most common form of eczema—and food allergies are all loosely clustered together as “allergic diseases,” in part because they tend to develop together. “It’s not like everyone with atopic dermatitis has food allergies [or] has asthma,” Seibold says. “But it occurs concurrently in enough individuals that we know there’s likely something underlying it mechanistically.” And people with allergic disorders share a specific type of inflammation, called Type 2 inflammation.

The immune system primarily uses another type of inflammation, Type 1, to fight off viral infections. But for people with allergic disorders, a viral infection can trigger both inflammatory alarm bells. “They have this sort of flamed-out state of their airway with two types of inflammation going on at once,” Seibold says, which can lead to more serious illness.

Beginning in the spring of 2020, the team of researchers from multiple US institutes recruited children and teenagers from 12 different US cities who were already participating in allergy or asthma studies, as well as their primary caregivers. Every two weeks between May 2020 and February 2021, 5,600 participants were tested for COVID, with additional testing for anyone who became ill.

This way, the study authors tracked not only symptomatic or serious COVID cases—which remain rare in children—but asymptomatic ones, too. From that data, they calculated the risk of overall infection along with risks of serious illness. Estimating the overall infection rate is a rarity among COVID studies, because gathering data on asymptomatic infections is so expensive. “It was a huge undertaking to get a group enrolled and get samples from them regularly over a long period of time,” Seibold says.

Over the course of the study, a quarter of all households, and around 14 percent of all participants, caught COVID.

[Related: CDC estimates 58 percent of Americans have been infected with COVID so far]

That infection rate suggests that COVID had spread more widely than previously realized. “We found that 75 percent of infections in kids were asymptomatic,” Seibold says. “If you line up our data versus CDC data for the same time period, we come up with a much higher probability of infection for kids.” And those kids had high viral loads, even when asymptomatic, suggesting that they could spread the disease.

Allergic diseases affected COVID risk—but not in the way researchers might expect. People with food allergies were 50 percent less likely to catch COVID, and household transmission was much lower when someone had an allergy. Atopic dermatitis didn’t affect risk. Nor did asthma—unless it was specifically asthma triggered by allergic reactions.

Asked why that would be, Seibold says, “The first thing I would say is: ‘We don’t know.’ ”

But the team has a guess. The proteins that cause Type 2 inflammation can change how cells function, particularly in the skin, respiratory tract, and other membranes. Type 2 inflammation can modify the expression for thousands of genes, Seibold says. “It’s a very powerful mechanism. If you affect a lot of things, you may tweak some aspect of the biology that affects something else, like SARS-CoV-2 risk.”

In particular, previous work by Seibold and co-authors showed that people who experienced high levels of Type 2 inflammation also had less of a protein called ACE2 on the cells of their respiratory tract. ACE2 happens to be the exact receptor that SARS-CoV-2 latches on to when it infects cells. That suggests that people with allergic disorders have fewer vulnerabilities at a cellular level to the virus.

“It’s not a foolproof story,” Seibold says. “Why are asthmatics, for example, not protected?”

The answer to that question could lie in another study from 2019, which found that kids with food allergies had much stronger Type 2 inflammation signatures than those with allergic disorders of the skin. “I think the food allergic individuals have the most extreme levels of Type 2 inflammation and therefore the biggest effect on their receptor,” Seibold says, before cautioning: “that’s all conjecture.”

He summaries the hypothesis like this: Inflammation reduces the ACE2 receptors in people with allergies. That, in turn, should drive down infection risk. But it’s not proven.  “We have A to B and we have B to C, but that’s a little different than going from A to B to C,” Seibold says.

Right now, the team is studying participants’ cells by RNA sequencing. That might show whether the participants known to be at low COVID risk actually had the high inflammation and reduced ACE2 predicted in other studies.

The findings line up with other studies on allergies and SARS-CoV-2. A study published in March found that when lung cells were exposed to another key marker of type 2 inflammation, they cleared SARS-CoV-2 virus faster. And people with allergic diseases were about 25 percent less likely to be infected, according to an observational study in the UK published in late 2021.

Cezmi Akdis, editor of the journal Allergy and the director of the Swiss Institute of Allergy and Asthma Research, wrote in an email: “Although the publications are controversial, I think that existing allergy prevents severe COVID development.”

Still, Seibold doesn’t want to draw broader conclusions about the relationship between infections and allergy. “I’m not sure that there’s any strong conceptual relationship” between this particular virus and the course of allergic diseases, he says. “It’s potentially two independent things that happen—it’s just how things play out sometimes.”

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This story has been updated. It was originally published on November 10, 2021.

In the last two years, vaccines, rapid tests, and a growing body of scientific research have allowed us to get back some sort of normalcy as the COVID-19 pandemic trudges on.  

With vaccination rates still growing around the world and many major airlines are dropping on-board mask mandates in the US, people are flying again, both domestically and internationally. As we move toward an endemic phase of the pandemic, some countries have relaxed their COVID travel requirements, while others have eliminated them altogether, making it easier for travelers to go abroad even if they’re not vaccinated.

But there’s still an abnormal level of uncertainty. The fluctuating nature of this health crisis, plus massive flight cancellations and an industry-wide understaffing problem, ominously threatens to spoil your long-awaited vacation, so your best bet is to stop improvising and prepare well in advance.

COVID-era requirements are easing and even disappearing

Depending on your destination, you may not be able to travel or do much at all if you’re not fully vaccinated against COVID. “Fully vaccinated” means you’ve received the correct number of shots (two for mRNA vaccines like Moderna’s and Pfizer’s; one for mono-dosage inoculations like Johnson & Johnson’s), and that at least two weeks have passed since the last one. Boosters are not a part of a complete vaccination schedule in the US, so if you don’t have any, you’re still good to go. This may not be the case in other countries, though, so make sure you know what “fully vaccinated” means at your destination.

[Related: You still probably have to wear a mask while traveling]

It used to be that some places wouldn’t recognize certain vaccines, but some countries have been adding more brands to their approval list—Australia, for example, has added Novavax. (You can check if your shot is accepted where you’re going by using Visa Guide World’s handy reference page.) Americans have it easy, as most of the world will accept any vaccine approved by the US Food and Drug Administration and the World Health Organization, but you may still have to validate your shots with authorities at your destination. 

In some countries, like Chile, the validation process takes place online before you arrive. It can take up to 48 hours, and it’s absolutely necessary if you plan to do anything indoors. In others, like France, you can take your Centers for Disease Control and Prevention card and your passport to any pharmacy to get your shots validated, though you’ll only need to do this if you’re stepping into a hospital or any medical establishment during your stay.

Vaccines are not technically mandatory in most countries, but they’ll definitely make your life easier. And depending on your destination, you may not need a vaccine or even a test. As of June 1, Italy lifted all of its COVID travel restrictions, which means you could be untested and unvaccinated and still be able to visit the Colosseum. The central Mediterranean peninsula is only the latest country to do this, and joins a list of European territories that include the UK, Sweden, Iceland, and Croatia.  

Do your research and stay up to date 

What you need to do in order to travel will depend on where you’re going, but can also change depending on where you are. As the pandemic evolves and waves come and go, restrictions that were once lifted may be reinstalled, so you’ll need to keep up. 

Once you have your tickets, most airlines do a good job of informing you about what you’ll need for your trip, and alerting you of any complications. Still, it is your responsibility to stay up to date with guidelines and regulations, so keep an eye out for announcements from the CDC, the Department of State, and the local health authority at your destination. 

Traditional news outlets and specialized traveling sites like Frommer’s, Lonely Planet, and Sherpa are constantly publishing stories and resources as news develops, so checking them regularly is also a good idea. 

Book in advance

The travel industry has been hit hard by COVID, and even though people feel safer taking a plane and going abroad, that doesn’t mean tourism has bounced back. 

“It’s a strange time to travel. A lot of attractions, resorts, or restaurants are still understaffed, so there’s not the same availability you’d expect,” says Pauline Frommer, the editorial director at Frommer’s. 

Due to shortages, a lot of places are functioning at a lower capacity—some that used to be open throughout the week are now only open on weekends or accepting fewer people in an attempt to keep travelers safe while also accommodating them correctly. 

This is definitely not the time to be a “winging it” kind of traveler, and Frommer says it’s more important than ever to make bookings and reservations in advance: from hotels and tours to museums and other spots of interest. 

Understaffing is also one of the major reasons airlines are canceling huge numbers of flights. Frommer says one of the culprits is a pilot shortage that predated COVID, but that has worsened with airlines forcing some of their staff into retirement. Even if this shortage is not directly linked to COVID, it is a result of a crisis deeply intertwined with the pandemic, and makes it even more likely that your flight will be canceled or delayed. That’s why being cautious is key. 

Consider getting travel insurance

You might have gotten the gist of it already: things, they are a-changin’. At the beginning of the pandemic, airlines waived fees and implemented extra-flexible measures to lure people into traveling. And even though some of those measures are still in place, travelers no longer have such an upper hand. 

American Airlines, for example, will refund you for the full price of your ticket if your flight gets canceled for any reason, but will not book a seat for you on a competing airline. This means you may get stranded during a layover or end up paying a lot more money for a new ticket on a new airline to get to your final destination. 

[Related: What’s next for China’s zero COVID policy]

This is why travel insurance is more important than ever, and Frommer says more and more people are getting it when planning a vacation. Keep an eye out for prices, as high demand might have driven them up. You can always go for the insurance your airline or online travel agency offers you, but it’s better to shop around and read the fine print to find an insurance policy that works for you.

And when you step out of your home to embark upon your trip, know that things are still far from normal. Wherever you’re going and whatever your vaccination status is, we encourage you to wear a mask on planes, in airports, and anywhere social distancing is not possible. Abiding by local regulations and doing your homework will help make your trip a truly fun and relaxing experience.

Updated June 13, 2022 at 11:04 AM: This story has been updated to reflect that as of June 12, 2022, the US has lifted its mandate requiring all international travelers to test negative for COVID-19 before entering the country.

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On Sunday, June 12th, the US government lifted all COVID-19 testing requirements for international travelers entering the country. The decision comes after the Centers for Disease Control and Prevention (CDC) reviewed new COVID-19 data and the availability of vaccines and treatments. However, the agency warns the restriction could return if a new variant drives infections up again, and will reassess the decision in 90 days. 

“The COVID-19 pandemic has now shifted to a new phase, due to the widespread uptake of highly effective COVID-19 vaccines, the availability of effective therapeutics, and the accrual of high rates of vaccine- and infection-induced immunity at the population level in the United States. Each of these measures has contributed to lower risk of severe disease and death across the United States,” the CDC told CNN.

[Related: Your up-to-date guide on international travel during COVID-19]

The CDC amended its travel restrictions in December 2021 requiring US-bound travelers to show proof of a negative COVID PCR or antigen test at least one day before boarding an international flight. Those recently infected with the virus had to show proof of recovery no more than 90 days prior to their flight and a letter from a doctor that it’s safe to travel. The rule applied to all travelers 2 years and older regardless of vaccination status or American citizenship. But with increasing immunity from COVID vaccines and prior infections, people have voiced concerns the testing restrictions are outdated and may be doing more to harm the travel industry.

According to a report from the US Travel Association, the number of international travelers to the states declined by 36 percent in 2021 compared to 2019. “Prior to the pandemic, travel was one of our nation’s largest industry exports. The lifting of this requirement will enable the industry to lead the way toward a broader US economic and jobs recovery,” said Roger Dow, president and CEO of the US Travel Association in a statement to CNN. 

Some public health experts also noted that the Biden administration’s decision was overdue. “I have long thought the testing requirement for travel to the US was not evidence-based or logical—and most other countries have abandoned this approach,” Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security, noted to Bloomberg. Indeed, multiple nations like England, Ireland, and Costa Rica removed their pre-boarding testing requirements in early spring 2022.

[Related: How do we track COVID as people get tested less?]

However, there is some worry over how laxer travel protocols will affect high-risk groups, such as people with serious preexisting conditions, individuals suffering from long COVID, or children under 5 who are not currently eligible for a COVID-19 vaccine. 

“Lifting COVID testing for international travel entirely negates that there remains a worldwide pandemic,” Meegan Zikus, a bioethicist at Grand Valley State University in Michigan who is immunocompromised herself, told The New York Times. “The world is exhausted by the pandemic. Trying to pretend that it is over is destructive, ignorant, and hurts those least able to protect themselves.”

The CDC continues to strongly recommend both domestic and foreign travelers take a COVID test before and after boarding a flight. Those who test positive should postpone their trip and follow the agency’s quarantine guidelines. Masks and boosters can also help prevent transmission of the virus in enclosed public spaces like planes.

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Omicron spread like wildfire in the winter of 2022, and vaccine maker Moderna is taking steps to prevent another resurgence. The pharmaceutical giant announced the results of an Omicron-specific vaccine booster trial on Wednesday. That mRNA vaccine produced a higher antibody response against multiple variants of SARS-CoV-2, the virus that causes a COVID-19 infection, than the vaccines already available.

The new booster is a bivalent vaccine, meaning it creates an immune response against the original virus and its variant. In this case, it contains the mRNA vaccine Spikevax, which the Food and Drug Administration  approved for people 18 and older in January, plus a vaccine candidate that specifically targets Omicron.

Omicron is the most infectious coronavirus variant yet. It has 37 mutations on its spike protein—the protein used by the virus to penetrate and enter cells—which is more than the Alpha and Delta variants. The high number of mutations disguises the virus, allowing it to go unrecognized by vaccine-induced and naturally acquired antibodies. Omicron’s success in evading the immune system led to a surge of reinfections in people who previously recovered from COVID-19 infections, and it caused breakthrough infections in fully vaccinated individuals. The variant was also behind an unprecedented number of hospitalizations in children between the ages of 5 to 11.

[Related: Moderna’s latest COVID vaccine trial for kids offers ‘really good news’]

In Moderna’s phase 2/3 clinical trial, researchers found that, after one month, patients who received the Omicron-specific vaccine booster had higher neutralizing antibody responses than those who had one dose of the Spikevax vaccine. The Omicron-specific booster also provided higher levels of protection against other variants of concern, including Alpha, Beta, Gamma, and Delta. The booster shot was well-tolerated among 437 study participants with no new side effects. 

While the results are promising, more research is needed to know how antibody responses translate into clinical outcomes and how long the immune response lasts. Peter Jay Hotez, an infectious disease expert at Baylor College of Medicine wrote on Twitter he worried whether this shot will protect against other emerging variants: “My concern on this new bivalent booster is whether it really offers much advantage, given omicron is already behind us.” Hotez added that there was “no evidence” this vaccine offers better protection against BA.2 subvariants, which are more infectious versions of Omicron with mutations that make it harder to detect on a PCR test than Delta or the original Omicron strain.   

Paul Burton, Moderna’s chief medical officer, predicts that the high antibody response could provide protection for at least a year, raising the possibility of annual boosters, according to NPR. Moderna is planning to submit more research data in the coming weeks and aims to have the new booster available later this summer, pending FDA review and approval.

The post Moderna is testing an Omicron-specific COVID vaccine. Here’s how it’s faring. appeared first on Popular Science.

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As production of the antiviral Paxlovid, made by Pfizer, ramped up this spring, the drug became a cornerstone of the US’s COVID response. The White House has invested in test-to-treat infrastructure that connects people with COVID to Paxlovid instantly, and the government is now distributing close to half a million doses of the drug each week. And the pill, which attacks a key protein involved in SARS-CoV-2 reproduction, is genuinely life-saving. In clinical trials, a five-day treatment reduced the rate of hospitalization and death by 90 percent. 

But for some people taking the pill, COVID still comes back. The phenomenon, called Paxlovid or COVID rebound, is relatively new and poorly understood. For a smattering of patients, rebound means a flare-up of fever, cough, or other symptoms. For others, the rebound is asymptomatic, but they begin testing positive after testing negative at the end of treatment.

Kami Kim, director of the Division of Infectious Disease and International Medicine at the University of South Florida Health Morsani College of Medicine, spoke to Popular Science while in quarantine with a rebound COVID case. Last month, Kim tested positive for the virus for first time during the pandemic. Although she’s not at high risk, “I got reasonably sick and my boss insisted that I take Paxlovid, because you have to give it early,” she says. Her symptoms—congestion and GI issues—cleared up soon after she started taking it.

But two weeks after her first infection started, Kim started to feel like she was allergic to something. She didn’t think much of it, until she was exposed to COVID during a trip a few days later. She took a rapid test, and it was “screamingly positive,” she says. So, she went back into quarantine. If not for that exposure, she explains, she would have just thought the symptoms were allergies. “That’s sort of like the classic story of Paxlovid rebound. You become symptomatic, but not as seriously as the first found.”

[Related: What to consider when taking Pfizer’s COVID-19 pill Paxlovid]

Reports of widespread Paxlovid rebound in the US go back to early spring 2022. On May 24, the Centers for Disease Control and Prevention (CDC) released revised guidance for people experiencing a relapse. According to the agency, patients should treat the rebound like a second round of the disease, and begin their isolation over again.

Clinical trials for Pfizer’s antiviral, which were conducted in people who smoked, were immunocompromised, or otherwise at high risk of severe COVID, saw rebound in only about 1 percent of patients. So far, there have been no comprehensive studies on the rate of Paxlovid rebound in the general public, but anecdotal reports make it more common than 1 percent. That difference could be in part because doctors are prescribing the pill to people at low risk of COVID—rather than the high-risk population included in the trial.  It “could be because we’re simply not using it in the populations in which it’s been studied,” Monica Gandhi, an infectious disease physician at the University of California at San Francisco, told STAT last month. 

According to the CDC, there are so far no reports of anyone experiencing severe disease during a rebound case, meaning the risk is more about continued transmission of the virus rather than danger to the patient. “It’s not like these drugs aren’t working,” Kim says. “Even with Omicron, it’s keeping people out of the hospital.”

The CDC and Food and Drug Administration (FDA) both advise against giving rebound patients a second course of the drug. The FDA even publicly contradicted Pfizer’s CEO, Albert Bourla, after he told Bloomberg that patients should repeat Paxlovid treatment after testing positive for COVID again.

Because Paxlovid was only recently developed to treat COVID, it has some unknowns. At first, researchers worried that rebound was a sign that the virus was becoming resistant to the drug. But genomic analysis of rebound cases hasn’t found any mutations to suggest that SARS-CoV-2 is adapting. Other possibilities are that the virus might survive the drug by hiding in some unknown organ reservoir, or that the body’s immune system doesn’t ramp up quickly enough to take down straggling viral particles.

[Related: An estimate of how many Americans have died from each COVID variant]

“If you think about how the drug works, it sort of mechanistically makes sense,” says Kim. Unlike monoclonal antibodies, which stop the virus from infecting cells, Paxlovid prevents SARS-CoV-2 from replicating. “But the virus is there, unless your immune system killed off all those cells that are infected. In theory, the virus could go silent,” Kim explains. “Then it wasn’t completely knocked out, and your immune system hadn’t killed off all the infected cells, in theory, it could start replicating again.”

Another reason why Paxlovid rebound has been so hard to diagnose is the unpredictability of untreated COVID infections. Some people have the live virus in their system and remain contagious well after 10 days. Early in the pandemic, here were even reports of patients recovering and relapsing repeatedly over the course of several months.

One study of those untreated relapses noted they were hard to count because they were largely self-reported. But it found that, at least in mildly ill patients, COVID rebound was unlikely to be caused by lingering virus particles. Instead, it probably had more to do with the individual’s immune response.

Immunologists are researching similar questions on long COVID, which for some people manifests as repeated flare-ups of infection symptoms. It’s likely that long COVID has a number of different causes, but one prominent hypothesis involves some kind of viral reservoir.

For individuals experiencing Paxlovid rebound, the biggest concern is that it could make them infectious once again. But at a scientific level, it’s not clear if it’s a feature of the drug, or the strangeness of COVID infections themselves.

The post What we know about COVID rebound so far appeared first on Popular Science.

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This article was originally featured on Kaiser Health News.

Older adults who have survived covid-19 are more likely than younger patients to have persistent symptoms such as fatigue, breathlessness, muscle aches, heart palpitations, headaches, joint pain, and difficulty with memory and concentration—problems linked to long covid.

But it can be hard to distinguish lingering aftereffects of covid from conditions common in older adults such as lung disease, heart disease, and mild cognitive impairment. There are no diagnostic tests or recommended treatments for long covid, and the biological mechanisms that underlie its effects remain poorly understood.

“Identifying long covid in older adults with other medical conditions is tricky,” said Dr. Nathan Erdmann, an assistant professor of infectious diseases at the University of Alabama-Birmingham’s school of medicine. Failing to do so means older covid survivors might not receive appropriate care.

What should older adults do if they don’t feel well weeks after becoming ill with the virus? I asked a dozen experts for advice. Here’s what they suggested.

Seek medical attention

“If an older person or their caregiver is noticing that it’s been a month or two since covid and something isn’t right—they’ve lost a lot of weight or they’re extremely weak or forgetful—it’s worth going in for an evaluation,” said Dr. Liron Sinvani, director of the geriatric hospitalist service at Northwell Health, a large health system in New York.

But be forewarned: Many primary care physicians are at a loss as to how to identify and manage long covid. If you’re not getting much help from your doctor, consider getting a referral to a specialist who sees long covid patients or a long covid clinic. Also, be prepared to be patient: Waits for appointments are lengthy.

At least 66 hospitals or health systems have created interdisciplinary clinics, according to Becker’s Hospital Review, an industry publication. For people who don’t live near one of those, virtual consultations are often available. For specialist referrals, ask whether the physician has experience with long covid patients.

Also, more than 80 medical centers in more than 30 states are enrolling patients in a four-year, $1.15 billion study of long covid that is being funded by the National Institutes of Health and is known as RECOVER (Researching COVID to Enhance Recovery). Older adults who choose to participate will receive ongoing medical attention.

Pursue comprehensive care

At the University of Southern California’s covid recovery clinic, physicians start by making sure that any underlying medical conditions that older patients have—for instance, heart failure or chronic obstructive pulmonary disease—are well controlled. Also, they check for new conditions that may have surfaced after a covid infection.

If preexisting and new conditions are properly managed and further tests come back negative, “there is probably an element of long covid,” said Dr. Caitlin McAuley, one of two physicians at the Keck School of Medicine clinic.

At that point, the focus becomes helping older adults regain the ability to manage daily tasks such as showering, dressing, moving around the house, and shopping. Typically, several months of physical therapy, occupational therapy, or cognitive rehabilitation are prescribed.

Dr. Erica Spatz, an associate professor of cardiology at the Yale School of Medicine, looks for evidence of organ damage, such as changes in the heart muscle, in older patients. If that’s detected, there are well-established treatments that can be tried. “The older a person is, the more likely we are to find organ injury,” Spatz said.

At the Shirley Ryan AbilityLab in Chicago, a rehabilitation hospital, experts have discovered that a significant number of patients with breathing problems have atrophy in the diaphragm, a muscle that’s essential to breathing, said Dr. Colin Franz, a physician-scientist. Once inflammation is under control, breathing exercises help patients build back the muscle, he said.

For older adults concerned about their cognition after covid, McAuley recommends a neuropsychological exam. “Plenty of older patients who’ve had covid feel like they now have dementia. But when they do the testing, all their higher-level cognitive functioning is intact, and it’s things like attention or cognitive fluency that are impaired,” she said. “It’s important to understand where deficits are so we can target therapy appropriately.”

Become active gradually

Older patients tend to lose strength and fitness after severe illness—a phenomenon known as “deconditioning”—and their blood volume and heart muscles will start shrinking in a few weeks if they lie in bed or get little activity, Spatz said. That can cause dizziness or a racing heart upon standing up.

In line with recent recommendations from the American College of Cardiology, Spatz advises patients who have developed these symptoms after covid to drink more fluids, consume more salt, and wear compression socks and abdominal binders.

“I often hear that going for a walk feels awful,” Spatz said. When returning to exercise, “start with five to 10 minutes on a recumbent bicycle or a rower, and add a couple of minutes every week,” she suggested. After a month, move to a semi-recumbent position on a standard bike. Then, after another month, try walking, a short distance at first and then longer distances over time.

This “go slow” advice also applies to older adults with cognitive concerns after covid. Franz said he often recommends restricting time spent on cognitively demanding tasks, along with exercises, for brain health and memory. At least early on, “people need less activity and more cognitive rest,” he noted.

Reset expectations

Older adults typically have a harder time bouncing back from serious illness, including covid. But even seniors who had mild or moderate reactions to the virus can find themselves struggling weeks or months later. 

The most important message older patients need to hear is “give yourself time to recover,” said Dr. Greg Vanichkachorn, director of the Mayo Clinic’s Covid Activity Rehabilitation Program in Rochester, Minnesota. Generally, older adults appear to be taking longer to recover from long covid than younger or middle-aged adults, he noted.

Learning how to set priorities and not do too much too quickly is essential. “In this patient population, we’ve found that having patients grit their teeth and push themselves will actually make them worse”—a phenomenon known as “post-exertional malaise,” Vanichkachorn said.

Instead, people need to learn how to pace themselves.

“Any significant health event forces people to reexamine their expectations and their priorities, and long covid has really accelerated that,” said Jamie Wilcox, an associate professor of clinical occupational therapy at the Keck School of Medicine. “Everyone I see feels that it’s accelerated their aging process.”

Consider vulnerabilities

Older adults who have had covid and who are poor, frail, physically or cognitively disabled, and socially isolated are of considerable concern. This group has been more likely to experience severe effects from covid, and those who survived may not readily access health care services.

“We all share concern about marginalized seniors with limited health care access and poorer overall health status,” said Erdmann, of UAB. “Sprinkle a dangerous new pathology that’s not well understood on top of that, and you have a recipe for greater disparities in care.”

“A lot of older [long covid] patients we deal with aren’t accustomed to asking for help, and they think, perhaps, it’s a little shameful to be needy,” said James Jackson, director of long-term outcomes at the Critical Illness, Brain Dysfunction, and Survivorship Center at Vanderbilt University Medical Center in Nashville, Tennessee.

The implications are significant, not only for the patients but also for health care providers, friends, and family. “You really have to check in with people who are older and vulnerable and who have had covid and not just make assumptions that they’re fine just because they tell you they are,” Jackson said. “We need to be more proactive in engaging them and finding out, really, how they are.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Since the winter of 2020, new coronavirus variants have shaped the COVID-19 pandemic, each of which led to sharp increases in case counts, and eventually, deaths, in the United States.

Those case spikes are obvious in retrospect. What’s harder is figuring out the exact toll of each individual variant. A new report, released in advance of formal publication and independent review, by a team from Yale University’s epidemiology department and the public-interest lobbying group Public Citizen, provides a basic estimate of each variant’s death toll.

 “A significant fraction, almost half and rising, have died after the ancestral strain” of SARS-CoV-2 was replaced by variants, says Jo Walker, a graduate student at Yale and the report’s lead author. Of the more than a million Americans who had died of COVID-19 as of early May, variants killed 460,000. 

While most deaths from each variant occur during a wave’s peak, the challenge is in sorting out the moment when one variant sweeps another out of the way. When Omicron first arrived in the US this past fall, the upper Midwest was deep into a wave driven by Delta. “Those transitions are going to take place at different times and at different speeds from state to state,” says Walker.

By lining up known death tolls with Centers for Disease Control and Prevention estimates of variant prevalence in different parts of the country, the researchers could estimate what fraction of people had died from a given COVID strain. “There’s not actually a lot of complicated math going on here,” says Walker. “It’s really just that there’s a lot of data covering different locations and time periods.”

Walker says that two elements of the findings jump out. The first is the toll from Omicron: Researchers estimate this currently dominant variant has killed 110,000 people so far. That’s despite the widespread misconception that Omicron is a mild variant. Two years ago, after 100,000 Americans had died in the first spring waves, Walker points out, the New York Times ran a front page headline calling the toll “an incalculable loss.” Now, Walker says, “we see a new variant come around and it’s caused a very similar death toll in the matter of a few months,” even with vaccines widely available. The 2022 death toll has fallen most heavily on older Americans, particularly those in nursing homes.

The second is the shifting geography of the pandemic. The Northeast experienced 215 deaths per 100,000 residents before the emergence of variants. Later, variants killed a disproportionate number of people in the South—158 per 100,000 residents. That’s something epidemiologists have understood in other ways; New York City experienced the highest per-capita death tolls of the entire pandemic in April 2020, while southern states experienced prolonged outbreaks over 2021. The new analysis, though, could put specific numbers to the trend.

[Related: A deep dive on the evolution of COVID.]

But Susan Hassig, an infectious disease epidemiologist at Tulane University in New Orleans, says that this finding also illustrates serious limitations of the analysis. “The variant isn’t the only thing that drives mortality,” says Hassig, who wasn’t involved with this paper. “If we were in lockdown during Delta, far fewer people would have died.” And she attributes regional differences to those policy differences—New York City, for example, required masks in indoor settings during variant-driven waves, while many southern states didn’t.

“They didn’t really discuss one of the most interesting findings—explaining why the Northeast’s [death toll] was high[est] in the non-variant environment, and lowest in the variant environment,” Hassig says. “They left so many things on the table.” She acknowledges that incorporating data on policies like school closures or mask mandates is challenging, but says that she would like to see at least vaccination status included in the analysis. 

The authors write in the report that the analysis was intended to observe deaths, rather than explain their causes. But categorizing deaths by variant without incorporating other explanations, Hassig says, risks overemphasizing the role of variants in each wave. Deaths over the last six months are as much a product of undervaccination—among other policy outcomes—as they are of Omicron.

It’s a point that Walker acknowledged in an interview with Popular Science. “The fact that we do see a shift in burden [from the Northeast to South] implies that there’s something going on that isn’t just the variants,” Walker says.

A focus on variants alone may not explain why a million Americans have died. But this approach demonstrates the continued toll of failing to control the pandemic globally. The deadliest variants in the United States emerged overseas, although Walker says “there’s nothing about the US which means that variants don’t emerge here.”

Variants are both “cause and effect,” Walker says. More infectious strains can drive outbreaks—but they’re also a symptom of uncontrolled global spread, which creates the runway for SARS-CoV-2 to accumulate new mutations.

The point of focusing on variants, says Zain Rizvi, research director at Public Citizen, and a co-author on the report, “is it gets us to the connection between the global and local. It establishes that what happens in Lahore really matters for what happens in Louisiana.” That’s a message epidemiologists have yelled before, but it’s increasingly urgent as Congress’ appetite for pandemic funding dries up. 

“We see the staggering cost imposed on the US population,” Rizvi says, “and yet we still are waiting for governmental action to help reduce the risk of new variants emerging globally and to protect the lives of Americans at home.”

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Since early in the pandemic, China has pursued a policy of “zero COVID”: The country  intends to come as close as it can to eliminating the disease from its borders. But even as other countries dropped their own zero-COVID goals over the past year, and despite a recent unusual statement from the World Health Organization calling the policy unsustainable, China’s government has stuck to its plan.

Setting zero COVID as a goal and enacting policies to meet that goal are two separate things. New Zealand and Australia also pursued zero COVID until last fall, when the Omicron surge overwhelmed their precautions. But China has held its policy, and ramped up its response to meet Omicron in spite of substantial costs. Understanding exactly how China has done so is important for figuring out whether the country can stay the course for Omicron.

Benjamin Cowling, chair of epidemiology at Hong Kong University who helped draft the WHO’s 2019 pandemic influenza guidelines, talked Popular Science through China’s strategy.

He says the policy wasn’t necessarily one that China had prepared before the pandemic. Instead, it grew out of the initial response to the Wuhan outbreak.

“There was no playbook before COVID for this,” he says. “It’s a new idea.” Three years ago, in the influenza playbook, Cowling says that he wrote that “containment is futile.” He’ll have to update that statement, he says: China has shown that, in some circumstances, containment is possible.

Step one: suppression

A national zero COVID strategy has two parts. First, contain existing outbreaks, and let them burn out. Then, stop new outbreaks from entering. Or, as Cowling puts it: “One is get to zero, and the other is stay at zero.”

That first step, suppression, is what has occurred in Shanghai over this spring. While the US’s brief and loose stay-at-home policies in the spring of 2020 were intended to bring transmission down to low levels, China’s lockdown has much tighter controls designed to entirely end transmission.

“They’re very, very good at a total lockdown,” Cowling says, “which then buys time for another thing they’re very good at, which is testing everybody in a city. You can see the strategy in Shanghai: Everybody stays at home, they test everybody repeatedly, and anyone who has a case they isolate outside the home, while any contact identified from contact tracing is quarantined.”

Joan Kaufman, a lecturer in global health and social medicine at Harvard University’s School of Medicine, noted that China has a precedent for wielding its infrastructure apparatus to contain a virus: during the 2003 SARS outbreak. “They built these quarantine hospitals and took a very aggressive approach to fully containing and eliminating the SARS virus,” she says. “I think that was the underpinning of this approach.”

Executing COVID lockdowns involves not just labs and medical workers to conduct millions of PCR tests, but civil servants who can trace contacts, and physical buildings to house thousands of people in government-overseen quarantine.

When cases are identified, Chinese authorities have locked down apartment buildings, neighborhoods, cities, or even entire regions, as in Hubei province in early 2020. That has meant different things depending on the circumstances. Sometimes, people are confined to an apartment block or neighborhood. In others, households are allowed a limited number of trips.

That can have a human cost. In Shanghai, residents have gone hungry, or slipped into desperation after months without work. And international outlets have reported growing unrest in the city at news of callous or even brutal quarantine policies—like the separation of parents and children, or police who broke down a door to bring a woman into quarantine.

While a lockdown is in place, China can mobilize a massive contact tracing apparatus to identify possible contacts of people who test positive—in November, the South China Morning Post reported that the police in the city of Chengdu had traced 82,000 close contacts of COVID cases. “There are people scouring CCTV videos, and looking at mobile phone location data,” says Cowling.

For the most part, people who test positive or who are identified as contacts are required to quarantine outside their home. Cities have built quarantine and isolation facilities that can hold thousands of people, and the country has a bank of mobile quarantine buildings that can be trucked to the site of new outbreaks. “They have them in central depots, and if there’s an outbreak in a particular city,” Cowling says, “those trucks just start driving there with these facilities ready to be dropped and connected to electricity and water.”

The speed of that response has meant that lockdowns often last a few weeks. Cowling contrasts this to Australia, which also pursued zero COVID but had to lock down Melbourne for nearly nine months in the face of a simmering outbreak. China’s lengthier exceptions, he points out, like Shanghai or Wuhan, were situations where an outbreak was already well under way before a lockdown.

[Related: What 1 million COVID deaths looks like from the frontlines]

The downside, Cowland says, is that casting such a massive net inevitably means quarantining people who aren’t sick. And quarantine facilities in hard-hit cities have ended up crowded, or without enough food or showers. But during most of the pandemic, life went on normally across the country—which meant that the country avoided not only deaths, but the emotional toll of school closures and other isolation precautions.

And stay out

Then, there’s staying at zero. The key to that has been travel restrictions.

Although it’s possible to enter and exit China, international flights can only land in a handful of cities. Passengers need to take a series of COVID tests—for anyone coming from the US, that means one PCR test seven days from departure, another two days from departure, and a final antigen test before leaving on a direct flight for China.

Anyone flying in is required to quarantine for 14 days and test as often as every day. According to the US State Department, people who test positive are moved to either a hospital or an isolation facility. “Then there’s another week of soft quarantine,” says Kaufman, “which means they’re allowed to move around that city but they can’t go anywhere else” for a set amount of time.

That’s not dissimilar to the approaches taken by Singapore and Korea for much of the pandemic. And, until fall 2021, New Zealand and Australia allowed virtually no international travel.

But China, unlike those countries, is not an island, and tight controls have had consequences for the southern border with Myanmar, Laos, and Vietnam. While most of the country has been spared the disruption of the pandemic, border cities have experienced waves of lockdowns, prompting local recessions and outmigration.

Those closures seem to have been an acceptable trade-off. “Most Chinese people are not international travelers, so the government may see it as an economic downside, but not a dealbreaker,” Cowling says.

Under pressure

These tactics seemed fairly sustainable—until Omicron. The arrival of that variant , which is so wildly transmissible, has changed that calculus, largely because suppression measures need to go further, and last longer, to be effective. That means the actions have been more disruptive to everyday life.

Although news has focused on outbreaks in Beijing and Shanghai, outbreaks are taking place across the country. On May 5, CNBC reported that an estimated 40 cities were affected by lockdowns this spring.

“I think the fear now in China would be that the disruption seen in Shanghai is going to occur again and again in coming months if Omicron gets into Beijing or Guangzhou,” Cowling says. “It’s inevitable that the virus will get in from time to time.”

[Related: The 5 phases of COVID’s endgame]

A major difference between China’s COVID zero plan and those of other countries, Cowling says, is that Australia and New Zealand had planned off ramps. China’s president, Xi Jinping, has said that the country can maintain zero COVID for the foreseeable future—though the policy has been rebranded “dynamic zero COVID” to acknowledge that COVID cases will still occur.

And that’s led to a contentious debate among both foreign and domestic epidemiologists over the country’s strategy. A letter published in Nature Medicine argued that China now has the medical infrastructure to successfully treat COVID outbreaks without resorting to lockdowns. But another recent paper in the same journal estimated that if the country were to end its current lockdown-and-isolate strategy, and instead rely on a patchwork of school and workplace closures, Omicron would kill between 800,000 and 1.6 million people, depending on the effectiveness of those strategies.

The challenge, Cowling says, is that 14 percent of China’s citizens over 60 and 50 percent of those over 80 aren’t fully vaccinated, in part because the populace hasn’t felt personally threatened by COVID. “If you’re not expecting cases in the community, then that means you most likely don’t need to be vaccinated,” he says. Ending the suppression policies could change that risk perception—but only after people had begun dying. That’s similar to what happened in Hong Kong, where morgues overflowed after Omicron overwhelmed a lockdown. To avoid something similar, China needs to find a way to get more vaccines in arms—or stay its current course.

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Vaccines against COVID-19, while protective against hospitalization and death, may not be great at preventing long COVID after breakthrough infections, a new study finds.

Epidemiologists associated with the US Department of Veteran Affairs looked at the medical records of 13 million individuals—mostly white male veterans aged 60 on average—including almost 34,000 who experienced breakthrough COVID-19 infections after vaccination. They found that while being vaccinated greatly reduces risk of hospitalization and death, vaccines only reduce the risk of long COVID by about 15 percent, as the researchers reported in a paper published on Wednesday in Nature Medicine. 

Vaccinated individuals experiencing breakthrough infections were protected from certain symptoms, like blood clots and lung disorders. But there was no difference between the vaccinated and unvaccinated when it came to longer-term risks of infection, which include neurological issues, gastrointestinal symptoms, kidney failure, and other conditions.

“This was disappointing,” Ziyad Al-Aly, lead author and chief of research and development service at VA Saint Louis Health Care System, told The Washington Post. “I was hoping to see that vaccines offer more protection, especially given that vaccines are our only line of defense nowadays.”

In the new study, 32 percent of vaccinated veterans had long COVID symptoms up to six months after their breakthrough infection, compared to 36 percent of unvaccinated veterans with COVID. The Centers for Disease Control and Prevention released a report on Tuesday estimating that “COVID-19 survivors have twice the risk for developing pulmonary embolism or respiratory conditions” compared to uninfected people.

Al-Aly also told the AP that the study authors conducted this study before booster shots were available to the public, and before the rise of the Omicron variant. The breakthrough infection rate is therefore probably higher than the 1 percent their study suggests, and it’s unclear how boosters impact the risk of long-term symptoms. It’s important to note, however, that the vaccine does in fact reduce your chance of getting long COVID, as it makes you less likely to catch the virus in the first place.

Al-Aly also mentioned that breakthrough infections and long COVID symptoms were more common among those who received Johnson & Johnson’s single-dose shot compared with two doses of either Moderna or Pfizer vaccines.

[Related: A new kind of COVID vaccine could soon be available internationally]

The causes and potential treatments of long COVID are still largely unknown. There have been more than 83 million COVID-19 infections in the United States alone, and even if just a small percentage of those infected develop long COVID, “that’s a staggeringly high number of people affected by a disease that remains mysterious,” Al Aly told Nature. 

While this new paper offers some information, the medical reports used in this research were from so early in the pandemic—from January to October 2021, when Delta was the largely dominant variant—that the findings clearly come with many limitations. Steven Deeks, an HIV researcher at the University of California, San Francisco, who was not involved in the study, pointed out to Nature that “we have no data on whether Omicron causes long COVID,” and so the findings “apply to a pandemic that has changed dramatically.”

“We don’t have a definition, we don’t have a biomarker, we don’t have an imaging test, a mechanism or a treatment,” Deeks added. “We just have questions.”

Demystifying long COVID through research specifically aimed to find its causes and possible interventions is direly needed for those now living with protracted symptoms. “We need continued research specifically on long COVID so specific therapies can be developed,” Greg Vanichkachorn, director of the Mayo Clinic’s COVID Activity Rehabilitation Program in Rochester, Minnesota, who was not involved with the new study, told NBC. But right now there’s only one good long COVID prevention method: “the best way to not get long COVID is not to get COVID,” said Vanichkachorn. And one of the best ways to not get COVID is to get vaccinated.

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On May 12 the White House acknowledged that more than a million Americans have died of COVID-19. Since infectious disease modelers began forecasting the course of the pandemic in early 2020, the US has exceeded worst-case predictions over and over. In the first year, 500,000 people died; and by spring of 2022, a million deaths had become a horrific inevitability. Currently, the national COVID toll hovers around 300 lives a day—three times more than the people who die from car crashes daily in the US.

Despite the historic weight of one million deaths, it can be impossible to wrap one’s head around the figure. “There was one human that put us over the edge of that number,” Maitely Weisman, a cofounder of the Essential Caregivers Coalition, puts it. To focus on the total can mean moving “too far from the Earth to see the individuals inside of it.”

Thousands of those deaths have taken place in the lull between COVID surges. When waves of infection are high, headlines: overwhelmed hospitals, thousands of mourners, and a steady drumbeat of updates from public officials. But right now, a third of Americans say the pandemic is over, and in spite of pleas from the White House, Congress has slashed pandemic funding. Yet the country is, in many ways, even more fragile than it was two years ago. Dwindling federal dollars threatens to cut off testing, antivirals, and possibly even vaccines for 31 million uninsured Americans, while the health care system itself has been eroded by a wave of hospital closures and nursing burnout. 

[Related: Meet the nurse who’s running a Texas COVID-19 clinic all on her own]

Popular Science reached out to people close to the pandemic response, hoping to open a series of windows on the country as it remembers, rebuilds, and rethinks public health and safety for the future.

These are excerpts from conversations.

Jennifer Avegno, director of the New Orleans Health Department

How has the news of a million COVID deaths in the US changed your perspective or actions?

As humans, we’re pretty bad at putting big numbers into context. I tend to say, a million people is basically the metro population of New Orleans completely wiped off the map. But that still makes it a lot more abstract—some city got wiped off the map, but I’m still here. I come back to those early days when we were hit so hard, and knew very little, and had almost no tools to stop the deaths. Those deaths were very personal, because everybody was reporting on every single one. It was the nursing home outbreak at Lambeth House, Zulu Social Aid and Pleasure Club, an Uber driver. So I try to reflect on who these individuals might be, and what they leave behind—I know people who died. You’d be hard pressed to find someone who didn’t know someone who died of COVID. I think that’s what makes it real.

It also makes me renew my focus: We cannot go back to those early days, nor can we continue on a trajectory where a million people is acceptable. In New Orleans, like most of the rest of the country, COVID is in the top three causes of deaths two years in a row. That can’t continue unless we want to live in a very different world.

What aspects of the pandemic are no longer getting the attention they deserve?

I think we have not done a great job historically paying attention to those who are disabled or are always going to be at risk. Those folks feel forgotten. Everyone else has moved on with their life, but if you’re immunocompromised in whatever way, you’re still in the same boat you were in March 2020. If we fail to take care of those who have the least protection, then we can’t move on as a society.

I’m an ER doctor, so it’s really important to me to make sure that your doctors feel comfortable prescribing paxlovid. At the city we are working really hard with the local partners to set up a hotline, so you don’t even if you tested positive at home, you don’t even have to go anywhere. Because again, that’s going to keep people from having to stay in the hospital.

Where are you finding hope as the country moves forward?

The good news is we do have a lot of tools at our disposal. We have widespread availability of tests. The next hurdle will be providing access to the additional layers of protection in oral treatments and antibodies that we have.

Ed Rupert, cofounder of First Responder Trauma Counselors

How has the news of a million COVID deaths in the US changed your perspective or actions?

We work with emergency room physicians and staff and EMS workers—they were kind of canaries in cages. While everybody else was locked down, these people were leaning into the problem. 

[Related: Who helps first responders in a crisis?]

Our work is a treadmill of trauma. We’re constantly working on this churn of trying to manage it. We’re at a more tenuous point. It’s bigger than COVID—that was just a stress test of the system, and we saw the inconsistencies where the weaknesses and the strengths were. The strengths were the people, and the inconsistencies were the support.

Where are you finding hope as the country moves forward?

We look at the pandemic and say, okay, how can we build capacity for mental health services for the people on the frontlines? We’re looking at groundbreaking technologies like eye-movement desensitization and reprocessing therapy, ketamine-assisted therapy, and sensory deprivation tanks, among other options. But there’s also the model of the response. We spend a lot of time normalizing help. It’s like when a fire department is overwhelmed and they call another department and say, “I need mutual aid”—it’s no big deal. We’re just the backup.

Maitely Weisman, cofounder of the Essential Caregivers Coalition

How has the news of a million COVID deaths in the US changed your perspective or actions?

We have never felt differently from the rest of the public—it’s not over until everyone can be treated quickly and successfully.

When I see a million deaths, it’s because it’s still a pandemic. It drives us crazy when we see people being very cavalier about it. Now that we’re allowed back into facilities, we have to stay safe. We’re masking everywhere we go. Members of our coalition and of other advocacy groups who go into long-term care homes need to work a job in an exposed place like grocery stores or restaurants. Some of them also take mass transit. The point is that they’re worried about accidentally contracting the virus every day.

When you’re out in the community, you don’t know who’s a family caregiver, who is a nurse, or a doctor. You don’t know the links, they’re invisible to you. You don’t know where they go and who they touch, who’s in their world.

What aspects of the pandemic are no longer getting the attention they deserve?

I imagine that we’ll be seeing more outbreaks. We’ve already heard of a couple, but they’re not reporting them as vividly as they did before. So you’re not seeing the struggle that nursing home residents are still experiencing, and that feeling of having their rights stripped as if they’re nonpersons.

Mary Owen, director of the Center of American Indian and Minority Health at the University of Minnesota

How has the news of a million COVID deaths in the US changed your perspective or actions?

I’m not reacting. We’ve watched as [the US] climbed steadily toward this number. My perspective of dismay over the lack of public health infrastructure and profit driven health care remains the same. 

What aspects of the pandemic are no longer getting the attention they deserve?

I’m anxiously watching what’s happening to our K-12 educational systems and the impact of COVID on a system that, pre-pandemic, faced chronic underfunding resulting in overcrowded classrooms, overworked teachers and support staff, and underserved youth. I’m watching what is happening in our healthcare system that, pre-pandemic, had physician burnout rates nearing 50 percent. I’m watching the impact on both systems of increased rates of early retirement and job flight because of the demands of COVID on top of already stressed systems. 

Where are you finding hope as the country moves forward?

I’m feeling hopeful that young people are aware, active, and fighting for change.

Govind Persad, bioethicist at the University of Denver Sturm College of Law

How has the news of a million COVID deaths in the US changed your perspective or actions?

It puts into perspective the extent to which our focus has been—in some ways—narrow: A million people at home have officially died of COVID, but many more people have died worldwide, and many others have died due to the pandemic (for instance, from delays in obtaining health care). Could emphasizing the broad harms of the pandemic rather than focusing on direct COVID deaths still lead to a better response?

What aspects of the pandemic are no longer getting the attention they deserve?

Despite having highly effective vaccines, we have invested insufficiently in research on which strategies for COVID-19 response achieve the most public health benefit with lowest burden. What dosing schedule for vaccines and boosters is optimal? Rigorous trials of non-medical interventions and efforts at program evaluation could help us move from policy based on hunches, precautionary reasoning, or repeated zigzags toward an mature, evidence-informed response. 

Where are you finding hope as the country moves forward?

The Food and Drug Administration appears to have the needed information to act quickly on authorizing a vaccine for children under 5. It has been frustrating to see repeated delays coupled with inappropriate rationales (e.g. that authorizing one vaccine candidate before others would be “confusing” to parents or that authorization decisions should aim to reassure “anti-vaccine communities”). Extending eligibility to these children will benefit them directly, provide relief for their families, and nudge our population protection further upward.

Cari Levy, palliative medicine chief and co-director of the Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center

How has the news of a million COVID deaths in the US changed your perspective or actions?

It’s very distressing, obviously. I think all of us at this point have friends or colleagues or family who are in some phase or denial—whether it’s “this isn’t real,” or “the vaccine doesn’t work.” I remember a family member saying [early in the pandemic], “Look, they all panicked and said a million people will die, but here we have 1,000 people.” I think about that two years later. We have a million dead, and yet people are still pretty flippant about things.

What aspects of the pandemic are no longer getting the attention they deserve?

A couple of things. One is that we had some early data that people who have had COVID are at a higher likelihood of developing dementia, and we are seeing that now in nursing homes. What we’re seeing is, where somebody might have taken three years to have a decline in their cognition, now it’s months.

The other is that nursing homes before the pandemic, half of them were not making a profit. Currently, we’re seeing a fair number go out of business, and none of them are properly staffed. There’s a really interesting thing happening: Nobody wants to go to a nursing home on a good day, and as soon as they get there and see how poor the staffing is, they want to get out. I think we’re going to see a big shift to home care, as there’s not enough beds available, or the beds available aren’t desired.

[Related: Finding a therapist can be overwhelming, but these tips can help]

The third is that a lot of people are emerging now 100 pounds overweight, or with a wound on their leg that is now basically going to kill them—all the things that people haven’t tended to because they were scared to go into a doctor’s office. We only had maybe one COVID patient last week, but the hospital is super busy.

Where are you finding hope as the country moves forward?

We initially thought, “Oh, suddenly people are going to appreciate how integral nursing homes are to society.” But they just got blamed for the problems. Now I guess the thing that I am hopeful about is home care models. I do think there will be a huge shift. It’s not necessarily a bad thing, because nursing homes are not doing well, and haven’t been doing well for a long time. And this will force the industry to turn upside down and reconfigure. So it’s going to be painful; it’s going to be clunky. A lot of people will be caught in the crosshairs of that, but I think ultimately, we will get better at caring for people at home.

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This article was originally featured on KHN.

For two years, you beat the odds. You masked, kept your distance, got your shots.

Now, despite those efforts, you, your child, or someone else in your home has come down with covid-19. And the last thing you want is for the virus to spread to everyone in the family or household. But how do you prevent it from circulating when you live in close quarters?

The Centers for Disease Control and Prevention recommends isolating covid patients for at least five days, preferably in a separate room with access to their own bathroom, as well as diligent mask-wearing for both patient and caregiver. But for many families, those aren’t easy options. Not everyone has an extra bedroom to spare, let alone a free bathroom. Young children should not be left alone, and the youngest can’t tolerate masks.

“For parents of a young child, it’s pretty difficult not to be exposed,” said Dr. Preeti Malani, chief health officer at the University of Michigan. “You have to work back from the perfect to the possible and manage your risk the best you can.”

But take heart. Scientists say there is still a lot people can do to protect their families, chief among them improving ventilation and filtration of the air.

“Ventilation matters a lot,” said Dr. Amy Barczak, an assistant professor of medicine at Harvard Medical School. “If you’re taking care of someone at home, it’s really important to maximize all the interventions that work.”

To understand why good ventilation can make a difference, it helps to understand how the novel coronavirus spreads. Scientists have learned a lot in two years about its infectious mechanisms.

Viral particles float through the air like invisible secondhand smoke, diffusing as they travel. Outside the home, viruses are quickly dispersed by the wind. Inside, germs can build up, like clouds of thick cigarette smoke, increasing the risk of inhaling the virus.

The best strategy for avoiding the virus is to make your indoor environment as much like the outdoors as possible.

Start by opening as many windows as the weather allows, said Joseph Fox, a heating, ventilation, and air conditioning engineer for a large school district in Ontario, Canada. If possible, open windows on opposite sides of the home to create a cross breeze, which can help sweep viruses outside and bring fresh air inside.

For extra protection, place a box fan in the patient’s window, facing outward, to draw germy air outside. Seal any openings around the sides of the fan, said Jim Rosenthal, CEO of Tex-Air Filters, a company that manufactures air filtration products in Fort Worth, Texas.

“It’s real simple, and it’s cheap,” Rosenthal said.

To prevent infected air from seeping out of the sickroom, Fox suggests wedging towels in the gap under the bedroom door. People should also cover return air grills with plastic. These grills cover vents that suck air out of the room and recycle it through the heating or cooling system.

Fox also suggests turning on bathroom or kitchen exhaust fans, which can shuttle germy air outside. Although running exhaust fans while taking a shower is relatively safe, Fox said, it’s important to open windows when running the fans for more than 10 minutes. That’s to avoid depressurizing the house, a circumstance that could result in carbon monoxide being pulled into the home from the furnace or water heater.

Coronaviruses thrive in dry air, and increasing the amount of moisture in the air can help deactivate them, said Linsey Marr, a professor of civil and environmental engineering at Virginia Tech. Marr suggests increasing humidity levels to somewhere between 40% and 60%.

Using portable air cleaners can provide additional protection. Research shows that high-efficiency particulate air filters, or HEPA filters, can remove coronaviruses from the air. If people have only one HEPA filter, it’s best to place it in the sickroom, to trap any virus the patient exhales.

“You want to put the filter as close to the source [of the virus] as possible,” Fox said.

If affordable for families, additional air cleaners can be used in other rooms.

Store-bought air purifiers can be expensive, with some models costing hundreds of dollars. Yet for about $100, people can build their own portable air cleaners using a box fan, four high-efficiency air filters, and duct tape. These do-it-yourself devices have been dubbed Corsi-Rosenthal boxes, after their co-inventors, Rosenthal and Richard Corsi, dean of the college of engineering at the University of California-Davis. The low-cost boxes have been shown to work just as well as commercial air purifiers.

Rosenthal said the pandemic motivated him to help design the air purifiers. “We’re not helpless,” Rosenthal said. “We need to provide tools that people can use right now to make things better.”

Although nursing a loved one through covid puts the caregiver at risk, the danger is much smaller today than in the first year of the pandemic. An estimated 95% of the population has some immunity to the coronavirus, due to vaccines, prior infections, or both, said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

Nonetheless, a recent study found that half of the people living in an infected patient’s household also contracted the virus.

Given that older people and those who are immunocompromised are at higher risk from covid, they might consider staying with a friend or neighbor, if possible, until the sick family member has recovered, said Priya Duggal, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

Patients can be considered covid-free after a negative PCR test, Barczak said. Because patients with even tiny amounts of residual virus can continue to test positive on PCR tests for weeks, long after symptoms disappear, patients can also use rapid antigen tests to assess their progress. If antigen tests are negative two days in a row, a person is considered less likely to be contagious.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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The US Food and Drug Administration has approved emergency use authorization of a Pfizer-BioNTech coronavirus booster shot for children ages 5 through 11. 

The agency announced on Tuesday that any kid in that age group who finished their primary vaccination series at least five months ago can go ahead and get their booster. Pfizer-BioNTech’s mRNA-based vaccine is currently the only COVID-19 immunization and booster available for children ages 5 through 17. Children younger than 5 are the only US age group that remains ineligible for a COVID shot.

“Vaccination continues to be the most effective way to prevent COVID-19 and its severe consequences, and it is safe,” FDA Commissioner Robert M. Califf said in a statement. “If your child is eligible for the Pfizer-BioNTech COVID-19 vaccine and has not yet received their primary series, getting them vaccinated can help protect them from the potentially severe consequences that can occur, such as hospitalization and death.”   

It’s unclear whether this new announcement will spur many parents to take their kids for COVID shots. Vaccination rates for children continue to lag far behind those of older populations. Although the FDA authorized the Pfizer-BioNTech vaccine for use in children ages 5 through 11 in November, the Centers for Disease Control and Prevention report that just 29 percent of those children are fully vaccinated. 

[Related: Moderna’s latest COVID vaccine trial for kids offers ‘really good news’]

While the FDA has authorized Pfizer-BioNTech’s booster for this new age cohort, the CDC still has to decide whether it wants to formally recommend the booster for these kids. The agency will discuss this option when it meets with its panel of expert advisers on Thursday.

Adults aged 18 and older in the US are eligible for primary vaccines and boosters made by Pfizer-BioNTech, Moderna, or Johnson & Johnson. People ages 50 and older are also eligible for a second booster, though the guidance for those boosters on the Centers for Disease Control and Prevention’s website was quietly updated Friday, indicating those who are eligible may want to wait till the fall to get additional shots in case variant-specific vaccines become available.

Another group must continue to wait, too: Parents of the country’s youngest children. The expected timelines for vaccine approval for children under 5 have been repeatedly pushed back. Both Pfizer and Moderna have been studying their vaccines’ effectiveness in small children, and the FDA is set to review those data in June. According to the CDC, 491 kids under the age of 5 have died from COVID-19. Evidence shows that children are also vulnerable to long COVID. However, research suggests that as many as three-quarters of all US children have already been infected by coronavirus, specifically during the winter Omicron wave.

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Almost two years and two months after the World Health Organization (WHO) called COVID a pandemic, the US officially passed the 1 million death toll for the virus. It is now well beyond any other mass-mortality event in American history, including the 1918 flu pandemic.

“Today, we mark a tragic milestone: one million American lives lost to COVID-19. One million empty chairs around the dinner table. Each an irreplaceable loss,” President Joe Biden shared in a statement early this morning. In respect, he ordered all American flags on public grounds across states and territories, along with those at embassies overseas, to be flown at half-staff through May 16. The White House has not scheduled a live address to discuss the death toll any further. The Centers for Disease Control and Prevention (CDC), the national agency leading the public health response to the virus, hasn’t commented on the grim figure. Its COVID data tracker still holds US fatalities at 995,474.

The first death of a person from SARS-CoV-2, the virus responsible/behind for COVID, was recorded in January 2020 in Wuhan, China. The first person in the US died about a month later in Kirkland, Washington. The domestic figure snowballed that April and May, and hit a new peak at the start of 2021. Even in January and February of 2022, the average daily death count hovered well over 2,000. At current, America has the highest body count from the pandemic—but many experts think other countries severely underestimated their losses. Last week, the WHO announced that the global COVID death toll could be as high as 15 million individuals.

It’s possible that the US passed the 1 million fatality mark even earlier this spring. NBC News reported that the millionth mortality happened before May 4 using data from state health departments, which is often more current and accurate than national sources. But the White House did not confirm or deny the number at the time.

[Related: The 5 phases of COVID’s endgame]

In addition to the unprecedented number of deaths, COVID has sickened millions of people in the US and hampered many of them with long-term disabilities. Last month, the CDC estimated that 58 percent of Americans had been infected by the virus before March 2022, based on antibodies in blood samples taken from around the country. That includes a good chunk of children below the age of 11, many of which are still not eligible for vaccines.

The vast majority of the people who died from COVID in the states and territories were ages 65 and older. The death rate is also slightly higher among male patients than female, and proportionally higher in Black, Native, and Latinx Americans than white and Asian Americans. There were also surges in late 2021 and early 2022 where unvaccinated individuals were dying at faster rates than the rest of the country’s populace. But over the past weeks, the heaviest mortalities have fallen on very old and sick populations, despite their high vaccination rates. (See this STAT News article for a detailed visual breakdown of the 1 million figure.)

President Biden also briefly touched on the need to continue to diagnose, treat, and protect people suffering from long COVID and other post-infection complications, along with those who have dodged the virus so far. “We must remain vigilant against this pandemic and do everything we can to save as many lives as possible, as we have with more testing, vaccines, and treatments than ever before,” Biden’s statement read. “It’s critical that Congress sustain these resources in the coming months.”

[Related: Masks can work—even if you’re the only one wearing them]

More than a dozen countries, nonprofits, and companies gathered in Washington, D.C. today for the second Global COVID-19 Summit. In her address at the beginning of the meeting, Vice President Kamala Harris said that of the $22.5 billion emergency COVID funds that Congress still needs to approve, “5 billion would be dedicated to continue [US] leadership in helping to save lives around the world,” namely in the form of vaccines and antiviral treatments for nations with low GDPs. “The future, of course, will present other global health crises,” she continued. “But they don’t have to become catastrophes if we do this work together.”

Meanwhile, COVID is still circulating in the US, with new Omicron strains causing infection and hospitalization rates to climb again. Last month, the Food and Drug Administration green-lit a second booster for Americans who are older than 50 or immunocompromised. Discussions are still ongoing on whether to allow another shot for anyone eligible for vaccines, along with the possibility of variant-specific immunizations as the pandemic continues into year three.

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As the US passes 1 million fatalities from COVID-19, a new analysis from the World Health Organization reveals how dramatically governments have undercounted deaths related to the pandemic.

The agency announced on May 5 that the pandemic claimed approximately 14.9 million lives in its first two years—more than twice the number of confirmed deaths reported by countries around the world. The WHO estimate includes people who died of COVID-19 as well as deaths that the novel coronavirus caused indirectly. 

Data on COVID-19 fatalities is tricky to make sense of, both in the US and globally. However, accounting for these deaths is important to gauge the full impact of the pandemic, experts say. 

“Understanding mortality is so critical,” says Albert Ko, an infectious disease physician and epidemiologist at the Yale School of Public Health. “Having these numbers will be important for decision makers to know how many lives could be saved in the future.” 

Analyzing mortality data reveals which groups are most at risk from COVID-19 due to their age, health status, race, or other characteristics. This information can help policymakers and public health organizations determine how best to protect vulnerable populations going forward. Mortality rates in different states or countries can also reveal the ability of control measures or vaccination campaigns to avert deaths.

There are several ways to measure the pandemic’s death toll. One is the number of deaths reported to national organizations such as the Centers for Disease Control and Prevention. This approach has a few drawbacks. Deaths tend to be undercounted in areas where COVID-19 tests aren’t widely available or health infrastructure is limited. 

“Those places that have the weaker surveillance or reporting systems are likely also the places that may have the highest death rates,” Ko says. And it’s often difficult to figure out “who actually died of COVID, versus those people who may have died of cancer or heart disease or trauma but were infected at the same time,” he adds.

Some governments are also more forthcoming with COVID-19 mortality data than others. Aleksei Raksha, a demographer who quit Russia’s state statistics service, recently told the New York Times that COVID-19 was frequently omitted as the primary cause of death in official reports.

[Related: The 5 phases of COVID’s endgame]

Another challenge is that the criteria used to define COVID-19 deaths isn’t necessarily consistent from one location to the next, says Justin Lessler, an epidemiologist at the University of North Carolina Gillings School of Global Public Health. It can even change over time; Massachusetts initially counted all deaths that occured after a positive test as COVID-related, but has since narrowed its criteria. 

“That presents challenges in the sense that you’re not making apples-to-apples comparisons when you’re looking across various jurisdictions and areas,” Lessler says.

Unlike Britain, which can rely on its National Health Service, the US and other countries that lack centralized healthcare systems face additional difficulties. “The fragmentation of information has certainly been a challenge in the United States,” Ko says. 

In such patchwork systems, death counts can jump quite a bit from one week to the next as some jurisdictions lag behind others in reporting data. “You can generally assume if there’s a two- or threefold increase in how many deaths are reported on a given day that it’s probably not the result of a lot of people dying then,” Lessler says. “It probably has something to do with reporting.” 

A more reliable way to assess COVID-19 deaths is a metric called “excess mortality.” Based on records from past years, researchers calculate how many people would be expected to die in a given time and place. The difference between the total number of deaths that occurred and this estimate is the excess mortality. Scientists often use this approach to understand the full impact of crises, including diseases and disasters such as Hurricane Maria.

In its new report, the WHO used excess mortality to conclude that nearly 15 million people died worldwide because of the pandemic in 2020 and 2021. Another excess mortality estimate published in March by an international team of researchers in the Lancet put the number of deaths even higher—at 18.2 million. 

Excess mortality doesn’t just capture fatal COVID-19 cases. It also includes deaths that occurred because hospitals became overwhelmed, or because people were afraid to seek treatment for other issues or schedule routine screenings. Furthermore, the estimates account for deaths that COVID-19 prevented. The early pandemic’s containment measures resulted in fewer traffic accidents and decreased the transmission of other diseases such as influenza. 

The WHO found that 84 percent of the fatalities came from Southeast Asia, Europe, and the Americas, with the US among the top five countries with the most excess deaths. For places with sparse mortality data, the agency used other measures such as the country’s COVID-19 containment efforts and population demographics to estimate excess deaths.  

Researchers will continue to fine-tune their estimates of the pandemic’s death toll. A century after the 1918 flu pandemic, Lessler notes, scientists are still attempting to unravel the mystery of how many people actually died. “We have much better data and much better information to go on now, and there aren’t going to be the same massive uncertainties for this pandemic as for that one,” he says. “[But] I think there will be debates and accountings and attempts to understand it for years to come.” 

However, Lessler and Ko predict, the message conveyed by the excess mortality estimates is unlikely to change.

“The bottom line is the number of people who died because of either direct or indirect effects of COVID is much larger than what was counted by reported deaths,” Ko says.

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About 58 percent of the US population has antibodies that resulted from COVID-19 infections, according to new data from the US Centers for Disease Control and Prevention. 

December’s rise of the Omicron variant caused a huge swell of coronavirus infections in the US. So many people have been infected that the proportion of Americans who have anti-N antibodies, a type of antibody that shows up in the blood post-COVID infection but not after vaccination, rose from 34 percent of the population in December to 58 percent in February. 

The highest bump occurred in the youngest cohorts. In December, 44 percent of children aged 0 to 11 years had natural antibodies. As of February, that figure has risen to 75 percent.

The CDC reported its figures on Tuesday, which are based on blood samples tests from a commercial lab network. The agency analyzed about 74,000 blood samples every month from September 2021 to January 2022, and 46,000 samples in February 2022, to arrive at its results. 

[Related: The 5 phases of COVID’s endgame]

The biggest increases in natural antibodies occurred in the cohorts with the lowest vaccination rates—young children—further emphasizing the need to vaccinate those who remain the least protected. Children aged 5 or older are eligible to receive Pfizer-BioNTech shots, though only 35 percent of kids ages 5 through 11 have received at least one vaccine dose. Children ages 0 to 4 are still ineligible for any COVID-19 vaccines.

While the lab results show how much of the population has been infected by SARS-CoV-2, they cannot tell us whether these antibody levels are high enough to protect people against future infection, said the CDC according to CNBC. CDC director Rochelle Walensky cautioned that the level of protection people receive post-infection is more uncertain than the level you receive from vaccines—vaccination is still the safest and most assured way to protect yourself against the virus. 

Natural immunity from infection wanes faster than immunity gained from vaccines, according to Johns Hopkins University. A CDC report from October 2021 says getting vaccinated for the coronavirus when you’ve already had COVID-19 significantly boosts immune protection and reduces risk of reinfection. And an earlier 2021 study showed that you are twice as likely to get reinfected with the coronavirus if you are not vaccinated.

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This article has been updated with more recent news on mask mandates.

Mask mandates have almost entirely vanished across the United States, after a Florida judge voided a federal requirement to cover faces while in transit. Major airlines and Amtrak swiftly discarded their mask rules. States, meanwhile, had been shedding their mask regulations all spring. Now, no state has a public mask rule. Guam, the final US territory to require masking indoors in public, may lift that requirement in early May.

Although cases have declined substantially, COVID transmission remains high in some areas of the country. Cases rose so sharply in Philadelphia that the city recently reinstituted an indoor mask requirement. Many epidemiologists have criticized the removal of mask precautions as premature, even if they agree that masking can be relaxed in the future.

You may be asking a now-familiar question: What’s your personal responsibility in the face of a societal problem? This is a story that has played out with booster shots, COVID testing, and relaxed isolation policies. The answers aren’t always satisfying: You can’t end the pandemic on your own, but you can make yourself safer.

No one around me is wearing a mask. Will wearing one protect me?

Short answer, yes.

Masks of all kinds appear to reduce someone’s chances of contracting COVID. Real-world experimental data has been hard to gather (it’s unethical to prevent people from wearing a mask for the sake of an experiment). But a study published recently by the CDC examined the habits of more than 1,800 Californians, and found that those who always wore at least a cloth mask indoors were 50 percent less likely to test positive for COVID than those who didn’t wear face coverings. That lines up with lab studies on mask efficacy, which find that most masks reduce the movement of particles both in and out. And the argument that masks are largely ineffective at slowing COVID transmission is the result of cherry-picked data, as Gothamist wrote in February.

That doesn’t mean all masks provide equal protection. The California study found that those who wore an N95 in all public indoor settings were 83 percent less likely to test positive—a massive improvement over cloth masks. Surgical masks sat in the middle.

“If you want to participate in daily life, and you feel you need to protect yourself more, you really need to upgrade your game and go to an N95 mask,” says Marcus Schabacker, president of ECRI, a nonprofit that independently evaluates medical equipment.

Part of the confusion over the benefits of masking comes from the fact that the Centers for Disease Control and Prevention used to recommend any kind of mask, before emphasizing the benefits of N95s in January. Does that mean that cloth masks weren’t effective in the first place?

Not at all: The key thing to keep in mind is that cloth and surgical masks provide a societal benefit, even if they do less to reduce your personal risk. A surgical mask is fairly good at preventing you from spreading viral particles, even though it’s less effective than an N95 at keeping them out. A cloth mask is less effective than a surgical mask or respirator, but still contains some of the aerosols you exhale.

And that means that any kind of mask can be a useful public health tool, even if it doesn’t provide the absolute best protection for its wearer. 

Think about it this way. Say a cloth mask reduces the chances of contracting COVID by 50 percent, as in the Californian study. COVID transmission will be slower, softening the blow to hospitals, and preventing many infections across a society. That’s a worthwhile goal. But there might still be some personal risk to you.

That’s why the CDC now recommends N95s or similar respirators for protecting yourself against infection. As long as these masks fit well, they filter out around 95 percent of incoming particles.

A person wearing a respirator can expect to be protected for about seven times as long as someone wearing a cloth mask, all other things being equal, according to an estimate published by ECRI. Another study from December 2021 found, based on particle modeling, that if a healthy person in an N95 spends 20 minutes right next to an infected person wearing a surgical mask, they have less than a 1 percent chance of catching COVID. If neither were masked, the healthy person would have a 90 percent chance of catching the virus.

N95 masks protect the wearer “even if the people you’re interacting with are wearing nothing and are infected,” says Schabacker. “That in combination with a certain amount of effectiveness of your antibodies, either from vaccination or from a natural infection, should help protect you in most situations, like mass transportation, a school room, shopping, at a Super Bowl game.”

Should I wear a mask around vulnerable people?

Masks are even better at preventing you from spreading COVID to others. If you have a loved one who is at high risk for severe disease, or a child who isn’t vaccinated yet, wearing a mask will absolutely make them safer.

The same rules of thumb from above hold true: While cloth masks reduce your risk of transmitting COVID, respirators come close to eliminating it.

The clearest demonstration of that efficacy comes from a study published in January. Researchers brought test subjects into a lab, gave them a variety of face masks, and recorded them speaking and coughing in front of a camera normally used to study the movement of jet fuel. 

(You can watch the results below.)

“What we found is that the propagation of aerosols and droplets in a cloth mask was on the order of like two feet for speech and 2.2 feet for a cough,” says Kareem Ahmed, senior author on the study, and an aerospace researcher at the University of Central Florida. “That’s still relatively large. If we’re speaking to each other, you’re most likely going to be within one to two feet.”

Surgical masks cut that down to about half a foot. The study didn’t even illustrate the effect of N95 respirators, Ahmed says, because there was nothing to see. Effectively no particles escaped.

What are the limitations of masking?

A mask works only if you actually wear it. Make sure it’s comfortable and fits well. You might have to try on a few different versions, though Schabacker notes that many drug stores now offer free N95s from the federal government. 

Ahmed says that an easy way to test the mask’s fit is to see if your glasses fog up while wearing it—if so, you need to adjust the nose to form a seal. (We have more details on buying masks here.)

And make a point of wearing a mask in situations where it matters most. In a paper titled “COVID-19 false dichotomies,” published last summer, a team of public health researchers, virologists, and epidemiologists argued that policymakers should seek a middle ground between universal masking and no mask requirements at all. “Not all settings and activities allow mask wearing or confer the same risk of SARS-CoV-2 infection,” the team wrote.

The same principles hold true for individuals. When there’s a high risk of being close to infected people, wear a mask. In general, that means public indoor spaces, or tightly packed crowds outside. In a home, masks are most useful when there are visitors. That still holds true when everyone is vaccinated, because for the moment, the CDC lists the entire United States as an area of high transmission.

A mask is just one tool for reducing your chances of infection. It’s not a magic shield. The less time you spend in tight quarters with people outside your immediate family, the less work the mask needs to do. 

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A federal judge in Florida declared that the national mask mandate for airlines and public transportation was unlawful, voiding the mandate on Monday. 

The US Centers for Disease Control and Prevention recently tried to extend the national mask mandate for commercial flights and public transportation settings, which was set to expire on Monday, until at least May 3. In her 59-page ruling, District Judge Kathryn Kimball Mizelle of the Middle District of Florida said the health agency failed to adequately justify its decision, and that the mandate was an overextension of health officials’ authority. 

“Because our system does not permit agencies to act unlawfully even in pursuit of desirable ends, the court declares unlawful and vacates the mask mandate,” she wrote in the ruling.

The CDC still recommends that people wear masks on public transportation and in other enclosed settings. The Biden administration is currently debating whether to appeal the ruling. 

“This is obviously a disappointing decision,” White House press secretary Jen Psaki said to reporters on Monday, according to the AP. 

Many health experts agreed. Rescinding mask requirements for travel right now is “very, very concerning,” Saskia Popescu, an infectious disease epidemiologist and assistant professor at George Mason University, told The New York Times. 

“We’re definitely starting to see a trend up in cases,” she said. “My concern is that we may see what happened in the UK, where they drastically pulled back restrictions and saw a significant surge, and this will contribute to rising numbers.”

[Related: Masks can work—even if you’re the only one wearing them]

The case against a national mask mandate was brought on behalf of the Health Freedom Defense Fund, a Wyoming-based advocacy group that filed a lawsuit challenging the mandate’s legality in July 2021. After Mizelle’s ruling, the group said in a statement that the decision was a “victory for basic American liberty and the rule of law.”

After the judge’s decision, United, Delta, Southwest, and American—the nation’s four largest airlines—said they were dropping their mask requirements, according to The New York Times. JetBlue, Alaska, Spirit, Frontier, Amtrak, and other transit companies have followed suit. Some travelers on Monday experienced the policy change mid-flight—social media posts show videos of passengers cheering as they were allowed to doff their masks.

The Transportation Security Administration will not enforce the federal mask mandate, but local and state authorities may have their own requirements. The Metropolitan Transportation Authority in New York City says it will keep its mask mandate in place. The Washington Metropolitan Area Transit Authority in the District of Columbia and the Southeastern Pennsylvania Transportation Authority in Philadelphia say that masks will be optional for passengers and employees. 

Mask mandates on flights have led to a rise in unruly passengers causing disruptions during air travel. The Association of Flight Attendants, which represents nearly 50,000 flight attendants, said in a statement it is urging “calm and consistency in the airports and on planes.” Clear communication will protect flight attendants from “violence created by uncertainty and confusion,” the union said.

The Biden administration has been facing mounting pressure from various sources to lift mask requirements. Last month, executives from 10 airlines sent a letter to Biden urging him to end pandemic-related travel policies. In late March, Republican-led states sued the government over the mask mandate, and earlier in April Republican leaders repeated their call for Biden to rescind mask policies. 

This isn’t the end of all mask rules. In fact, in response to rising case numbers, cities and institutions across the US have begun reinstating indoor mask mandates. People in public indoor spaces in Philadelphia must wear masks, a policy that returned after COVID-19 cases jumped more than 50 percent in the city over the last two weeks. Institutions like the University of Connecticut, Columbia University, and Johns Hopkins University, among others, have also brought back indoor masking. 

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Americans will soon be able to detect signs of COVID in mucus, saliva, and breath. On Thursday, the FDA issued an emergency use authorization for a doctor’s office breathalyzer by the drug testing company InspectIR.

To take the test, a patient blows for ten seconds into a sterilized straw attached to the side of the analyzer, which looks like a black plastic box the size of a suitcase. Inside is a mass spectrometer, which can analyze the specific chemicals in a gas. The device will look for five different volatile organic compounds—the type of chemical that creates smells like pine needles or orange rind—emitted by SARS-CoV-2, the virus that causes COVID.

The test will deliver results in three minutes, faster than the typically 15-minute at-home rapid tests, with comparable accuracy. According to the FDA announcement, the breathalyzer correctly identified positive cases 91 percent of the time.

In addition to speed and accuracy, the other advantage is comfort, which may encourage more people to get tested, Yvonne Maldonado, a Stanford University School of Medicine infectious disease researcher, told the New York Times. “The easier we can make it, the better off we are.”

[Related: COVID relief funds are drying up—and so are free tests and treatments]

But unlike at-home rapid tests, the breathalyzers will have to be performed “by a qualified, trained operator under the supervision of a health care provider,” according to the FDA. That means that people will likely need to schedule healthcare appointments to access testing—which has been a barrier to equitable COVID care throughout the pandemic. The device could also be used at mobile testing sites, but those are rapidly dwindling as federal funding runs out.

InspectIR said in the FDA announcement that it expects to be able to produce 100 of the analyzers a week, each of which can handle 160 samples a day. If the company manufactures 400 by the end of the month, the new technology would be able to test approximately 64,000 Americans every day. Currently, about 30,000 new COVID cases are diagnosed every day, and several hundred thousand new tests are conducted.

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This winter, demand for COVID-19 treatments outstripped supply in many areas as the Omicron variant brought cases to record-high levels in the United States. 

As this surge has ebbed, medications to combat COVID-19 have become more accessible. One particularly promising treatment is Pfizer’s Paxlovid, which has received emergency use authorization in COVID-19 patients aged 12 years and older who weigh at least 88 pounds and are especially vulnerable to developing severe COVID-19. In clinical trials, the antiviral pill was nearly 90 percent effective at protecting unvaccinated people at high risk of severe COVID-19 from hospitalization and death if given soon after symptoms started. 

“The fact that we have a drug that does that is really remarkable,” says Scott Roberts, the associate medical director of infection prevention at the Yale School of Medicine. “We’ve seen supply go up and most patients who do qualify for this are able to receive it.”

Paxlovid has several advantages over other COVID-19 treatments, but has a key drawback: it interacts with a number of other medications, including some antidepressants, heart medicines, and hormonal birth control. However, these complications can often be avoided by adjusting the dosage of the other drugs, Roberts says. 

Drug interactions

The most common side effects of Paxlovid treatment tend to be mild and include diarrhea, muscle aches, high blood pressure, and an altered sense of taste, Roberts says. However, the medication isn’t recommended for people with severe liver or kidney disease. 

Paxlovid also interacts with various other medicines. “The list is longer than most, and I think possibly most concerningly…it interacts with some medications that are really critical for many diseases,” Roberts says. “A lot of these patients who are high-risk for COVID…are on medications that do need to be evaluated before administering this.”

Some of these drugs include medicines for heart arrhythmias, immunosuppressants for organ transplant recipients, and blood thinners, he says. 

“Both the drugs [in Paxlovid] affect enzymes in the liver that normally help clear other medications from a person’s body,” Abinash Virk, an infectious disease specialist at the Mayo Clinic, said in an email. “Levels of some [of] these other medications may be increased or decreased.”

The drugs, or compounds, that makeup Paxlovid are nirmatrelvir and ritonavir. During treatment, patients take nirmatrelvir and ritonavir tablets twice daily for five days. While monoclonal antibody treatments for COVID-19 target the ever-changing spike protein on the novel coronavirus’s surface, Paxlovid prevents the virus from making copies of itself. Nirmatrelvir blocks a kind of enzyme known as a protease that would normally snip strings of proteins the virus makes during replication into smaller, functional pieces. Ritonavir, which was originally developed as an HIV medication, prevents nirmatrelvir from being metabolized.

“That component can hang around the bloodstream longer and act on COVID longer at much higher concentrations and work to inhibit viral replication in a more efficacious way,” Roberts says.

But Roberts explains that the presence of ritonavir in particular, “causes many drug levels to fluctuate wildly.” Often, this means the concentrations of drugs such as blood thinners rise “quite substantially” because they can’t be broken down properly.  

[Related: The FDA is inching closer to a long-term COVID booster plan]

Paxlovid can make some drugs less effective and sometimes cause serious or even life-threatening reactions. “Before a patient takes Paxlovid, the patient, the pharmacist and the prescriber should review all of the patient’s medications to identify and avoid clinically significant drug interactions,” Virk said.

Some medications, such as the statins used to treat high cholesterol, can be stopped for a few days while the patient is taking Paxlovid, Roberts says. In other cases, the dosage can be adjusted. Paxlovid may affect how some birth control pills work, so people taking them should consider using a backup form of contraception while undergoing treatment. 

Unfortunately, some drugs cannot be safely discontinued while a person is on Paxlovid, including certain heart and anti-seizure medicines, Roberts says. 

There’s also a concern that in people with undiagnosed or uncontrolled HIV, the exposure to ritonavir could teach the virus to become resistant to HIV drugs that work similarly. In theory, this could mean these drugs won’t work as well if the person needs them in the future to treat their HIV. However, Roberts says, the Infectious Diseases Society of America considers this very unlikely since Paxlovid treatment is so brief. Additionally, Paxlovid can be given along with antiretroviral therapy to COVID-19 patients who have HIV. 

Pfizer told Popular Science in an email that it’s working to educate physicians, pharmacists, and other healthcare providers on how to manage potential drug interactions with Paxlovid. “We are also working with some of the largest telemedicine companies to ensure their [healthcare providers] are knowledgeable about PAXLOVID and ready to treat appropriate patients, and we are reaching out to pharmacy customers directly to help address questions,” the company said.

For those who cannot take Paxlovid, the antivirals remdesivir and Molnupiravir may be an option.

Paxlovid is still really effective

Roberts suspects that in time additional antiviral medications will become available that match Paxlovid’s advantages without interfering with so many other medications. Something similar happened with HIV treatments, Roberts notes, which initially contained ingredients that caused a lot of interactions with other drugs.  

“They came out with a new class of medications that do not require those [ingredients], and that drug-drug interaction concern is significantly lowered,” he says.

Although Paxlovid does have limitations, Roberts emphasizes that “It’s a really game-changing drug.”

Antibody treatments, which have fewer known adverse drug interactions, worked against previous versions of the virus, but were rendered ineffective against Omicron because the variant’s spike protein has so many mutations. Paxlovid, on the other hand, has held up well against Omicron in laboratory tests. It also has the added benefit of being taken as a pill, while other treatments, such as remdesivir, must be taken intravenously, explains Roberts. Merck’s antiviral Molnupiravir is also given orally, although it only reduced hospitalizations and deaths by 30 percent in clinical trials.

[Related: COVID antiviral pills work against Omicron—when people can get them]

Preliminary data also indicate that Paxlovid protects non-high-risk patients—clinical trial participants who were treated with medicine were 70 percent less likely to be hospitalized than COVID-19 patients who were given a placebo. 

“The next big frontier I think with Paxlovid is expanding its use to even low-risk people,” Roberts says. “As more data comes out and supply increases…anybody diagnosed with COVID might qualify for Paxlovid.”

Researchers are optimistic the drug will also be effective against future variants of SARS-CoV-2 as well as other coronaviruses, Roberts says.

Until then, he advises people to get tested as soon as possible if they develop COVID-19 symptoms, and inform their doctors if they test positive. Like Tamiflu, the earlier Paxlovid is given the better its chances of success. 

“I would advise patients if they do have COVID the first and foremost treatment to look at would be Paxlovid,” he says. “That would be my first choice for anybody in the outpatient setting testing positive who qualifies.”

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In a marathon hearing on April 6, a panel of independent scientific advisors to the Food and Drug Administration (FDA), debated the details of a plan for using vaccines to head off future waves of COVID, whether caused by an Omicron-like variant, or waning immunity from previous shots at a population level.

The hearing was a chance for the public health community to begin transitioning from an emergency response to a long-term planning phase. The panel, which normally votes on vaccine approvals and policies, wasn’t asked to decide on a specific strategy. Instead, the FDA wants to “get input rather than waiting for the next crisis to start talking about it,” Jerry Weir, director of the FDA’s Office of Vaccines Research and Review, told the panel.

The agency came with two central questions: How should the country decide how often to deliver boosters, and when would vaccine manufacturers needed to update their formulations for evolving variants? The goal, FDA officials said, was to develop a COVID vaccination strategy that would be both consistent and understandable to the general public after a year of confusing, sometimes contentious, booster announcements.

How often should Americans get more shots?

Much of the discussion centered on comparisons to influenza, a virus that’s fought with a continually updated and distributed vaccine. Twice a year, the World Health Organization recommends updates to flu vaccines to target emerging strains, and regional authorities approve the changes. But, as Trevor Bedford, who studies viral evolution at Fred Hutchinson Cancer Research Center in Seattle, Washington, pointed out in a presentation to the FDA, SARS-CoV-2 looks very different from influenza—in ways that complicate vaccine policy.

Based on the last two years, he said, he expects constant, minor evolution that lets the virus evade antibodies, which wouldn’t be unlike the annual rhythm of the mutating influenza virus. But the bigger challenge, he said, is the emergence of “wildly divergent” strains like Omicron and Delta, whose spread “was remarkably fast” compared to influenza strains, which take three to five years to emerge and dominate. “We can expect that Omicron-like events will happen again,” Bedford said. The frequency, however, is up in the air: It could be once every two years, or once a decade.

Another key difference is that influenza is a winter virus, while SARS-CoV-2 has yet to exhibit a clear seasonal pattern. Chris Murray, director of the Institute for Health Metrics and Evaluation, said in a presentation that he expects another winter wave of COVID. But that’s based on a combination of factors like waning antibodies and the virus’ steady mutation, not just cold weather.

[Related: Everything you should know about getting a second COVID booster]

The timing of follow-up shots is also complicated by questions on whether immunity from any vaccine wanes over time, and if so, how long the effects of a booster would last.

Two Israeli public health officials presented data on the country’s decision to deliver fourth shots to the elderly in January 2022. That extra dose made recipients roughly 3.5 times less likely to experience severe disease, and half as likely to catch the virus—at the time, mostly Omicron—at all. Still, after eight weeks, recipients lost their resistance to infections. The results, which were also published in the New England Journal of Medicine this week, suggest that while more boosters could shield the vulnerable, they’re not likely to be effective at containing COVID spread.

At the same time, data from the states presented by Ruth Link-Gelles, a lieutenant commander within the US Public Health Service, showed that waning immunity was almost entirely limited to people with preexisting immune conditions. For adults ages 18 to 44 years and over 65 years, “there’s no evidence of waning of vaccine efficacy against Omicron,” she said. There was no clear estimate for middle-aged patients.

The FDA panel had previously argued that the use of boosters should be limited to the highly vulnerable, and shouldn’t be a keystone of the country’s response to COVID surges.  But they were overruled by agency leadership last fall, and weren’t consulted on the recent decision to offer fourth doses to some Americans. 

Should vaccines be updated for new variants?

Many advisors agreed that the formulation of all COVID vaccines would be revisited at some point in the future. That could mean developing a vaccine to specifically target a new variant, like Omicron, a vaccine that works on multiple strains, or a “pan-coronavirus” vaccine that would elicit strong immunity against any member of SARS-CoV-2’s immediate family. It could also mean developing nasal vaccines that would create longer-lasting antibodies in the upper airways, which a WHO presenter described as a priority.

Although vaccine manufacturers rushed to develop an Omicron-specific formulation last fall, published research from clinical trials has found that they provide no clear advantages over the original formulation. Instead, it appears that as the body learns from a vaccine dose, it produces defenses against a range of variants.

[Related: A third mRNA shot is extremely effective against Omicron]

There’s even less real-world research on pan-coronavirus or multi-strain shots. And unlike influenza, there’s no clear global framework for updating vaccine formulations, which requires collaboration between many governments and drug makers. The vaccines approved in the US use two different types of technology, and there are many other kinds being approved across the world, making it hard to see how manufacturers could jointly issue an update.

But as panelist after panelist noted on Wednesday, the central problem is that if the world wants to respond quickly to emerging variants by updating vaccines, it will need to loosen its reliance on clinical trial data. There were only a few months between the first US Omicron case and the wave that swept the country this winter, which was not nearly enough time to gather data from thousands of real-world experimental subjects. Influenza vaccines can be rolled out quickly because immunologists know how to convert between immune markers and real-world protection, and so can evaluate new influenza vaccines in the lab. That’s still not true of SARS-CoV-2, although research is ongoing.

“We’re using things like influenza … where we have a huge amount of information,” said Hayley Gans, a pediatric infectious disease researcher at Stanford University in California. “Obviously what we’re grappling with in this is an unsettled environment in which we’re trying to move forward.”

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Senate leaders have reached an agreement to provide $10 billion for COVID-19 response funding for the US to continue to purchase vaccines, tests, and other therapeutics for the public. That aid package, which still needs to be voted on by Congress to pass, does not include any support for global aid contributions. 

The $10-billion figure is less than half of the $22.5 billion the White House requested in March, which included funding for overseas initiatives like COVAX. The Department of Health and Human Services estimated in February that the country would need $30 billion this year to keep its COVID-19 response going—the Senate’s aid package is just a third of that. Half of the $10 billion will be designated for therapeutics like antiviral drugs and monoclonal antibodies, with the rest going toward vaccines, booster shots, and testing. 

With an aid package so much smaller than the White House’s preferred amount, experts say many non-health relief programs will suffer, too. For example, the bill cuts $2.31 billion from a COVID program to boost aviation manufacturing and repair businesses, and nearly $2 billion from a program to support shuttered venues like live performance venues, museums, and movie theaters, Reuters reported.

Last week, as the Senate was still mulling over their unfinalized agreement, President Joe Biden implored Congress to approve enough relief funding, including global aid, before another surge of infections occurs. Vaccinating the world is “critical to our ability to protect against new variants,” he said. “There’s no wall that you can build high enough to keep out a virus.” 

[Related: COVID’s coming back in Europe. Are we next?]

The new funding will all be repurposed from the leftovers of previous COVID aid packages, including the $2 trillion CARES Act of 2020 and the $1.9 trillion American Rescue Plan of 2021. The plan “will not cost the American people a single additional dollar,” Sen. Mitt Romney [R-Utah] said in a statement. Romney also acknowledged the lack of funding to help international vaccination efforts. and said he would be willing to “explore a fiscally responsible solution to support global efforts in the weeks ahead.”

Some leaders are already critical of the Senate’s exclusion of an international aid package.

“The US has turned its back on the world,” Zain Rizvi, research director for Public Citizen, a consumer advocacy organization, told The Washington Post. “Penny-pinching in a pandemic will have devastating consequences for vaccinating the world, for reducing the risk of variants, for all of us … Abandoning the global COVID response will put American lives at risk.”

Senate Majority Leader Chuck Schumer [D-NY] has said that Congress will be pursuing a “second supplemental” later in the spring.

Insufficient COVID-19 response funds could exacerbate the already huge health disparities across the US and around the world. In high-income and upper-middle-income countries about 75 percent of the population is vaccinated; in lower-middle-income countries that figure drops to roughly 50 percent; and in low-income nations it further plummets to just about 10 percent.

With the relief funding still being negotiated, uninsured people in the US are starting to feel the impacts of resources running dry. Starting in March, COVID-19 tests, treatments, and vaccines were less available in some places, and many individuals can no longer get their bills reimbursed through government aid. The Food and Drug Administration has authorized a second booster shot for people over the age of 50, but analyses show that the US government will not have enough resources to provide free shots if that recommendation is expanded to all Americans. 

The Senate deal “demonstrates that one of the main take-home messages of this experience—that this is truly a global phenomenon—has not resonated, or at least not resonated above politics,” Jen Kates, director of global health policy at the Kaiser Family Foundation, told The Washington Post. The outcome, she added, would be “a victory for the virus.”

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This week the U.S. Food and Drug Administration authorized a second booster dose of COVID-19 vaccines for older people and some immunocompromised people who received their first booster at least four months ago. 

Under the new guidance, the agency said, all adults 50 and older and individuals 12 and older who have received an organ transplant or have an equivalent level of immunocompromise may receive the additional booster of an mRNA vaccine.

“Current evidence suggests some waning of protection over time against serious outcomes from COVID-19 in older and immunocompromised individuals,” Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, noted in the announcement. “Based on an analysis of emerging data, a second booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine could help increase protection levels for these higher-risk individuals.”

For now, studies indicate that a single booster dose provides strong protection against severe COVID-19 in most people. But a second booster may have advantages for those who are most vulnerable to COVID-19, experts say.

“These data are still relatively early,” says Jonathan Li, an associate professor of medicine at Brigham and Women’s Hospital and Harvard Medical School. “But on the other hand, it’s clear to me that your antibody responses do wane over time and to get the optimal benefit I think that having a second booster makes a lot of sense right now.”

The move comes as an extremely contagious Omicron subvariant sweeps the country. 

“I would say people don’t need to rush out and get the booster, but for those who are older, who have more medical conditions, this is something to seek out,” says Preeti Malani, the chief health officer and an infectious diseases professor at the University of Michigan. “I don’t see a lot of downside to this other than the inconvenience of getting another booster.”

Is protection from boosters waning?

The Centers for Disease Control and Prevention recently analyzed how effective the vaccines were in preventing emergency room and urgent care visits as well as hospitalizations in 10 states during the Omicron wave. The researchers observed that protection did decline somewhat around two to four months after participants received their second or third dose of an mRNA vaccine. 

It’s unclear how generalizable these data are. The report didn’t account for mild COVID-19 infections that did not require medical attention. It only included a small number of participants who’d gotten boosted at least four months prior to data collection. Because people in high-risk groups in the US had access to a third dose earlier than the general public, they might have made up a disproportionate share of the participants. The study authors note that this may have caused the third dose to seem less effective since immunocompromised people may not mount as strong of a response as those who do not have preexisting conditions.

[Related: A deep dive on the evolution of COVID and its variants]

However, the finding “reinforces the importance of further consideration of additional doses” to bolster protection against COVID-19, the team concluded on February 11. The researchers also noted that the vaccines remained more effective in people who’d had a third shot than those who only received two. 

“The third dose is really important, especially when it comes to Omicron,” Li says. “You really get full protection from severe disease against Omicron with the third dose.”

Even so, the majority of COVID-19 hospitalizations are still occurring in people who haven’t been vaccinated, Malani says. A study released on March 18 by the CDC found that when Omicron was peaking in January, hospitalization rates among unvaccinated adults were four and 12 times higher, respectively, than in adults who received their primary vaccine series and adults who received a booster. 

What’s the data say about second boosters?

Knowledge about how much protection a second COVID-19 booster provides is still preliminary, Li says.

Some data has begun to emerge from Israel, which has been offering a fourth shot to adults 60 and over, healthcare workers, and immunocompromised people since January. One recent study, which was posted on March 24 to the preprint site Research Square and is currently undergoing peer-review, found that older adults who received a fourth dose of an mRNA vaccine were 78 percent less likely to die of COVID-19 than those who’d only had three shots. 

“Our study results may provide primary evidence regarding the life-saving potential of an additional booster dose,” the researchers wrote. However, they added, it’s still critical to reach those who haven’t received any COVID-19 vaccines, and follow-up studies are needed to determine how durable the effectiveness of the second booster will be. 

[Related: Just had COVID? Here’s when you should get a booster.]

In a March 16 letter to the New England Journal of Medicine, another team reported that a fourth mRNA vaccine dose restored antibody levels in healthcare workers to similar levels seen after the third shot. However, the fourth dose didn’t add much additional protection against infection, suggesting that young, healthy people may only receive “marginal benefits” from the extra shot.

“What data we have suggests that the more comorbidities that you have—the higher the risk that you are of having severe disease—the more benefit you will have from a second booster,” Li says. “I would urge people who are eligible–those who are older, those who are immunosuppressed—really to take advantage of this and to get the second booster when you can.”

Malani, who is 52, says that she plans to get a second COVID-19 booster now that she is eligible. “It’s more about disruption, for myself personally, than worrying about severe illness,” she says. “For my parents and in-laws, this is a recommendation that I feel good about because I know that they have travel plans and grandchildren graduating, and I want them to be able to enjoy all those moments and at least mitigate that risk.”

Some people with weakened immune systems may still not mount a robust response even after a second booster, Li adds, but for this group long-acting monoclonal antibodies, lab-made proteins intended to prevent COVID-19, can provide additional protection. 

How long will the second booster last?

That remains to be seen.

“We are still in some uncharted waters here in terms of how long will a second booster last for,” Li says. So far, most research has focused on how boosters affect antibody levels. But scientists must also investigate how well the T-cell response—another arm of the immune system that helps stave off severe disease—endures after vaccination. For now, the FDA’s guidance offers a good rule of thumb for when you should receive the shot, he says.

It’s possible that people who get their second booster now may wind up getting another booster at some point, Malani acknowledges. “I don’t think there is a perfect way to time this,” she says. But “for those individuals who are older, there’s really not a reason to wait.”

After a booster shot, she says, it’s a good idea to continue taking other preventative measures such as wearing masks while in crowded indoor spaces.

“We’re in such a different place than we were two years ago,” Malani says. “Even though vaccines haven’t proven to be the end of the pandemic, they’re the most important way that we can manage the pandemic and boosting is part of that strategy.”

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The antiparasitic drug ivermectin has been falsely hailed as a coronavirus cure thanks to widespread misinformation. A new large study shows that the drug does not reduce hospitalizations or decrease time to recovery from COVID-19, aligning with many other trials in which ivermectin failed to help patients with coronavirus infections.

Researchers in Brazil studied and compared more than 1,300 symptomatic COVID-19 patients. In their double-blind study, half of the patients were treated for three days with ivermectin while the other half received a placebo. Ivermectin did not help with a number of other health measures such as viral clearance after a week, speed of recovery, hospitalization, or risk of death. The findings add to a growing pool of research disproving the drug’s touted benefits against coronavirus. The paper was published on Wednesday in the New England Journal of Medicine. 

The findings show that “treatment with ivermectin did not result in a lower incidence of medical admission to a hospital due to progression of COVID-19 or of prolonged emergency department observation among outpatients with an early diagnosis of COVID-19,” the study authors wrote.

The type of ivermectin administered in this study is created for humans, but there is also another version meant for use in livestock. The Food and Drug Administration strongly advises against using the animal version of ivermectin to fight COVID-19—something some people have done in attempts to cure or preempt infection. The agency warns that it can cause nausea, vomiting, abdominal pain, neurologic disorders, and potentially severe hepatitis that requires hospitalization.

[Related: Seriously, do not take ivermectin to treat COVID]

Misinformation about ivermectin as a potential remedy against coronavirus began in 2020, within the pandemic’s first months. Demand for the drug surged, creating black markets around the world. Ivermectin prescriptions accelerated even more during the summer of 2021, reaching more than 88,000 prescriptions a week in August. This represents a 24-fold increase from the pre-pandemic prescription baseline, according to the US Centers for Disease Control and Prevention. 

“Now that people can dive into the details and the data, hopefully that will steer the majority of doctors away from ivermectin towards other therapies,” David Boulware, an infectious disease expert at the University of Minnesota who was not involved in this research, told The New York Times.

Researchers worldwide have conducted studies and clinical trials of ivermectin against SARS-CoV-2. One meta-analysis that has since been retracted claimed that ivermectin was beneficial against COVID-19, but further investigation showed that this review included flawed and potentially fraudulent studies. In an updated review including only the more rigorous studies, researchers found that ivermectin showed no benefit. 

Given the size of the new study, and the body of research on ivermectin that exists, experts told The New York Times that it is probably time to move on from studying this therapy: “I welcome the results of the other clinical trials and will view them with an open mind,” Paul Sax, an infectious disease expert at Brigham and Women’s Hospital in Boston who was not involved in the new research, said to The Times. “But at some point it will become a waste of resources to continue studying an unpromising approach.”

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Starting last week, uninsured people in the US seeking COVID-19 tests, treatments, and vaccines are no longer able to get bills reimbursed through government aid. A stalemate in Congress is preventing continued emergency funding for virus-fighting resources—and it’s already causing some medical programs to rollback coverage for COVID-related costs for uninsured patients. The Health Resources and Services Administration stopped accepting claims for COVID testing and treatment on March 22, and will discontinue covering vaccine reimbursements on April 5.

Throughout the pandemic, the American government had been purchasing preventative and medical care resources so that they were free to any individual. “​​The federal pre-purchasing has really ensured the availability of vaccines [and other COVID resources] for everybody who needs it, regardless of the ability to pay,” says Ali Khan, an epidemiologist and professor at University of Nebraska Medical Center’s College of Public Health. “If we disrupt that, then we should expect that vaccines may be less available or available in a more variable pattern to people across the US.” 

In his State of the Union address on March 2, President Biden announced a COVID preparedness plan that initially called for $22.5 billion in additional aid from Congress. But the fate of the plan remains uncertain. On March 15, White House officials warned about the impacts of lack of continued funding, stating that “failure to fund these efforts now will have severe consequences, as we will not be equipped to deal with a future surge.” Analyses have already found that the US government will not have enough resources to provide free boosters if another shot is recommended for all Americans. Even so, on March 29 the Food and Drug Administration authorized a second Pfizer or Moderna booster for people 50 years and older.  

[Related: Will the world run out of COVID vaccines]

Current supplies of vaccines, tests, and treatments already purchased by the government will remain free, but after those resources run out—if Congress doesn’t approve supplemental funding—medical providers will have to decide whether to cover the costs without support from reimbursement programs. That means most uninsured individuals will have to end up paying out of pocket.

“There are still vaccines available, and people just got new at-home tests [from the government website]. But I think it’s really about once these monies run out, what’s going to happen next?” Khan says.

COVID costs for the uninsured 

The people that will probably be hit the hardest by the rollback of new relief funds are uninsured patients, who have largely depended on receiving tests, vaccines, and treatment covered by the federal government throughout the pandemic. As of 2020, an estimated 11.5 percent of the US population was uninsured. 

“This is the uncomfortable truth about American health care compared to other high-income countries—that there’s still 31.2 million people who are uninsured,” says Khan. “They’re the ones at the greatest risk of losing coverage.” 

This, he adds, will feed the ongoing increase in health disparities in low-income populations and communities of color. Black Americans and other non-white people, as well as low-income households, have significantly lower rates of health insurance.   

Take testing, for instance. The average cost of a diagnostic PCR COVID test is around $127—but it varies depending on the health care facility, with a range of anywhere between $30 to $850, according to a 2021 report by the Kaiser Family Foundation. Uninsured individuals who are unable to cover the cost out of pocket might forgo getting tested even if they think they have symptoms or were recently exposed. In fact, in a a recent survey on 2,000 Americans by the business research site ValuePenguin, 20 percent of people without health insurance said they’d chosen not to get a COVID test because of costs.

Not getting tested can increase the chance of spreading disease, says Khan. Providing COVID relief funding, he notes, “is the right thing to do for these uninsured individuals—it’s because you are broadly protecting society.” 

Supply disruptions in tests, vaccines, and treatments

However, uninsured patients won’t be the only ones affected by the funding freeze: The lapse also has implications on supply chains across the US, Khan says. The federal government’s investments over the past two years has allowed manufacturers to scale up production of supplies to combat COVID, such as diagnostic tests, vaccines, and antivirals and monoclonal antibody treatments. But with the funds no longer guaranteed, those suppliers will have to get money from private investors, which can raise prices for the public and create instability. 

“If this all devolves to the private marketplace, then individual companies and large distributors will now have to make arrangements with vaccine manufacturers to get into the queue to buy vaccines for people,” Khan says. “That could delay the availability of vaccines, and it may also potentially drive up costs.” 

[Related: Just had COVID? Here’s when you should get a booster.]

This also applies to the availability of monoclonal antibody treatments and antiviral medication. The White House’s statement on March 15 noted that there’s no more federal funding for additional monoclonals or other future antivirals. The current level of testing capacity in the US also won’t hold beyond June, according to the administration.  

The market disruption could have “national-level effects” that impact people and systems beyond the 31.2 million who are uninsured, Khan says. 

How to prepare for the COVID funding freeze

Free tests, vaccines, and boosters are available, but they could run out soon. Khan advises uninsured individuals ages 12 and older to immediately get fully vaccinated and boosted while supplies last.    

Some uninsured kids and adults may also be able to receive the COVID vaccine through two existing federal programs run by the Centers for Disease Control and Prevention: ​​the Vaccines for Children Program and the Section 317 Vaccine program. According to a report by the Kaiser Family Foundation, however, it’s likely the Section 317 program’s vaccine supplies will be limited if Congress doesn’t renew additional funds. Medicaid and Medicare will continue to provide diagnostic testing and vaccines at no cost, but only the first will cover COVID treatments like monoclonal antibodies and antiviral pills. People can also still order their four free at-home tests from the government and grab free masks offered at a number of pharmacies and retailers. 

“Have all of that ready,” Khan says. “Hopefully that’ll bridge people to when some of this is sorted out and there’s a more permanent solution.”

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Sarah Hellewell is a Research Fellow at the Faculty of Health Sciences and the Perron Institute for Neurological and Translational Science at Curtin University. This post was originally featured on The Conversation.

Far from the respiratory disease it seemed at first, COVID can impact almost all parts of the body, including the brain. For a small number of people, COVID infection may be accompanied by an episode of post-COVID psychosis, a break from reality which can be frightening for the patient and their loved ones.

Psychosis is a condition characterised by confused thoughts, delusions, and hallucinations. People with psychosis can struggle to tell what’s real from what isn’t. Psychosis occurs in “episodes” which may last for days or weeks. Since the start of the COVID pandemic, reports of post-COVID psychosis have come from all over the world.

Post-COVID psychosis is different to psychosis seen in other brain illnesses and diseases. So-called “first episode psychosis” is usually seen in teens or young adults in the development of schizophrenia, or alongside dementia in elderly people.

But people experiencing post-COVID psychosis are typically in their 30s, 40s and 50s, and are experiencing psychosis for the first time. They usually do not have any family history of psychosis. People with post-COVID psychosis also frequently have insight into the way they are feeling. They can recognize this is not normal for them, and something has changed in the way they are thinking.

Features in common

Based on the small number of reports so far, the start of psychosis has been days, weeks or even months after COVID diagnosis. While the symptoms of post-COVID psychosis can be varied, there are some commonalities: people usually have problems sleeping, followed by paranoid delusions and hallucinations. Some people feel compelled to hurt themselves or others.

The scientific evidence of post-COVID psychosis comes mostly from “case reports”, which are research papers describing symptoms and recovery of individual patients.

In the first and most widely reported case, a 36-year-old American woman developed psychosis approximately four days after she started having mild COVID symptoms. She became delusional, thinking that her partner was trying to kidnap her children. She was convinced she was being tracked through her mobile phone.

After trying to pass her children through a fast-food restaurant drive-through serving counter to protect them, she was taken to hospital for care. After one week of in-patient care to treat her psychosis, she was discharged. Her delusions did not return.

In another case, a 43-year-old Bulgarian man began experiencing psychois two days after he was discharged from hospital for severe COVID.

He believed the doctors had faked the results saying his COVID illness had resolved. He also had delusions that he had already died and his organs were rotten. He became a danger to his family, believing he should kill them to “spare them the same slow suffering”. After two weeks of treatment in hospital, his psychotic symptoms resolved and did not return.

Other case studies have reported people having delusions that patients in the hospital were actors and medical staff were trying to harm them, hearing voices speaking in foreign languages or telling them to take on grand tasks, like saving the earth.

Changes in the brain

The cause of post-COVID psychosis is not well understood. Some scientists think it could be due to persistent inflammation in the brain, prolonged inflammatory signals in the body or due to changes in blood vessels in the brain.

There is new evidence that brain areas undergoing change in mild COVID infection may also be areas that change in people who are at risk of, or who are experiencing, first-episode psychosis (that is, not after COVID infection). These areas are the orbitofrontal cortex at the front of the brain, and the parahippocampal gyrus–a key memory region deep in the brain. These regions may shrink in both mild COVID and psychosis.

However, more research is needed to understand this link.

Not the first time

COVID is not the first virus to be linked to psychosis. During the “Spanish flu” influenza pandemic of 1918 there were reports of post-viral psychosis.

Psychosis has been reported after infections with the other human coronaviruses, like those that cause Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Links between coronaviruses, immune system activation and psychosis have also been found, suggesting COVID may not be the only coronavirus capable of causing psychosis.

Just how common is post-COVID psychosis? The evidence to date suggests it is rare, occurring in about 0.25% of COVID cases who are not hospitalized (and likely have a mild infection), and 0.89% of people who are hospitalized for COVID.

Because there have been so many cases of COVID worldwide, isolated reports of post-COVID psychosis may stand out more. The frightening nature of what people might experience means we might hear more and more about them on social media and in the news.

Although the risk of post-COVID psychosis is low, people who have had COVID and their families should look out for any sudden changes in personality, paranoia or delusions in the days, weeks and months following infection.

If these signs are noticed, seeking medical help is vital. Most cases of post-COVID psychosis resolve quickly with proper psychiatric care and treatment with medication.

If you or someone you know are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting HOME to 741741.

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The demand for single-use plastic significantly increased when the COVID-19 pandemic began, especially with the steady need for personal protective equipment (PPE) such as surgical face masks, gloves, face shields, and gowns to prevent virus transmission. An estimated 3.4 billion single-use face masks or face shields are discarded every day due to the pandemic. Food packaging and plastic bag waste in households also multiplied with the increase in online shopping and delivery services.

Improper waste management will only aggravate existing global pollution and endanger the lives of both people and animals. It’s necessary to come up with an effective strategy that will minimize the environmental impact of the continuous COVID-19 waste stream—and some scientists think turning trash into fuel could be an option.

Numerous studies propose that COVID-19 waste could be converted to fuel

Several studies over the past two years have proposed pyrolysis—an effective method that will not only mitigate plastic pollution but also convert waste into usable fuel. A 2020 study published in Biofuels proposed that discarded PPE kits be converted into liquid fuel through the process, which is the thermal decomposition of a solid material. Pyrolysis heats the material to a temperature high enough to deconstruct polymers.

“Typically, when we talk about pyrolysis as a technology, we heat a solid up without oxygen and then collect the vapors as an oil,” says George Huber, director of the Center for Chemical Upcycling of Waste Plastics who was not involved in the study. “Pyrolysis of plastics is a technology that is being used to produce oils from plastics. These oils can then be used to make new plastics or fuels.”

[Related: Humans created an extra 8 million tons of plastic waste during the pandemic.]

According to a 2021 study published in Chemosphere, pyrolysis is an environmentally friendly, efficient, and cost-effective COVID-19 waste management technique. “Considering the advantageous nature of pyrolysis techniques and its capacity in effective dealing of municipal wastes, the same can be enforced for the treatment of COVID-19 waste. The technology utilizes high-temperature combustion, which can be applied for complete degradation of the infectious agents that are carried along with the COVID-19 waste,” the researchers said.

Face masks and surgical gloves can be easily converted into fuel because they are made of polypropylene and polyvinyl chloride, which are thermoplastic polymers with high oil content. The oil obtained through pyrolysis is comparable with commercial fuel because its properties are similar to that of fossil fuels.

A 2022 study published in Bioresource Technology converted surgical masks into liquid oil and found that its higher heating value is 43.5 megajoules per kilogram, which is only slightly lower than that of diesel fuel and gasoline at 45.8 and 46.3 MJ/kg respectively.

Although pyrolysis is a promising method of processing waste PPE, assessing its overall energy and environmental sustainability is still a crucial step.

Pyrolysis-based waste processing systems would produce fewer carbon dioxide emissions

In a life-cycle assessment (LCA) conducted by the authors of the Bioresource Technology study, the researchers found that processing waste through pyrolysis produces fewer carbon dioxide and phosphorus emissions than most conventional waste management approaches.

A different 2022 study published in Renewable and Sustainable Energy Reviews also proposed an optimal pyrolysis-based PPE waste processing system that could reduce the use of fossil fuels by 31.5 percent and produce 35.04 percent fewer greenhouse gas emissions compared to the incineration process. Compared to their proposed system, the landfilling process poses 143 and 46 percent higher environmental impacts on marine ecotoxicity and human toxicity.

[Related: This new recycling system could keep COVID PPE out of landfills.]

Effective waste treatment mitigates plastic pollution, eliminates the risk of viral infection, and compensates the heavy fossil fuel use in PPE production, says Fengqi You, study author and professor at Cornell University. With their framework, PPE waste could be collected and transported into pre-processing and decontamination facilities. Afterward, it will then be brought to integrated pyrolysis plants for conversion into downstream, value-added products such as gasoline, diesel, and propane, among others. Not to mention, the system can handle waste mixtures as opposed to only a specific type of PPE, says You. 

That’s the benefit of pyrolysis as a technology—it can convert all plastic feedstocks into an oil, says Huber. Despite all the research, there have yet to be any implementations of the proposed methods on a large scale. Last September, the U.S. Environmental Protection Agency (EPA) solicited real-world cost, design, process, and environmental information about pyrolysis technologies to assist in the potential development of regulations for it, given that the country is still in the early stages of development of the technology.

However, according to a 2020 report, by the Global Alliance for Incinerator Alternatives (GAIA), converting plastics into fuel would not contribute to a circular economy because it does not produce new plastics. It would be difficult for pyrolysis to produce oil that can be used to make new plastic, and doing so would require additional chemical processing and massive amounts of energy, according to the report.

Still, some researchers are ready to make our old masks into new fuels. “The technologies [to treat PPE waste effectively] already exist and were proved to be economically and environmentally efficient while protecting public health and mitigating climate changes,” says You. “The next step is scaling up the technology and process.”

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Moderna’s COVID-19 vaccine is safe and effective in children aged 6 months to 5 years old, the vaccine maker said Wednesday, citing a newly completed Phase 2/3 study. The company hopes the Food and Drug Administration will soon authorize emergency use of its vaccine in that age group.

In the randomized, observer-blind, and placebo-controlled trial, 2,500 children ages 6 months to 1 year and 4,200 children ages 2 to 5 were given two doses of Moderna’s mRNA vaccine. Each shot was 25 micrograms, administered 28 days apart. Adults receive two shots of 100 micrograms each, by comparison. The company said in a statement that vaccine efficacy was 43.7 percent in children 6 months to 2 years and 37.5 percent in the 2 to under 6 years age group, with “a favorable safety profile.” 

While the vaccine efficacy percentages seem low, Moderna said in a statement that they are on par with what would be expected of a two-dose vaccine against the Omicron variant, which was the most prevalent variant at the time of the trial. None of the vaccinated children experienced severe disease, hospitalization, or death. Seventeen percent of 6-month to 1-year-olds and 14.6 percent of 2- to 5-year-olds experienced fevers greater than 100°F, but those rates are comparable to other pediatric vaccines.

“We believe these results are really good news for the parents of children who are under 6 years of age, and for the children themselves,” Jacqueline Miller, senior vice president of infectious diseases at Moderna, told The Wall Street Journal. “We are hopeful to be able to bring this vaccine forward to address that unmet medical need.”

[Related: A deep dive on the evolution of COVID and its variants]

There is no vaccine authorized for emergency use in children under the age of 5. For kids ages 5 through 11, the FDA has authorized Pfizer-BioNTech’s vaccine. But the youngest members of the population still remain unprotected.

Vaccinating the youngest cohorts of our population “has been somewhat of a moving target over the last couple of months,” Bill Muller, an investigator in Moderna’s pediatric studies, told The Associated Press. “There’s still, I think, a lingering urgency to try to get that done as soon as possible.”

“A [vaccine efficacy] of 40 percent with adequate safety data could be very meaningful, especially to higher risk individuals,” Luciana Borio, a former FDA acting chief scientist who is now a partner at Arch Venture Partners, told STAT News. 

While having an available vaccine for the youngest kids will provide huge relief for some, evidence shows that most parents won’t seek shots for their young kids right away. A Kaiser Family Foundation poll shows that as of February 2022, only 21 percent of parents of children under 5 say they’ll vaccinate their kids right away. Twenty-six percent say they plan to “wait and see,” 15 percent say they will vaccinate their kids only if required, while 35 percent say they definitely will not. 

Unlike Pfizer’s vaccine, Moderna’s vaccine has not yet been approved for use in children ages 6 through 11. The FDA has also been delaying its decision to approve the Moderna vaccine for teens aged 12 through 17—the agency says it is evaluating the potential risk of dangerous side effects, like myocarditis. Moderna said in its statement that it will be resubmitting the request for emergency use in this age group while providing additional follow-up data. Moderna also plans to test a booster dose for all child populations.

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Best KN95		Powecom KN95 (ear loop version)		SEE IT	In a sea of potentially counterfeit masks, this comfortable, affordable option offers a way to verify its authenticity.
Best N95		3M Aura N95		SEE IT	A favorite for its comfort and adjustable fit, this mask offers one of the best seals.
Best for kids		BOTN Child Fit KF94		SEE IT	Of the four masks we tried, our pint-sized tester’s parents preferred this one due to its comfort and adjustability.

Two years (and counting) into the COVID-19 pandemic, most of us have gotten used to wearing a face mask. Since the disease’s earliest days, cloth masks offered a convenient and stylish way to don the essential accessory, but most common textiles aren’t great at filtering out the tiniest droplets, called aerosols, that might carry the SARS-Cov-2, the virus that causes COVID-19. As the highly contagious Omicron variant dominated virus cases in the US and around the world, the CDC leaned on recommendations for switching to a high-filtration mask (also called a respirator). These masks—which bare standards like N95, KN95, and KF94—will provide you with the highest level of protection from COVID-19. In January 2022, the US government started a program giving out free N95s at pharmacies. Anyone can also supplement the freebies with readily available and relatively inexpensive options, as well. But how do you know which of these masks will provide the best protection? Here’s what you need to know to pick the right one.

• Best N95 mask: 3M Aura N95 
• Most comfortable N95 mask: Kimberly-Clark PROFESSIONAL N95 Pouch Respirator (a.k.a., the “duckbill”)
• Best KN95 mask: Powecom KN95 (ear loop version)
• Best KF94 mask: Bluna Facefit KF94
• Best mask to make a statement: MaskLab KF-style
• Best mask for kids: BOTN Child Fit KF94

How we chose the best high-filtration masks

To learn the science behind high-filtration masks, we talked to three engineers with expertise in aerosols, three doctors in areas like infectious diseases and emergency medicine, a nurse with expertise in disease prevention, and a pediatrician (for the wee faces). We also referenced the facewear-centric YouTube channel of self-styled “mask nerd” Aaron Collins—a mechanical engineer with a background in aerosols who’s been testing the masks on his and compiling the results into a publicly available spreadsheet—as well as the testing by mask company Armbrust. In addition, we consulted scientific studies about general mask use and the effectiveness of high-filtration models, though few formal studies have compared different brands.

Based on our expert source’s experiences with masks and filtration data, we selected eight adult masks and four children’s masks to try out ourselves. We also tested four ways to make a surgical mask more effective. We evaluated the options based on their fit and comfort, while also making sure the masks didn’t leave any gap that allowed exhalations to escape—and that they were easy to put on and to wear for long periods of time.   

Things to consider before buying a high-filtration mask

Filtration

N95, KN95, and KF94 masks all have high filtration efficiency, meaning the materials they are made of, which usually consist of several layers, are extremely effective at filtering out tiny particles. These materials, such as polypropylene, are usually non-woven and sometimes carry an electrostatic charge, which attracts these particles and traps them in the filter. N95 masks are approved by the United States government agency the National Institute for Occupational Safety & Health (NIOSH). NIOSH greenlights these masks’ use for people in workplaces who are exposed to any kind of hazardous small particles, from viruses to smoke to remnants from construction or industrial processes. The “95” means that the mask is designed to filter out 95 percent of particles that are 0.3 microns across. (For comparison, a single human hair is usually between 50 and 90 microns wide.) Because of the way these filters work, smaller or larger particles would be filtered out more effectively. N95 masks attach to your face using headbands, creating a tight seal.

KN95 is a similar designation for masks in terms of filtration, but these masks meet standards set by the Chinese government. It’s more common for non-healthcare workers in the US to wear these than N95s. These masks also often have ear loops, making them easier to put on and more comfortable to wear than N95s, though there are some headband-style versions. This standard has, however, proven problematic: The CDC warns that many KN95s in The States are counterfeit, so if you choose this route buying from a reputable seller is key—and we prioritized varieties that have mechanisms for verifying their authenticity. 

KF94 masks are usually made in South Korea—the “KF” stands for “Korean filter,” while the “94” denotes 94 percent filtration of the same type of tiny particle. Like KN95s, the masks are used mostly by the general public and have ear loops. Though KF94s technically filter out 1 percent less particles than KN95s, they’re “really pretty close to a KN95,” says Nina Shapiro, a pediatric ear, nose, and throat doctor at UCLA Health. A very small August 2020 study also found that KF94s and KN95s provided similar protection.

Fit

Although there are small differences between these types of masks, no product will be effective unless it fits your face. A small January 2021 study found that even slight facial differences had a significant impact on how well any mask, even a NIOSH-approved N95, fits and therefore functions effectively.

“Everyone’s faces are different,” says Thomas Russo, professor and chief of infectious disease at the Jacobs School of Medicine and Bioscience at the University of Buffalo. “And masks are designed differently as well.” From cup-shaped and “duckbill” N95s, to KN95s that fold down the middle, to the boat shape of many KF94s, there are a lot of options to fit different face shapes and sizes.

If you’re trying to figure out if your mask fits well, “the best way to do that is that is to look around the seal itself to assure there are no gaps,” says David Marcozzi, chief clinical officer at the University of Maryland Medical Center and professor of emergency medicine at the University of Maryland School of Medicine. This means the mask forms a firm seal around your nose, mouth, and chin that conforms as closely as possible to the contours of your face.

You might be able to feel on your face if air is coming out of any gaps. “When you exhale, you can feel the jets of air coming out” if the mask doesn’t fit well, says Scott Sanders, a professor of mechanical engineering at the University of Wisconsin, Madison. You can also try holding up your hands to the edges of your mask while you exhale to see if you can feel the air that way. If you wear glasses, fogging them up might be a sign you don’t have a good seal; though “mask nerd” Aaron Collins points out in a video that minor fogging isn’t necessarily an issue, since a well-fitting mask can trap the warm, humid air of your breath as you exhale, causing it to flow upward and condense on your glasses.

Healthcare workers and others using N95 masks undergo a formal fit test. This includes using a spray with a scent, like banana oil, around a person’s head, and if the person can smell the spray with the mask on, the process gets repeated with a different mask until one passes the test. Obviously, the average person won’t go through this, but Marcozzi says you can try holding a lit match or lighter about six inches from your face with the mask on and blowing on it: If the flame wavers or goes out, your mask might not be working well. You can also smell perfume with the mask on and off to see if you can tell the difference.

Comfort

“If it’s an uncomfortable mask, it doesn’t matter how good it is if you’re not going to wear it,” says Shapiro. This is especially true for children, she says, who might just take their mask off if they think it’s uncomfortable. To be functional, a mask should also be breathable, easy to put on and take off, and wearable for long periods of time. Like fit, many of these things depend on your face shape and personal preference.

“For one person, they might find the elastic strap [around the head] something that is too tight, it’s uncomfortable, they don’t like dealing with it. And another person, it makes them feel more secure,” says Russo. “There’s a certain amount of individualization here in terms of what works best for you.”

The best masks: Reviews & recommendations

Best N95 mask: 3M Aura N95 

3M

SEE IT

Why it made the cut: A favorite for its comfort and adjustable fit, this mask offers one of the best seals. 

Specs: 

• Fit: Headband 
• Nose piece: Foam padding and wire
• NIOSH Certification: Yes

Pros: 

• Excellent, adjustable fit
• Tight seal
• Very breathable, and no fogging
• Great for smaller faces and head sizes

Cons:

• Fit can be too tight

3M masks in general are one of the standards for industrial and medical uses. These have foam padding around the nose, making them more comfortable as well as better-fitting than many other N95s. Sanders calls the Aura mask “pretty forgiving” as far as the fit goes. “As long as you wear it,” he said, “you get a good seal.” Like many N95s, they are on the tighter side, but I found that once I got used to it, this mask was not uncomfortable—especially if, like me, you have a relatively small head and face. The mask is also very breathable and easily passed the glasses-fogging test, due to its foam and very flexible nose wire. The tri-fold “boat” shape, more common in KF94s, means the mask conforms more closely to the face than many masks, including the Powecom KN95.

Most comfortable N95 mask: Kimberly-Clark PROFESSIONAL N95 Pouch Respirator (a.k.a., the “duckbill”)

Kimberly-Clark

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Why it made the cut: Compared to other face-squeezing N95 options, this funny-looking respirator gains great points for its comfort. 

Specs:

• Fit: Headband
• Nose piece: Bendable wire
• NIOSH Certification: Yes

Pros: 

• Extremely comfortable
• Excellent breathability
• Fits most adult faces

Cons: 

• Funny looking
• Looser seal than some other N95s

Though these masks aren’t intended for healthcare workers, they’re true N95s. Plus: you’ll probably not find an N95 as comfortable, wearable, and easy to adjust as these bill-like offerings. With headband straps made of comfortable, stretchy fabric and broad, extremely bendable nose wire, they can adjust to fit snugly over almost any face, though not quite as snugly as the Aura masks. They are also super breathable. Their main downside is that they look a bit strange, which is why you likely won’t see as many in public places. Some people might also prefer tighter N95 masks if they feel that it gives them a more secure seal. But with a NIOSH certification, these masks will still protect you extremely well. If you want great protection and don’t care what you look like, these might be perfect.

Best KN95 mask: Powecom KN95 (ear loop version)

Powecom

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Why it made the cut: In a sea of potentially counterfeit masks, this comfortable, affordable option offers a way to verify its authenticity. 

Specs:

• Fit: Ear loops
• Nose piece: Adjustable wire
• NIOSH Certification: No

Pros: 

• Anti-counterfeit QR code
• Fits well on small faces
• Very breathable and no fog on glasses

Cons: 

• Prone to copycats
• Not US certified

Though these were my go-to mask before researching this guide, several sources also recommended these Chinese-made KN95 masks. They have a common bi-fold style and ear loops (though they’re also available with headbands), with a wire across the top to create a better seal around the nose. The masks are comfortable to wear even for long periods of time, take almost no time to put on, and fit even smaller faces like mine snugly and securely. 

They are also extremely breathable; I found mine to be far more breathable than a cloth mask. The nose wire also bends well to fit the shape of the nose with minimal adjustment, and did not fog up my glasses after I molded it in place. (Note: I do not typically wear glasses and tested each mask using clear blue light glasses and sunglasses.)

Powecom masks also come with an anti-counterfeit code that you can enter on their website to make sure the product isn’t a knock-off. The numbers are at the bottom of a small QR code on the bottom of the packaging, and you scratch off a protective coating in order to reveal them.

Best KF94 mask: Bluna Facefit KF94

Bluna

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Why it made the cut: Adjustable straps make this South Korean mask variety ideal for finding a fit that’s both comfy and snug. 

Specs:

• Fit: Ear loops
• Nose piece: Adjustable wire
• NIOSH Certification: No

Pros: 

• Adjustable ear loops
• No glasses fogging
• Somewhat stylish
• Good for larger faces

Cons:

• Can dig into noses
• Not a great fit on smaller faces

This mask is unobtrusive, stylish, and conforms to the profile of the face without sticking out. The straps are adjustable, and I got the mask to conform well enough to my nose and cheeks to not fog up my glasses by substantially pinching the nose wire and pulling it away from my face. The mask forms a secure seal that, as the name suggests, fit my face, extending from the bridge of the nose to the very bottom of the chin (another KF94 mask I tested, the BOTN mask, only covered a portion of my jaw and chin, which felt far less secure).

While this mask is effective and convenient, it dug into the bridge of my nose, making it increasingly uncomfortable to wear over time. Because the mask was very large on me without adjusting the straps, I had to tweak them significantly to get a good seal around my chin—all of which possibly contributed to the mask’s tightness on the upper half of my face. This mask might work well for you if you have a wide chin and jaw, and a broad, less prominent nose.

Best mask to make a statement: MaskLab KF-style

Masklab

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Why it made the cut: Held to the same standard as other high-filtration offerings, this facewear offers a variety of colors and patterns that add a little extra flair. 

Specs:

• Fit: Ear loops
• Nose piece: Adjustable wire
• NIOSH Certification: No

Pros: 

• Available in a variety of colors
• TIght seal
• Good for larger faces

Cons:

• Some glasses fogging
• Not ideal for smaller faces
• Nose wire doesn’t always hold its shape

Because these masks are made in Hong Kong, they are technically not true KF94s, but still conform to rigorous safety standards for high-filtration masks. This mask did not have adjustable ear loops, though it is easy to knot and/or twist the straps to adjust the mask (you can even make a slip knot for easier adjustability). The design of KF94s means this will not create any gaps or otherwise negatively impact the fit.

Besides the non-adjustable ear loops, this mask felt very similar to other KN94s. It formed a secure seal that went all the way down to cover my chin, but also dug into the bridge of my nose. The nose wire did not conform to my shape quite as easily as the one on the Bluna mask. Though I managed to bend it enough to avoid fogging up my glasses all but very slightly, the nose wire did not hold its shape as well as the one on the other mask. This mask might work well for you if you have a generally larger face and head, as well as the broad chin and less prominent nose described above.

Best mask for kids: BOTN Child Fit KF94

BOTN

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Why it made the cut: Of the four masks we tried, our pint-sized tester’s parents preferred this one due to its comfort and adjustability. 

Specs: 

• FIt: Ear loops
• Nose piece: Adjustable wire
• NIOSH Certification: No

Pros: 

• Adjustable ear loops
• Tight seal
• Comfortable

Cons: 

• Flat black color may not entice kiddos 

This mask fit our tester, age 5, the best and most securely out of the four tried—largely because of the adjustable ear loops. As with adults, a high-quality mask is only as good as its fit, and because children have such variable face sizes, an adjustable mask like this one may be especially helpful. Our tester also preferred earloop masks over headband-style ones because they were easy to put on and didn’t mess up her hair.  

“Mask hacks” and alternatives

If you have a bunch of surgical masks and really don’t want to or can’t afford to invest in these high-filtration masks, there are a few ways that you can try to make your surgical mask more effective. Most surgical options are made of high-filtration material but do not conform well to the face. To give yourself a better seal, you can double-mask. One study published in American Journal of Infection Control found that wearing a cloth mask over a surgical one made protection about 85-91 percent effective at filtering out aerosols. You can also try this mask-knotting trick to make your face covering tighter-fitting.

Another option is using a mask brace, which gives you a tight seal by holding a surgical mask closely against the face. The same study found that an elastic mask brace can make your surgical mask up to 95-99 percent effective, similar to an N95. I tried three mask braces: the University of Wisconsin, Madison’s Badger Seal, Fix the Mask’s Essential Mask Brace, and a brace made from a Fix the Mask template that you can make yourself. 

At around 8 dollars for a pre-made brace, the Badger Seal was the most affordable as well as the easiest to put on. This brace isn’t made of purely elastic materials, but Aaron Collins found that it performed basically the same as Fix the Mask’s brace; when worn over a surgical mask, both made it so that the mask filtered out about 97 percent of the particles in his test. But here’s the bad news: I found these braces to be uncomfortable. They press down very firmly on the face, particularly the bridge of the nose. In fact, they are as tight as many N95s, but are harder to put on. Most people would prefer a KN95 or KF94 mask for comfort and convenience.  

FAQs

The final word on high-filtration masks

High-filtration masks like N95s, KN95s, and KF94s provide the best protection against COVID-19. For the best possible filtration, wear a mask that is a good fit for your individual face shape. These masks can be comfortable, breathable, and affordable, and in some cases, may be available for free. No matter how prevalent the virus is in your area, these masks can help protect you, your community, and the people you love from COVID-19.

The post Best N95 and other high-filtration masks of 2023 appeared first on Popular Science.

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This op-ed was originally featured on Undark. Michael Rose is a senior resident physician specializing in internal medicine and pediatrics at Johns Hopkins University School of Medicine and has a degree in public health policy from the Harvard T.H. Chan School of Public Health.

As the Omicron wave wanes, people across the U.S. are welcoming reprieve from a virus that has killed nearly 1 million Americans and hospitalized millions more. But as recent articles in The New York Times, The Atlantic, and other outlets have pointed out, the threat of Covid-19 still looms large for millions of Americans who have compromised immune systems. As mask mandates expire and social distancing measures are curbed, cancer patients receiving chemotherapy, patients on aggressive immunosuppressive regimens, transplant recipients, and many others at high risk for severe Covid-19 continue to live in fear.

And their fear is well-founded.

Even after vaccination, severely immunocompromised people face substantial risk. For example, when researchers measured mortality of fully vaccinated solid organ transplant recipients, they found that, of those who suffered breakthrough infections, nearly one in 10 died. (Notably, this analysis predated widespread use of helpful boosters.)

But many of the pleas to protect immunocompromised patients have missed a crucial public health point: Shielding them is not only an important matter of health equity and social justice, it is a critical component in efforts to forestall the rise of new coronavirus variants. Put simply, by protecting people with weakened immune systems, we protect all of us.

Variant creation is driven by the amount of replicating virus in existence. Whether an evolutionary offshoot ultimately takes hold is a product of viral fitness, selection pressures, and host susceptibility. This equation explains why the most immunocompromised amongst us are so pivotal for preventing the rise of new mutations. When someone who is severely immunosuppressed is infected with the coronavirus, large loads of the virus can replicate for weeks or even months. And if natural immune responses and therapeutic treatments are unsuccessful, this uncontrolled viral replication can lead to the creation of mutant strains. Due to the high viral loads, the variants can easily spread to other susceptible individuals if enhanced isolation precautions are not strictly followed.

Careful case reports confirm this reality. A case study of a patient with leukemia and an acquired immune deficiency, who caught Covid-19, found that she shed the virus for as many as 70 days, and that the virus evolved significantly within her over that time. Similar reports have found evidence of within-host viral evolution of the SARS-CoV-2 virus in transplant recipients and in patients suffering from autoimmune diseases requiring aggressive immunosuppression. Patients on regimens designed to suppress B-cells, the cells which produce our natural antibodies, appear to be at especially high risk for long-term infection and the accumulation of viral mutations.

If not used carefully, antiviral and antibody therapies, which many experts believe are even more critical in curing Covid-19 in immunocompromised hosts, risk worsening the problem by exerting evolutionary pressure that selects for resilient strains. Unfortunately, few, if any, high quality studies exist that doctors can use as guidance for maximizing the benefit of these therapies to immunocompromised patients while minimizing public health risk. 

The reality of this concern was shown by researchers from Britain when they sequenced viral samples from a Covid-19 patient with lymphoma who had been treated with the antiviral remdesivir and convalescent plasma. Over time the researchers found evidence that the treatment was selecting for mutations resistant to the antibodies in the plasma. This pattern has since been replicated by researchers at the University of Sydney, who published their results last week in a correspondence in the New England Journal of Medicine. They identified eight patients with sustained SARS-CoV-2 infections who were treated with sotrovimab, the only recommended monoclonal antibody with retained efficacy against the omicron variant. Fifty percent of those treated with the antibody developed mutations which blocked efficacy of the drug.

These are not new principles in microbiology. Infectious disease experts have long known that tuberculosis patients who stop their treatments before the infection is cleared are at higher risk of developing drug-resistant strains. Similarly, patients with HIV who don’t consistently adhere to treatment regimens are more likely to develop strains of the virus that are resistant to antiretrovirals. Lawrence Corey, a virology and immunology expert at the Fred Hutchinson Cancer Research Center, and colleagues summarized the phenomenon in a recent commentary on Covid-19 variants: “Prolonged viral replication in the context of an inadequate immune response facilitates the emergence of immune-pressure escape mutations.” 

Thankfully, we have ways to protect immunocompromised groups and fight back against the emergence of new variants. In the absence of widespread masking, access to the most effective masks, namely N-95 respirators, will be increasingly important for the “one-way” protection of immune suppressed individuals. So will other non-pharmacologic interventions, such as quality indoor ventilation, rapid antigen testing of close contacts, and maintaining options to physically distance in school and work environments. Fourth doses of vaccines and increased use of long-acting antibody therapy may add additional layers of protection. And for people who do get infected, following personalized, test-based criteria for discontinuing isolation precautions can help them avoid passing any potential new variants onto others.

However, patients with cancer, transplants, and autoimmune diseases aren’t the only immunocompromised patients. Worldwide, 38 million people are estimated to be living with HIV. Although treatment efforts have made tremendous progress, only three out of four patients were on antiretroviral treatment as of 2020, according to UNAIDS, and two-thirds of patients have fully suppressed the virus.

If not used carefully, antiviral and antibody therapies, which many experts believe are even more critical in curing Covid-19 in immunocompromised hosts, risk worsening the problem by exerting evolutionary pressure that selects for resilient strains.

Michael Rose

A case report published by the Centers for Disease Control and Prevention last October demonstrated that patients with uncontrolled HIV/AIDS, too, carry increased risk of variant generation. In one such patient, SARS-CoV-2 was able to replicate and mutate for weeks, ultimately acquiring mutations associated with resistance to immune neutralization.

But the case report also revealed a key to preventing the emergence of new variants in patients with HIV: After the patient started antiretroviral therapy, her HIV viral load plummeted to nearly undetectable levels and, soon after, she also cleared her SARS-CoV-2 infection. The result suggests that the public health strategy of “treatment as prevention”—treating HIV to also block transmission via viral load suppression—may be doubly important for HIV patients during the pandemic as it can reduce the harm from two viruses instead of one.

The strategies for minimizing the risk of Covid-19 variant creation among patients with uncontrolled HIV/AIDS look much different than they do for transplant recipients, cancer patients, and people with autoimmune disorders. Unlike the other groups, whose lives depend on maintaining their immunosuppression, patients with uncontrolled HIV/AIDS can reverse their immunosuppression, usually by just taking one pill once a day. The challenge for patients with uncontrolled HIV/AIDS is that many of them are disconnected from the health care system. This means public health efforts must focus not just on medical innovation but on providing social support to address the multitude of maladies that disproportionately affect people with uncontrolled HIV/AIDS—a combination of poverty, stigma, substance use, housing instability, and mental illness.

As a physician who has cared for patients with Covid-19 in the clinic, hospital, and ICU, I understand all too well the acute threat that Covid-19 poses to immunocompromised patients. And I also understand that the accumulating evidence is clear: If we care about reducing the risk of the next deadly SARS-CoV-2 variant, it is imperative that we do all we can to protect the immunocompromised. By doing what we can to save them, we just might also spare the world.

The post We can’t end the pandemic without protecting those most at risk appeared first on Popular Science.

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Across Europe, COVID cases are rising once again. Much of the western part of the continent, including Germany, France, the UK, and Italy, are experiencing sustained increases in outbreaks over the last two weeks. Switzerland and Austria are both reporting per-capita case rates that exceed those during the Omicron surge in the US. In Scotland, one in every 14 residents had COVID in the last week. So far, however, deaths haven’t increased across the region.

There are signs that the US could be headed in the same direction. The Centers for Disease Control and Prevention (CDC) reports that in 25 percent of the wastewater surveillance sites it tracks across the country, COVID readings have at least doubled in a week. As the Pandemic Prevention Institute pointed out on Twitter, those counts could just be noisy data—when COVID rates are low, as they are now, doubling isn’t necessarily a significant change.

Local case counts still haven’t increased, but it’s not clear that early markers of a surge would be captured in those numbers. More Americans are using at-home COVID tests, which generally aren’t reported to public health authorities. “I think [wastewater] is a very sensitive barometer of what’s happening, and it may precede actual increased case counts,” says Davidson Hamer, an infectious disease researcher at Boston University who has been advising the Swiss government’s pandemic response.

So why would cases be increasing just as a global wave subsides? In both Europe and the US, a more infectious lineage of Omicron, called BA.2 (sometimes described as “stealth Omicron”)” is spreading rapidly. At the same time, public health officials on both continents have relaxed mitigation efforts, although European protocols were much more stringent than America’s to begin with. Denmark and Switzerland no longer require vaccine verification to enter restaurants. Hawaii is now the only US state with an indoor mask mandate. 

Those two forces combined are probably driving the COVID wave in Europe, infectious disease researchers told Popular Science. And because Europe resembles the US in terms of vaccinations, prior outbreaks, and COVID policies, it’s probably a model for another surge here—if not for the human toll an outbreak would take.

BA.2, one of four distinct strains of Omicron, was first detected last fall. It’s similar enough to BA.1, which mostly drove the US’s winter surge of COVID cases, to be considered the same variant, but has enough distinct mutations to behave slightly differently. In particular, it spreads somewhere from 30 to 50 percent faster than the already-quick BA.1, although it doesn’t appear to be deadlier or better at escaping vaccines. (Vaccinated people can catch Omicron strains, but are still shielded from severe illness.)

[Related: ‘Deltacron’ could exist after all]

Early reports showed that the antibodies a person produces in response to other types of Omicron do recognize BA.2, and should protect them from infection, at least for a while. But more recent research has suggested that the Omicron lineages vary enough to require different levels—and probably types—of antibodies. “‘Protective’ isn’t a binary switch,” Kristian Andersen, who studies the evolution of viruses at Scripps Research, writes in an email to PopSci. “BA.1-induced immunity will provide protection against BA.2 infection, but … I expect that effect will wane faster.”

Research on previous waves found that people are extremely unlikely to be reinfected with the same COVID strain within nine months of recovering. But BA.2 might cut that period down significantly.

Because the first Omicron wave peaked in the US about two months ago, immunity from those infections may have waned enough to give BA.2 a larger population of susceptible hosts. (With an extremely infectious virus, it doesn’t take many susceptible individuals to fuel an outbreak.) In Europe, the initial wave of Omicron came earlier, and BA.2 became dominant in February, so the continent could be a preview of what might happen next in the US.

That, coupled with the increased infectiousness of the subvariant, might explain rising case numbers on both sides of the Atlantic. According to an analysis by Financial Times data scientist John Burn-Murdoch, overall case counts in Europe have grown in tandem with rising BA.2 rates. Right now, BA.2 causes about a quarter of all COVID cases in the US, according to CDC estimates, but that number has grown steadily since January. The Northeast seems to be on the leading edge of that curve. Nathan Grubaugh, an epidemiologist at Yale University who uses viral genetics to investigate disease transmission, tells PopSci that the variant might cause all new COVID cases in Connecticut by mid-April.

But that’s probably only the first part of the equation. “A lot of European countries were seeing an increase in cases right after they released indoor mask mandates,” says Boston University’s Hamer. The faster-spreading variant might have taken off at the exact same time as people began to gather indoors unmasked. The US saw a similar surge after it lowered its defenses in the summer of 2020.

“The timing of this with masks coming off isn’t great,” says Grubaugh, “and I just hope that our leaders and we as a society are willing to put them back on if the cases do indeed start rising.”

Sorting out the exact role of indoor mask requirements or social distancing policies is extremely challenging. “The bottom line is, masking will still slow transmission, no matter which variant it is,” says Susan Hassig, an epidemiologist at Tulane University. “But it’s hard to know how much impact the mask mandates were having before they were dropped. We’ve never really been able to measure that effectively.” People don’t always follow COVID policies when they are in place—and plenty of individuals, especially those at personal risk, will continue wearing a face covering without a mandate, or just stop going into public altogether.

Right now, the CDC’s new guidance only recommends wearing a mask indoors when cases in a US county skyrocket to above 200 per 100,000 residents in a week. Rising hospitalization rates can also trigger mitigation policies. As public health researchers Julia Raifman and Eleanor Murray wrote in the Washington Post earlier in March, those guidelines encourage mask use only after a new surge is well underway. What’s more, the CDC’s updated recommendations don’t explicitly instruct local governments to implement distancing or masking policies, which “has basically given jurisdictions a free pass not to do anything,” says Hassig.

[Related: Masks can work—even if you’re the only one wearing them]

While the experts who spoke to Popular Science agreed that some kind of BA.2 outbreak is likely in the US, their opinion on the consequences are more mixed.

When asked if Europe’s growing outbreak would be followed by a surge of hospitalizations and deaths, Hamer says, “I would be willing to bet no.” Even if BA.2 is able to spread among people who already had another strain of Omicron, they should have built up enough antibodies to avoid severe symptoms. People who are both vaccinated and previously caught Omicron should be even safer.

But Europe has a much more heavily vaccinated population than the US. Roughly two-thirds of adults in the EU have received a booster dose. More critically, 90 percent of everyone over the age of 50 in the UK has had a booster, and the picture is similar across western Europe. Many of the people most vulnerable in an outbreak are also highly protected. In the US, only 66 percent of those over the age of 65 have been boosted, so the consequences of a surge could be more dire.

Hassig calls the idea that cases and hospitalizations have “decoupled” during recent waves deceptive. Denmark, which has been especially quick to end restrictions at bars, end vaccine requirements, and lift mask policies on that logic, had a per-capita death rate that approached America’s during the Omicron outbreaks. “We had nearly as many people hospitalized in Omicron as we did in other surges,” Hassig says. “With infinitely more cases, so yes, it wasn’t the same ratio. But it’s still absolutely high. A death is a death.”

It’s hard to know whether that means the US will see a wave of hospitalizations like it did when Omicron peaked. Europe is only a week or two into its new wave, which means it’s still too early to use data from there to draw predictions for the states. What’s clear is this: The pandemic isn’t over, even if governments are putting away the tools to fight it.

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An Italian study of high-risk volunteers found that vaccine side effects were similar to those seen in the general population

Moderna and Pzifer’s mRNA-based COVID-19 vaccines are safe for immunocompromised people with a wide range of illnesses, a new analysis shows.

Researchers in Italy tracked more than 550 people in fragile health who received two doses of an mRNA vaccine, and found that the side effects were in line with those experienced by the general population.The individuals who participated have immune systems that have been weakened by illness or treatments such as chemotherapy. “Our patients did not show a higher incidence of severe adverse events and we did not see an increased risk of discontinuation of treatment programs due to vaccination,” Nicola Silvestris, a professor of medical oncology at the University of Messina in Italy, said in a statement. “Therefore, vaccination for COVID-19 is confirmed as safe, even in this group of high-risk patients.”

Silvestris and his collaborators reported the findings on March 17 in the journal Frontiers in Oncology.

“This is reassuring data,” says Erin Longbrake, an assistant professor of neurology at the Yale School of Medicine who wasn’t involved in the research. “We want to give these vulnerable patients every layer of protection that we can, and they can be more confident in taking that vaccine, in taking that protection against COVID infections.”

[Related: If you’re unsure about getting the COVID-19 vaccine, read this]

The clinical trials that originally assessed the safety and efficacy of the mRNA vaccines for COVID-19 focused on healthy volunteers. People whose health was frail due to cancer or other serious illnesses face a heightened risk of complications from COVID-19 but weren’t included in these studies. This led some to hesitate about getting vaccinated once the shots were authorized due to concerns about side effects or fears that the immune response prompted by the vaccine would worsen their disease. 

“We need more data to understand what types of reactions these patients will have,” says Karen Reckamp, the director of the division of medical oncology at Cedars-Sinai Medical Center in Los Angeles and who was not involved in the research. “So the data we get outside the randomized trials can be very helpful [as] patients and physicians make decisions.”

Silvestris and his team recruited 566 adults from across Italy who were being treated for blood cancers, solid tumors, and neurological or autoimmune diseases from March to early September of 2021. Twenty-eight percent of the participants were young adults, almost 53 percent fell between the ages of 51 to 70 years, and nearly 19 percent were older than 70. The research group evaluated their responses to the Moderna or Pfizer vaccines via questionnaire; all but 10 received both doses. 

About 77 percent of the participants reported experiencing side effects after the first dose, including 11 percent who described their symptoms as severe. After the second dose about 66 percent of participants reported side effects, and about 15 percent said their symptoms were severe. The most frequent side effects were pain at the injection site, fatigue, bone pain, headaches, and fever. Other symptoms included nausea, diarrhea, insomnia, skin rashes, or enlarged lymph nodes.

Additionally, younger people were more likely to experience severe fever than older ones, and women had an increased likelihood of severe symptoms. People who received the Moderna vaccine were more likely to report severe fever and pain at the injection site than those who were given Pfizer’s shot. The only severe symptom that varied by disease was injection site pain, which was more common in people with neurological or autoimmune diseases than in people with cancer.

Two participants died during the course of the study, but their deaths were caused by their underlying illnesses and not related to vaccination, the study authors report. None of the participants were hospitalized due to side effects from the vaccine, and less than 2 percent of the participants had to delay treatment for their illness while they coped with side effects.

“Whatever the underlying disease…the mRNA-COVID-19 vaccine should be considered a crucial step to allow a safe program of treatment more than a possible obstacle or danger to pursue the control of the disease,” Silvestris and his team concluded in the study. 

The findings are consistent with a number of other reports that have concentrated on people with cancer, multiple sclerosis, and other medical conditions that put them at high risk of becoming seriously ill from COVID-19 and found vaccination to be safe, the authors added.

[Related: Long COVID can manifest in dozens of ways. Here’s what we know so far.]

However, Longbrake and Reckamp note, immunocompromised people may mount a less robust immune response after vaccination than their peers, particularly if their treatments have depleted their antibody-making white blood cells. 

“We’ve established that [the vaccines] are safe,” Longbrake says. “Now we have to determine how effective they are relative to non-immunosuppressed individuals and whether or not there’s things that we can do to more effectively vaccinate this vulnerable population.”

This is also one more reason why it’s important for people who aren’t immunocompromised to still get immunized against COVID-19, she adds.

“Them getting vaccinated stands to protect this frail population in a large way as well,” Longbrake says. “It’s not just about them getting vaccinated, but it’s about everybody around them getting vaccinated too.”

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In mid-February, a team at the Institut Pasteur in France uploaded a SARS-CoV-2 genome with a strange family tree to a global epidemiology database. As one scientist explained on a forum used to identify new variants, the virus, which had infected an older man in northern France, appeared to share its “body” with Delta, but had borrowed the genetic information for most of its spike proteins from Omicron. Based on a standard naming convention, the new COVID type, if it sticks around, will likely be dubbed “XD.” The public has been calling it “Deltacron.”

A month later, a second team posted their own preliminary evidence that three similar cases had appeared in the US during the height of the Omicron surge, between November 2021 and February 2022.

SARS-CoV-2 has produced hybrids before, mostly involving the Alpha variant. But none of those ended up driving widespread outbreaks, and instead disappeared in the face of newly evolved strains.

[Related: A deep dive on the evolution of COVID and its variants]

Organisms swap genetic code with surprising regularity—influenza viruses, for example, have a modular structure that allows them to swap whole segments with one another. If a person catches two strains of COVID at the same time (rare, but possible when millions are falling ill), the pathogens can go through a process called “recombination” as they replicate, leaving bits of themselves inside the other.

Most of the time, that kind of Freaky Friday swap will kill the virus. But every so often, the recombinant has enough pieces intact to survive and continue spreading, which appears to have happened in the French “XD” case that’s now making headlines. 

Why you’ve probably heard of “Deltacron” before

Earlier this year, Bloomberg and other news outlets trumpeted the possibility that a “Deltacron” strain had emerged in Cyprus.  Those headlines were debunked, even if hybrid COVID variants remained possible.

The coverage based on an interview aired by a local TV station. Leondios Kostrikis, a microbiologist at the University of Cyprus, said his lab had identified cases of the Delta variant with a few stray mutations that looked like those seen on Omicron. 

Other scientists, including one from the World Health Organization, were quick to say that although a recombination was possible, this didn’t appear to be such a case. The issue was with the genetic data, which many outside observers believed showed traces of cross-contamination between samples. In other words, the Cyprus lab might have sequenced individual Omicron and Delta viruses at once, not a hybrid of the two.

In a January interview with Nature, Kostrikis said his words had been misconstrued, and that he didn’t think the viruses were a true hybrid. He explained that the Delta- and Omicron-like traits on the variant he’d sequenced might have resulted from convergent evolution—in the same way that bats and birds both have wings. He also argued that his samples hadn’t been contaminated, and withdrew them from an open-source database while waiting for other experts to confirm his findings.

[Related: Why everything eventually becomes a crab]

But there was another simpler explanation than cross-contamination: Sometimes viruses just happen to share a handful of overlapping mutations. Sequences with features of multiple variants “get uploaded all the time,” Thomas Peacock, who researches viral evolution at Imperial College London, told Nature at the time. “But, generally, people don’t have to debunk them because there isn’t a load of international press all over them.”

Is this fake “Deltacron” again?

Scientists are much more confident that the new strain from France is a real recombinant. The genetic sequencing data is cleaner, and the Institut Pasteur team reports that it has cultured the virus in a lab, demonstrating that it isn’t a product of cross-contamination.

But just because a new variant combines genetic material from two strains doesn’t mean that it will combine their worst features in real life. Delta and Omicron are very different viruses: They invade human cells in distinct ways, and appear to have developed divergent strategies for evading the human immune system. It’s not at all clear that mixing and matching two independently evolved sets of mutations will improve the virus, rather than just creating a chaotic mishmash. Omicron surprised virologists in part because it used an odd set of adaptations to “unlock” a key receptor on human cells to invade them. Individually, each mutation could have made the virus worse at its job—but together, they ended up being extremely effective.

Since the “Deltacron” case was diagnosed last month, researchers have identified roughly 30 similar cases spread across France, the Netherlands, and Denmark. (It’s not clear if all of those are descended from the same infection, however.) That’s enough to suggest that the recombinant is capable of spreading. Still, with Europe currently seeing a new uptick in COVID cases, it would take many more than 30 “Deltacron” cases to demonstrate that the hybrid present a bigger threat than the virus that’s already in front of us.

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As COVID-19’s Omicron variant waned and we took a second to catch our breaths, another anxiety-inducing and devastating event began: Russia’s invasion of Ukraine. People in the area have suffered unspeakable traumas while trying to hunker down or flee their home country, and the world has looked on in terror and exhaustion. If dealing with an ongoing pandemic and the rippling effects of an overseas war seems like too much, it’s because it is.

While some of us might simply be stressed or concerned about the war, it can be clinically traumatic for others. To medically count as trauma, an event has to involve “actual or threatened death, serious injury, or sexual violence,” according to the Diagnostic and Statistical Manual of Mental Disorders. Experiencing multiple traumas at once, or repeated trauma—as many are right now—is “complex trauma.” Such layered traumas are linked to increased emotional problems, including post-traumatic stress disorder (PTSD).

Complex trauma typically involves at least one interpersonal trauma, such as an assault, rape, or neglect, often as a child. A secondary traumatic event could be interpersonal, such as a natural disaster, serious accident, or exposure to war; or non-interpersonal, such as intense anxiety about world events. The level of trauma varies for everyone, and can obviously be much more traumatic for someone directly experiencing a situation, such as those enduring daily life within a conflict zone. 

According to Craig Bryan, psychologist and director of The Ohio State University’s trauma program, psychologists refer to trauma in two ways: “Trauma” with a capital T, and “trauma” with a lowercase t. 

“There’s a lot of debate over what should be classified as trauma,” says Bryan, who served in the US military, deployed to Iraq in 2009, does Department of Defense-funded research, and works with military personnel on mental health. “Trauma with a little ‘t’ is a more generic use, and people [use it to] refer to ‘Well, this is very stressful, very upsetting.’ But for others, the pandemic was traumatic with a capital ‘T’: They were on a ventilator; they almost died, and they recovered; or had a family member who contracted COVID and died,” he says. Healthcare workers seeing large numbers of patient deaths may also have that capital-T trauma, and the same can be true for people processing the events in Ukraine. 

“For some people, it is traumatic with a capital ‘T’ because they’re either witnessing it directly or seeing it. They have family members who have been killed, or that they’re worried about, and then there’s the rest of us,” he explains. “[For us], it’s unsettling, it’s uneasy, we’re anxious, we’re afraid, but it wouldn’t necessarily be a trauma with a capital ‘T.’”

[Related: The best apps for dealing with anxiety]

Still, those still suffering financial, emotional, and logistical tolls from the pandemic can feel that added anxiety from war and other stressful events can feel like too much to process. For those experiencing “trauma with a lowercase ‘t,’” piled onto previous trauma with any kind of “t,” here’s how to cope.

“It’s fair to take a more broad view of the impact of traumatic experiences—these can be anything that leaves us with a feeling of uncertainty, of confusion,” says Ross Goodwin, a psychiatrist at Kaiser Permanente. He adds that acknowledging one traumatic event layered on the next is a “useful framework” for defining our current experience and finding ways to cope. 

“We can acknowledge that there may be people in our community who do have a more direct connection with what’s going on across the ocean. [Be] attuned to that and listen for community members who may have family or have heritage in Eastern Europe,” he says. “Maybe we can [then ask]: ‘What can we do to be proactive? What can we do to build our community and contribute to taking care of folks who are suffering?’” He recommends volunteering, donating, and advocacy as a way to reverse feelings of confusion and powerlessness. And if you are able, keep listening and thinking about how you can serve affected people in your community, long after today’s current events have passed. It’s not pleasant to think about, but there are always potentially traumatic events occurring across the world.

“Take back a sense of ownership, or empowerment, or self-advocacy—that ‘I can make a difference, I can contribute.’ That’s healing… trauma typically takes away people’s sense of power or agency,” Goodwin says.

“It sounds weird to say, but in some ways, we could say the pandemic is more predictable than another world leader that might not be predictable,” he says. For some, this might alleviate the feeling of dealing with two global crises at once, and create a sense of security that we know how to handle one problem, at least.

Refuel your emotional capacity with “preventative maintenance” 

Bryan is the last person you’ll catch using the overused term “self-care,” but not because he doesn’t believe in it. Instead, he advises his current and former military clients to rely on an alternate term they may have learned during their service: “preventative maintenance,” which is typically used to refer to maintaining firearms and ensuring equipment is in working order.

“Why do we do that?” he asks clients. “So it works when you need it,” they might answer. We have to do the same for ourselves. That means exercising, eating nutritious food, spending time with loved ones, taking leave from work, and taking part in enjoyable activities. Then, when we need to tap into our emotional reserves, it “reduces the likelihood of malfunction,” he says.

By using these preventative tools to build up your emotional capacity, you can fortify your mental health in a way that makes it easier to navigate multiple major stressors or traumas, Bryan explains. “There is a sense that we all have a certain amount of reserves to respond to stressful events and adversity, and if we have to tap into those reserves frequently, then we have less available when a bigger stressor occurs,” he says.

Limit catastrophizing

Adding what some see as the threat of World War III to a pandemic that has killed more than 6 million people can seem like the literal end of the world. But that type of catastrophizing, as it’s called in the mental health field, only adds to your perceived trauma and stress. Both experts point out that this type of thinking can be the result of too much doomscrolling.

If you are using social media to get your news without any intentional limits, it’s easy to be overwhelmed by multiple crises in the world during your day, Goodwin says.

“It’s important to remain informed about what’s going on because we can gain a sense of empowerment through being aware and knowledgeable, but at the same time, it’s important to have limits,” he says, suggesting people identify their trusted sources, visit those sources for their “daily dose of media consumption,” and then stop. In a similar vein, Bryan had to delete certain social media platforms because “it was just constant anxiety, fear, and anger.” He says it’s crucial to take control of our environment in this way, and doing so also helps remind us that these major stressors or traumas aren’t the only thing happening in our lives.

[Related: Soothing stories to take your mind off of stressful things]

Bryan especially attributes repetitive exposure to stress as something that can retrigger PTSD symptoms, especially for veterans watching war coverage. They may be more inclined to experience a great degree of stress, as opposed to someone who hasn’t been in a conflict zone and can process the events as “unfortunate” while still viewing the world as an overall safe place inhabited by good people, he says. In a veteran’s case (or anyone else experiencing the same type of serious stress), he says therapy is definitely helpful, as opposed to some of the DIY solutions above alone.

Parents should also pay attention to how much catastrophizing they are doing in front of children, whether through media consumption or overheard conversations. Staying aware of how much kids can handle can help mitigate any potential damage to their mental health. “Kids are going to hear everything and absorb everything, even if they seem like they’re not,” Goodwin says.

Both therapists highly encourage anyone dealing with anxiety, trauma, or other mental health concerns to promptly reach out for mental health services. Goodwin recommends a site his practice collaborates with, “Find Your Words,” which aims to help connect people with both the language and services necessary to understand and ease mental health issues. Bryan recommends people consider STRIVE, OSU’s suicide and trauma reduction initiative for veterans, first responders, and their families. If you are contemplating suicide, reach out to the National Suicide Prevention Lifeline at 1-800-273-8255.

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When SARS-CoV-2 was first isolated in January 2020, researchers who studied viral genetics said it would mutate at some point. With millions of chances to replicate and adapt, mutations were an inevitability. But at first, many scientists thought the process would play out over years or longer. Instead, the past 24 months have been shaped by a procession of new variants, each with its own ability to cause disease.

Over the last two years, a flood of imaging, genetic sequencing, and experimenting with everything from modified viral particles to disembodied spike proteins has allowed scientists to explain how this pathogen and its variants killed more than 6 million people and infected millions more.

[Related: Why it’s so hard to make quick, accurate estimates on new COVID variants]

The infectiousness and deadliness of SARS-CoV-2 depends on countless factors. To be successful, the virus has to grab onto host cells, reproduce inside, and then make a quick exit. It also has to adapt to different kinds of cells, from the lungs to the heart, and survive in tiny droplets in the air so it can spread from person to person.

Mutations affect all of those traits. But for the moment, the clearest window into the forces shaping the evolution of SARS-CoV-2 comes from studying the moment a single virus enters a human cell. Understanding that process can give researchers hints to how it might change next.

How the coronavirus attacks

A SARS particle is shaped like a chestnut seed: It has a packet of RNA and reproductive materials inside a thin shell covered with spike proteins. Those extensions pulse and sway, looking for a compatible protein on the surface of human cells to latch onto. Because the spikes are SARS-CoV-2’s main tool for invading cells, they’re also the primary target of antibodies—a person’s first line of defense against infections.

The tips on the spikes aren’t static, either. They each have a suction cup-like attachment, called the receptor binding domain (RBD), that flips up and down. The virus can only invade a cell when the RBD is flipped up, but that also leaves it open for attacks by the host’s immune system. Shang-Te Danny Hsu, a structural biologist at Academia Sinica in Taiwan, compares the RBD to a submarine’s periscope. “SARS-CoV-2 will lift the periscope to find a target, but at the same time, the antibody will recognize it,” he says.

Once a spike latches onto a human cell, the virus needs to fuse its body with the host and dump its genetic contents inside. All the machinery needed for that sits locked behind the RBD, in a piece of the spike called “S2.” To release it, the virus relies on a specific human protein, TMPRSS2 (“tempress”), to act like a pair of scissors. When tempress comes across a SARS-CoV-2 spike protein attached to a human cell, it snips off the RBD, exposing a spring-loaded system that sucks the virus and cell together. (Biologists still aren’t exactly sure what tempress does in humans, besides its role in COVID and other diseases.) Tempress coats human cells in the lungs, heart, liver, kidney, and gut, which might explain the range of symptoms caused by COVID-19.

There are three central factors that shape the virus’s journey through that process. First is how often spikes send up their “periscopes;” second is how tightly the RBD latches to human cells; and third is how well the spike can dodge human antibodies. Those mechanisms are determined by 1,273 amino acids, which fold up to form the body of the spike protein. A tiny change of as much as a single missing molecule can reshape the virus’s weaponry in surprising ways.

D614G mutant (“DOUG”)

First identified: February 2020 in Europe

Why it matters

D614G isn’t technically a variant—it’s just a single mutation that appeared in many of the first global COVID outbreaks. But it was the first mutation that tipped virologists off to the speed that SARS-CoV-2 could adapt. In early research posted online in April 2020, a team led by scientists from Los Alamos National Laboratory in New Mexico determined the anomaly made the virus more infectious.

How it works

The mutation sits near the middle of the spike protein, and makes each individual receptor binding domain more likely to flip up to bind to human cells. How often coronavirus spikes are open seems to be related to the deadliness of the disease, for reasons that aren’t entirely clear. Modeling by Maxwell Zimmerman, a computational biologist at Washington University in St. Louis, found that SARS-CoV-2 is more aggressive in extending its RBDs than mild human coronaviruses, but less so than SARS-1, which killed 10 percent of people it infected.

But what makes the mutation “weird and unique” is that it appears to set the stage for other variants, says Kyle Wolf, a biophysicist at the University of Wisconsin-Madison. SARS-CoV-2 infects cells faster when it has more RBDs flipped up—but that also makes its spikes more likely to fall apart before they find their target. A virus with DOUG appears to be more stable: When its RBDs up, they wedge together, holding the spike proteins together until it finds a host, Wolf explains. The mutation could be required for other variants, which opened the spike even further, but needed a way to stabilize the package, says Sophie Gobeil, a structural biologist at Duke University.

Alpha variant

First detected: September 2020 in the UK

Why it matters 

This was one of three strains that emerged in quick succession in the first year of the pandemic. All of them showed different but overlapping sets of mutations, which researchers believe could have arisen from prolonged infections in people who were immunocompromised. Alpha spread about 50 percent faster than the original virus, and was even more infectious than the DOUG mutant.

Lab experiments showed that the variant was better at grabbing onto cells and at fighting off antibodies. Many of those changes had to do with mutations on Alpha’s RBD. One of the bigger mutations boxes out antibodies while also fitting extremely tightly into the binding site with the host cell, Gobeil says. Other receptor binding domain mutations lock down the virus against additional antibodies.

Alpha’s mutations also made it a more efficient invader. The variant lost two amino acids that sit deeper in the spike protein. Without them, the RBD flips up more often, which makes it easier to grab onto cells and slip inside quickly.

Those aggressive qualities also seem to play a role in later stages of the infection. After SARS-CoV-2 storms a human cell, it can cover the outer lining of its new vessel in spike proteins. Then, like a pirate crew steering a stolen ship, the infected cell grapples in and fuses with other cells, allowing the virus to hijack multiple hosts without leaving its original refuge. Alpha appears exceptionally good at that process, creating globs of infected cells that probably cause severe lung damage.

Tools to ID COVID variants

Cryo-EM

To see how SARS-CoV-2 fits together on the molecular level, and how it interacts with human cells, structural are tapping a powerful imaging method called cryo-electron microscopy, or cryo-EM.

The process is deceptively simple. Scientists place tens or hundreds of thousands of SARS-CoV-2 spike proteins on a thin slide, and then freeze them to get a clearer picture. The cryo-EM then shoots electrons through the slide to cast a silhouette of each individual protein. Each shadow is just a blob, but with thousands of them, algorithms can stitch together into a 3D image that captures the near-atomic-level differences between the shapes of variants.

Image by NIAID

Beta and Gamma variants

How they work

Both variants have a set of mutations that allows them to shrug off antibodies that would otherwise clog up their binding machinery. This is, according to coronavirus researcher Thomas Gallagher, a professor at Loyola University Chicago, “the most obvious and straightforward way to evade [antibodies].”

Most strikingly, one mutation called E484K changes the shape of a “hook” structure on the side of the spike protein that some antibodies latch onto. In the original virus, the hook was present half the time, Gobeil from Duke University says. But with the mutation, the hook falls apart like a pile of spaghetti, so there’s nowhere for antibodies to bind.

Delta variant

First detected: February 2021 in India

Why it matters

Although it wasn’t identified for a few months, the Delta variant emerged during India’s catastrophic COVID wave in fall of 2020 before creeping across the world. It’s two or three times more infectious than the first strain of SARS-CoV-2 (the Centers for Disease Control and Prevention have compared it to chickenpox), and was the first signal that a SARS-CoV-2 variant could be infectious enough to spread widely among vaccinated individuals, says Ravindra Gupta, a microbiologist at the University of Cambridge. But further analysis showed that it was also good at evading antibodies, both in people who were previously infected and in those who were jabbed.

As cases multiplied, it quickly became apparent that those with vaccines were more likely to catch and spread Delta than previous variants, although they were still protected from getting sick. But for the unvaccinated, it was several times more likely to cause severe illness and death. When it finally arrived in the US in the summer of 2021, the CDC reevaluated its vaccine-dependent COVID strategy, writing that “the war has changed.”