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The disgruntled patient walked into the University of Utah urgent care facility without a mask, and when staff gave him one to wear, he left it dangling against his chest.
A security member told the patient that the face covering was important for protecting him, staff and other patients. The man pulled the mask up but left his nose jutting out over the top of it.
A report on the standoff over face coverings describes the ensuing escalation, as the man continued to argue with nurses and other staff members. He lunged toward a medical assistant with his arms raised as if he was going to hit the health care worker, the report states. The patient hurled misogynistic profanities at the assistant, threatened to sue and spat in the security officers direction as he was leaving the building.
The clash appears among more than 200 pages of incident reports from the University of Utah Health, documenting the harassment and abuse suffered by workers at one of the states largest health systems during the pandemic.
The documents echo many of the stories Utah medical providers have been sharing about patients and families pushing back against masking and or lashing out at them in conspiracy-fueled rants about COVID-19.
I had several health care workers contact me that said they were the victims of this type of aggression, said Utah Rep. Robert Spendlove, who sponsored legislation this year to protect hospital and clinic staff. One of the things that really struck me was they said theres not only the physical harm but theres mental harm from having to withstand this kind of abuse.
The incident reports, obtained by The Salt Lake Tribune through a public information request, show that these conflicts ranged from some minor grousing to physical aggression or threats of violence. Health care workers were accused of being foot soldiers for a political agenda; struggled to calm belligerent visitors; and faced heightened exposure to disease when people with COVID-19 refused to cover their faces.
The increase in workplace violence showed up across the states health care systems during the pandemic, not just at the University of Utah Health, according to data collected by the Utah Hospital Association.
Within the states four largest health care systems, reported instances of threats or verbal abuse went up 13% from 2019 to 2021, the association found. And the number of times police had to get involved jumped even more dramatically, increasing by 18% between the two years.
Representatives of the University of Utah Health say these conflicts are not the norm within their workplaces but dont dismiss the impact that aggression and harassment can have on their employees.
Our staff are a cornerstone of our success as a health system, said Dustin Banks, director of support services for U of U Health. If we dont give the tools for our staff members to be safe, they will leave the workforce. That is not something that we want.
(Charlie Ehlert | University of Utah Health) Health care workers attend to patients in the intensive care unit at University Hospital in Salt Lake City, Wednesday, March 9, 2022.
The incident reports describe several conflicts that flared up between hospital staff and visitors of COVID-19 patients or sick people who were resisting the medical care they needed.
One patient hit a nurse on her arm while she was trying to perform a COVID-19 test. Other people argued with their health care team about what treatment they would receive.
A man who was in the hospital with coronavirus became confused and demanded to leave, even though his care team had determined it wouldnt be safe. The patient shoved an aide and cursed at one of the nurses who was giving him a low dose of sedatives.
The records show there were conflicts over oxygen masks, with one coronavirus patient complaining that the supplemental oxygen made his belly blow up like a balloon.
Another time, the daughter of a patient with COVID-19 rushed into a critical care unit without permission and was going from room to room looking for her father. When staff members tried to stop her, she hit one of them and screamed: You people gave my father COVID. Im going to kick your asses.
And even when the disagreements werent directly about coronavirus, the disease made arguments more dangerous, the records show.
One report describes an interaction between security staff and an irate woman who was walking from car to car at a hospital, yelling that she needed a ride. Because she wouldnt stop screaming, the security officers began walking her off the property while she mocked and threatened to cough on them.
They later learned shed recently been diagnosed with COVID-19.
(Francisco Kjolseth | The Salt Lake Tribune) A sign encourages people to continue wearing masks on the University of Utah campus on Tuesday, Nov. 30, 2021.
Mandatory masks were among the most common sources of pandemic-related friction between health care workers and patients or visitors, the University of Utah Health records suggest.
For instance, a woman at an eye center refused to wear a face covering, telling the staff that masks were all an experiment. Others blew off the rules and argued they didnt have to don a mask because theyd already been vaccinated or because they believed it would cause health problems.
One man declared that he was exempt from masking and would get a stroke if he covered his face. When he finally relented, he warned that if he had a health complication because of the mask, the hospital would hear from his attorney.
Hospital workers told security about a patient who angry that she had to wear a surgical mask rather than a mesh one ripped through a provided package of face coverings and contaminated all of them. She then threw the box at an employees head.
In one document, a pair of visitors wouldnt comply with the hospitals masks even though one was unvaccinated and the other had tested positive for COVID-19 just a few days before.
Several of the conflicts described in the records escalated to aggression or threats of violence.
The husband of a cancer patient who was getting an MRI exploded at medical staff who asked him to put on a mask and began yelling and swearing at the workers and another patient in the waiting room.
The man made everyone feel in danger and unsafe when he stood up and got in the face of the hospital workers, according to the report.
Security officers were so alarmed by the mans aggressive behavior that university police led him off the property. They decided he could drop his wife off at the hospital in the future, but he wasnt allowed to enter the building for her subsequent treatments.
Another time, a man wearing a gaiter mask became enraged when hospital workers told him that it wasnt an approved face covering but told him he could contact the university offices to ask for an exemption. A security officer told the man that if he wouldnt comply and wasnt at the medical center for an appointment or emergency, he needed to leave.
Id like to see you try, the man mumbled, according to the report.
As he was leaving the building, the man apologized to one of the officers for getting angry. But he continued to criticize the centers customer service manager, pointing to a pocket knife on his cargo shorts and suggesting he might have used it if the security officers hadnt arrived.
Health care workers nationwide are five times more likely to be injured because of an on-the-job attack than people in other industries, and theyve been experiencing growing levels of aggression over the last decade, according to federal labor data.
Banks said the University of Utah Health has been proactive in tamping down these incidents, launching a program to send multidisciplinary behavioral response teams into potentially volatile situations. The teams typically include a security staff member, nurses and a social worker and focus on non-violent responses when a patient or family member begins acting aggressively, he said.
The team receives a briefing before heading into the situation and chooses one point person to do all the talking during the encounter, with the other members standing by for support.
We have found that is incredibly successful, Banks said.
To head off these flare-ups, the universitys security officers also make rounds through the hospitals every day to check in with the nurses and help prevent patients from becoming agitated in the first place.
But the pandemic has exacerbated hostilities, with the rancorous fights over public health measures such as vaccines and masks, says David Gessel, executive vice president of the Utah Hospital Association.
That became a proxy for a lot of people in feeling like with the pandemic, that they had no control in their lives or they didnt like where things were going or were just fed up, he said.
Urged by state health care leaders to help stem this rise in violence, Utah lawmakers earlier this year passed a bill that would stiffen penalties for assaulting medical providers or hospital staff.
Previously, state law only enhanced criminal penalties for attacks against health care workers if they were performing emergency or life saving duties at the time of the assault. But with the changes brought forward by Spendlove, someone could face increased repercussions for harming nurses, doctors and other hospital staff whenever theyre at work, regardless of the care theyre providing.
A handful of lawmakers raised concerns about offering special protections to a particular profession, and Spendlove said hes generally against these types of carveouts. But health care workers are essential employees, he notes, and theyre also legally prohibited from turning away people who need help.
So these workers are essentially forced to care for these people that may be abusive or aggressive, the Sandy Republican said. I think they definitely merit and deserve an extra layer of protection.
As he prepared his bill, Spendlove says he heard alarming stories about attacks in health care settings, including a nurse who suffered a concussion after being assaulted in the workplace.
Gessel said even with the jump in workplace violence, attacks are still relatively uncommon in the states hospitals and health clinics. And he recognizes that hospitals are often reluctant to speak out about harassment and abuse toward employees, not wanting to make people feel uncomfortable or fearful walking through their doors.
We want the public to feel like they can come, and its a place of healing and hope and health and safety, he said.
Hes also optimistic that as the pandemic recedes, so will some of the anger and aggression toward medical providers.
Spendloves bill, which took effect in May, contains a five-year sunset provision meaning it will go away at that point unless legislators extend it. Gessel hopes by that time, the state wont need it anymore.
Editors note This story is available to Salt Lake Tribune subscribers only. Thank you for supporting local journalism.
Good morning, Chicago.
Tornado sirens in downtown Chicago signaled an evening of wild weather last night that will usher in temperatures in the upper 90s today.
Damage reports were being tallied Monday evening after heavy rains and high winds hit the Chicago area, forecasters said. Castro said there were reports of 84 mph wind gusts at OHare International Airport and a structural collapse in Bellwood.
Heat indexes are expected to top 105 degrees for two consecutive days on Tuesday and Wednesday, a benchmark that triggered a National Weather Service heat advisory.
And at Wrigley Field, Tribune photographer Brian Cassella captured some striking images of Monday nights storm.
Here are the top stories you need to know to start your day.
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Chicago Public School Kenwood Academy High School students return to school, Jan. 12, 2022, after five days off for COVID-19 protocol discussions between CPS and CTU. (Antonio Perez / Chicago Tribune)
About one in every dozen Chicago Public Schools students contracted COVID-19 this school year, the districts first year of full-time, in-person learning since the pandemic began. With CPS closing out the school year Tuesday, the district is reporting nearly 22,500 cases among 272,000 students from the first week of school in August through last week.
Each case represents an individual report of COVID-19, so a student reinfected with the virus would count as two cases. The data doesnt include CPS charter, contract and alternative learning students, of which there are 58,000.
This was supposed to be a recovery year for CPS, but thats not the way it unfolded.
Carmen Navarro Gercone, a longtime official in the sheriff's office pictured in February, has lost her bid to stay on the June 28 primary ballot for Cook County sheriff. (John J. Kim / Chicago Tribune)
The Democratic primary for Cook County sheriff will officially be a two-man contest this month after challenger Carmen Navarro Gercones last hope for getting back on the ballot was dashed.
The Illinois Supreme Court declined Monday to hear Navarro Gercones appeal in a case that started with incumbent Sheriff Tom Dart challenging her candidacy under a controversial new state law that requires all sheriff contenders to be certified law enforcement officers.
It was the final twist in a high-profile saga that saw Navarro Gercone, a former top aide to Dart who now works for the Circuit Court clerks office, get tossed from the ballot, reinstated and then removed once more.
Mayor Richard M. Daley chats with Ald. Ricardo Munoz in 2002. (NANCY STONE / CHICAGO TRIBUNE)
Former Chicago Mayor Richard M. Daley has been released from the hospital and is now at a rehabilitation center after experiencing what his doctor called a neurological event.
Daley, 80, spent five nights at Northwestern Memorial Hospital after falling ill. His physician, Dr. Eric Terman, said in a news release Daley experienced a neurological event and is expected to recover fully.
Meta employees celebrate the 15th anniversary of the social media company in Chicago during an event at their new Loop offices, June 8, 2022. (E. Jason Wambsgans / Chicago Tribune)
When Meta, the social media giant formerly known as Facebook, hosted the grand opening for its Fulton Market headquarters last week, it was a celebration delayed more than two years by the pandemic. Despite welcoming hundreds of cheering employees, the celebration, which also marked Metas 15th anniversary in Chicago, was muted by a hybrid return to office that could make the expansive new workplace a monument to the past.
Companies across Chicago are beginning to herd employees back into the office, but after two years of remote working and the lingering COVID-19 pandemic, it is a tentative process at best. Employees used to the flexibility of remote working are balking at a mandatory return, while hybrid work schedules turn the once busy office into a fortress of solitude.
The team behind Kasama walks the red carpet while attending the James Beard Foundation Awards at the Lyric Opera House, June 13, 2022 in Chicago. (Armando L. Sanchez / Chicago Tribune)
The James Beard Foundation Awards returned to Chicago on Monday after a two-year hiatus, celebrating the best and brightest of the culinary world on a national scale. Prominent chefs and restaurateurs from across the country gathered at Lyrics Civic Opera Building for the award ceremony, which began just as sirens began to blare in downtown Chicago for a tornado warning.
Of the nine Chicago chefs, restaurants and bars up for six awards during the ceremony, only Virtue chef-owner Erick Williams took home an award, for the regional Best Chef: Great Lakes category, which pitted him against chefs in Illinois, Indiana, Ohio and Michigan.
Study population
106 patients with laboratory-confirmed COVID-19 who were admitted to the ICU for treatment of ARDS at University Hospital Aachen, Germany, were recruited to this retrospective subcohort study. 59 of these patients were published8,9 previously in respect to a single-centre cohort study, COVAS. Patients in the present study were admitted between February 24, 2020, until May 15, 2021 and fulfilled the following criteria (Fig.1). Inclusion criteria for the subcohort were a positive respiratory SARS-CoV-2 PCR result and admission to the ICU requiring mechanical ventilation due to COVID-19 and ARDS. Exclusion criteria of this study were lack of consent, positive PCR result or age of majority, as well as pregnancy or inability to legally give consent. In order to calculate the variability of FPG levels, we excluded patients who did not have at least 3 days of consecutive glucose measurements during their admission to the ICU.
Flowchart of patient enrolment. The register population represents all patients included in the COVAS cohort. A total of 106 out of 271 patients were enrolled in this subgroup analysis. ARDS acute respiratory distress syndrome; DGV daily glycaemic variability.
Since University Hospital Aachen is designated a tertiary care facility, patients with minor or mild severity were triaged by the emergency services towards other regional hospitals. Thus, the present study includes a significant number of patients with severe clinical course from other regional hospitals, who were either previously screened for ECMO or other high-end treatment methods.
All patients gave their written informed consent before participating in the COVAS study, which complies with the Declaration of Helsinki. Study approval was acquired by the ethics committee at the Faculty of Medicine of RWTH Aachen University (EK080/20). This trial has been retrospectively registered in the German Clinical Trials Register (DRKS00027106).
Based on national guidelines10 and internal standards of operation, all patients with an FPG above 180mg/dl were titrated to a FPG target of 150mg/dl using continuous insulin infusion during ICU admission.
ARDS was defined according to the Berlin definition11. Comorbidities were defined as conditions that were known before hospital admission. Likewise, previous medication included any medication prescribed before admission to our hospital.
Baseline vital parameters are characterized as the first available measurements after ICU admission. Respiratory disease was defined as a composite of bronchial asthma, chronic obstructive pulmonary disease, obstructive sleep apnoea syndrome and pulmonary malignancy. Moreover, composite heart disease is a composite of arterial hypertension, atrial fibrillation, coronary artery disease, heart failure and previous myocardial infarction. History of T2D was specified either by a previously known T2D diagnosis, diabetes medication at time of hospital admission or HbA1c at admission of6.5% (48mmol/mol).
For outcome measures, the primary endpoint was defined as all-cause mortality during ICU admission. As exposures, high and low glycaemic variabilities during ICU admission were defined as daily glycaemic variability (DGV)25.5mg/dl and DGV<25.5mg/dl. To determine this cut-off for DGV, we fitted a regression tree model (25.5mg/dl) and compared it to a cut-off based on a hazard ratio of 1 derived from a Cox-PH model, which was adjusted for age, sex and history of T2D (31mg/dl). The regression tree-based cut-off demonstrated a higher AUC (0.729 vs. 0.689) in 30-day survivalROC curves, therefore we used the cut-off DGV value of 25.5mg/dl in further models and testing rather than the Cox-PH based cut-off of DGV 31mg/dl.
We collected symptoms on admission, co-morbidities and previous medication either per interview/questionnaire in alert patients or per admission/discharge documents from our emergency department and previous hospitals. Vital parameters were acquired immediately on the first day of ICU admission. On subsequent days, we recorded the worst daily value, in the context of shock and/or respiratory failure. All data was manually retrieved from our EHR software, which automatically transfers ventilation parameters at set intervals from the ventilator to the patients electronic health record. In order to reduce confounders in ventilation parameters due to this automated process and initially extreme ventilation parameters, we intentionally omitted the first four hours of ventilation parameters after admission and intubation to allow the staff to properly configure the ventilator according to the patients requirements at the time.
PCR results were acquired by quantitative real-time polymerase-chain-reaction (PCR). Diagnosis of COVID-19 was established by positive respiratory PCR from either a throat swab or tracheal fluid in awake patients and bronchoalveolar lavage (BAL) in intubated patients. Respiratory PCR was repeated on days 7 and 14 of admission. Additionally, BAL, serum, stool and urine samples were tested for bacterial, fungal and viral pathogens, including Legionella pneumophila and Streptococcus pneumoniae antigens as well as SARS-CoV-2. All patients received daily routine laboratory tests including glucose levels between 03:00 05:00 AM.
All statistical analysis was performed in R version 4.1.212 using packages ggplot2 (version 3.3.5)13 for scatter plots, tangram (0.7.1)14 for tables and Rmarkdown for text. The characteristics were described as median (IQR) for continuous and percentages for categorical variables. Categorical parameters were compared by Fishers Exact Test and continuous parameters by KruskalWallis test. Statistical significance was determined as a p-value below 0.05. We opted not to do any parameter imputation for missing values.
In order to select a suitable metric to evaluate fasting plasma glucose variability, we first compared established parameters: standard deviation (SD), Neumans (root) mean square of successive differences (MSSD and rMSSD), bias corrected coefficient of variation (CoefVar) and median of the absolute difference between successive values (DGV, daily glycaemic variability). In order to compute DGV, we first calculated the absolute differences of FPG (FPG) for consecutive days, where FPGday represents the fasting plasma glucose of the current day and FPGday+1 the fasting plasma glucose of the following day (Eq.1):
$$Delta FP{G}_{day}=left|FP{G}_{day}-FP{G}_{day+1}right|$$
(1)
Then, we calculated DGV as the median of all (FPG) values for each patient.
We calculated MSSD and rMSSD using the psych package (version 2.1.9)15 and CoefVar using the implementation provided by the DescTools package (version 0.99.44)16.
The cut-off DGV was estimated by regression tree analysis using rpart (version 4.1.16)17. Through rms (version 6.2.0)18, smooth hazard ratios and survival analysis were examined in Cox-proportional-hazard (Cox-PH) regression models, which were compared by likelihood ratio (LR) test, Akaike information criterion (AIC) and Concordance Index (C-Index).
All Cox-PH models were tested for the proportional hazard assumption as well as for collinearity utilising the variance inflation factor (vif function rms18 package). While recommendations vary, in accordance with most studies, we defined a VIF<5 as acceptable.
Before analysis and based on clinical judgment we selected the following confounders for adjustment of our final Cox-PH models: age, sex, BMI, history of type 2 diabetes (T2D), dialysis during admission, dexamethasone treatment, median procalcitonin (PCT) and FPG during ICU admission. To reduce overadjustment of the models, we removed BMI and dialysis during admission from the final model. For this model we additionally used Firths penalized maximum likelihood bias reduction method, provided by the coxphf (version 1.13.1)19 package.
To evaluate the accuracy of the outcome-based cut-offs, we compared the AUC in 30-day survival models using the implementation of survivalROC (version 1.0.3)20.
Utilizing survminers (version 0.4.9)21 ggforest function, forest plots were created. Furthermore, KaplanMeier estimator was calculated with the survival (version 3.2.13)22 package and plotted with survminers (version 0.4.9)21 ggsurvplot function, which compared survival curves and computed p-values using the log-rank test.
Study approval was acquired by the ethics committee at the Faculty of Medicine of RWTH Aachen University (EK080/20). The present research complies with the Declaration of Helsinki.
Babies whose mothers were infected with the coronavirus during pregnancy may face a higher risk of brain development disorders such as autism and bipolar disorder, a new study that examined more than 7,500 births suggests.
The finding, published Thursday in the journal JAMA Network Open, adds to the urgency to get coronavirus transmission under control even though newer variants are less likely to cause severe cases of COVID-19.
Other viruses, such as influenza and measles, are thought to make babies more vulnerable to conditions such as autism, schizophrenia and depression if they are exposed in utero. Researchers at Massachusetts General Hospital and Harvard Medical School wondered whether the same might be true about SARS-CoV-2, the coronavirus that causes COVID-19.
There are more than a decade of studies that suggest viral infection during pregnancy might be associated with neurodevelopmental disorders, so there was reason to be concerned likewise with this virus, said Dr. Roy Perlis, director of the Center for Quantitative Health at Massachusetts General Hospital and the studys senior author.
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The researchers examined data from electronic health records of deliveries that took place in eight medical centers in Massachusetts in the early months of the pandemic, between March and September 2020. The records tracked the babies development for a year after birth, looking for specific codes that would indicate a diagnosis of a developmental disorder related to motor function, speech or language, among other things.
The researchers found that among 7,550 babies whose mothers were infection-free during their pregnancies, 3% were diagnosed with a brain development disorder before their first birthdays. Among the 222 babies who were exposed to SARS-CoV-2 in utero, 6.3% received a diagnosis by the time they turned 1.
After the researchers accounted for other factors that could affect a childs risk for a neurodevelopmental issue such as preterm births, the mothers age and the babys gender they calculated that babies with prenatal exposure to SARS-CoV-2 were 86% more likely to be diagnosed in their first year compared with babies who werent exposed before they were born.
Perlis emphasized that the overall risk of developing these disorders remains low for all babies.
He added that one year is not enough to completely understand how prenatal coronavirus exposure affects children. Still, he said, he was surprised to find any link in the first place.
Candidly, I would have been much happier if we had seen nothing at all, he said.
In a commentary that accompanies the study, Dr. Torri Metz suggested that the coronavirus might not be directly responsible for the babies developmental issues.
We wonder whether it is the virus itself or the societal changes and stresses of the pandemic that are adversely affecting childhood outcomes, wrote Metz, a maternal-fetal medicine specialist at University of Utah Health.
But Dr. Kristina Adams Waldorf, an obstetrician-gynecologist who studies infectious diseases in pregnancy at University of Washington Medicine, said the findings were similar to research looking at infections caused by other viruses.
We know from previous studies, including one involving millions of pregnancies in Sweden, that exposure to different kinds of infections such as influenza during pregnancy can impact neurodevelopment of the child, said Adams Waldorf, who was not involved in the new study.
With the coronavirus, further research will be necessary to see whether the severity of a mothers infection matters.
Unfortunately, it is very possible that asymptomatic or mild infections might also be linked to neurodevelopmental disorders in the child, she said.
Regardless, the medical advice for pregnant women remains unchanged.
This should be another wake-up call for pregnant women to get vaccinated, and boosted, and stay masked and take as many precautions as they can, Adams Waldorf said.
Throughout the pandemic, the SARS-CoV-2 virus has laid bare weak points in the worlds health care systems. This has been true in arguably every country and every community, but the fractures have been especially apparent in rural areas, where poor access to health care long predated the pandemic.
In this three-part story, Undark explores the gaps in rural health care systems around the world, following the daily work of a village health worker in a small township in central Zimbabwe; a newly graduated rural doctor on a required year-long stint at a remote clinic in northern Ecuador; and a family doctor at a private practice in upstate New York.
Rural life in each of these countries is vastly different, and the challenges that the health care workers face, in some cases, also vary. In Hoja Blanca, Ecuador, for instance, its a three-day round trip just to send a Covid-19 test for analysis, requiring travel by motorcycle, bus, and ferry, and in Makusha Township, Zimbabwe, the health care worker gets around on a bike. Meanwhile, doctors in New York State have access to couriers and can hop in a car for house calls. There are also inequalities when it comes to vaccine availability, funding, and even access to basic medicines like ibuprofen.
But Covid-19 has also revealed common problems. There are far fewer doctors and nurses in these remote areas compared to their urban counterparts. Each rural community feels the pinch of badly broken health care systems on the national level. Covid misinformation and disinformation, as well as pandemic fatigue, reaches even the most remote areas. And as the pandemic lingers, all of the health care workers, no matter their country of origin, continue to toil to keep their villages safe.
This reporting project was created in partnership with Undark and produced with the support of the International Center for Journalists and the Hearst Foundations as part of the ICFJ-Hearst Foundations Global Health Crisis Reporting Grant.
On a recent Sunday, Lucia Chinenyanga, 42, navigates her bicycle through the bumpy terrain of Makusha Township in Shurugwi District in rural Zimbabwe, 200 miles outside the countrys capital city of Harare.
Chinenyanga, a village health worker, is headed to a nearby home to educate a family on vaccines and other Covid-19 protection measures. On her way, she meets Robert Nyoka, a local. As they talk, he expresses concern about his pregnant wife receiving her second dose of the Covid-19 vaccination.
Chinenyanga assures him its safe. Your wife can receive her second jab, she says. But should she feel any slightest side effect afterwards, she must report to the nurses to check her.
As a village health worker, Chinenyanga oversees and responds to the health needs of people in Makusha Townships Ward 9. She works at the local clinic. Her tasks include education around tuberculosis, home-based care for the elderly, monitoring pregnant women, and health awareness programsespecially on Covid-19 vaccines. The position required three weeks of training conducted by the Ministry of Health and Child Care, which coordinates health workers. She has worked in the village since 2019, the year before the pandemic hit Zimbabwe.
While nearly two-thirds of Zimbabwes 15.3million people lived in rural areas like Makusha Township as of 2020, rural health facilities in the country are often under-resourced, with fewer nurses and doctors compared to urban hospitals. Village health workers such as Chinenyanga fill the gap. And although the village health workers play an essential role in the primary health care system, providing care for the marginalized or remote communities in rural areas, they receive little paythe equivalent of $42 every month from nongovernmental organizations that work with the government.
The health sector in Zimbabwe is a mix of public and private facilities; the latter are costly, charging more and offering better services compared to government-run institutions. In Shurugwi, there are three private facilities, but most local residents cannot afford those services due to poverty and opt for the public clinics. Others rely entirely on the services of health workers who do community rounds. Shurugwi consists of 13 wards, with a population of 23,350 according to a 2014 census.
The pandemic has stretched the system even more. Over the past months, Covid-19 has increasingly become a dominant problem, killing high numbers of community members, Chinenyanga says in January following a spike in Covid-19 cases in the country. The deaths came with shortages of pretty much every necessity: quarantine facilities, personal protective equipment, medicines, and doctors. Like many places around the world, the country has also struggled with people sharing fake news about the dangers of vaccination.
Enforcing Covid-19 protocols can be draining for Chinenyanga. Every day she has to convince the rural villagers, mostly small-scale gold miners in the area, many of whom are skeptical of vaccines, to mask up, practice physical distancing, sanitize, and avoid gatherings at places like pubs, where people tend to forgo prevention measures.
Despite some pockets of vaccine hesitancy, as ofJune 7,2022, a total of4.3million Zimbabweans have been fully vaccinated for Covid-19, amounting to about28percent of the population.More than a millionhave received a booster shot.
In Shurugwi, people grew scared when family members started dying of Covid-19, Chinenyanga says. One family would lose both the wife and the husband at the same time. This is when locals started understanding that Covid-19 wasnt just a flu, but a deadly disease which had come to our community.
***
When Zimbabwe gained independence from the United Kingdom in 1980, the new countrys health sector adopted a strong focused health care system, moving from only providing more advanced health care services for the urban population to involving more vulnerable sections of the society in rural areas. Health workers like Chinenyanga now play a pivotal role in the countrys health systems, says Samukele Hadebe, a senior researcher at the Chris Hani Institute, a South African think tank.
In rural areas, the health workers must be empowered with both finances and resources to do their job effectively, he adds, as a majority of people rely on them.
If you come from a health background you will realize those who have succeeded in building universal health care or a viable health care system, it is not the specialist doctors, he says. Wherever there is a successful health care system, it is actually the basic community health care, the one that in some countries where they dont even earn salaries. Those are the people fighting to just get recognized. Those are the people who manage the fundamental work.
But over the years, Hadebe says, Zimbabwes government neglected the rural health sector by not taking care of its health care professionals and paying them inadequate salaries, which pushed many qualified workers to leave the country for better opportunities overseas. In Zimbabwe, the infrastructure is gone, he adds, and health workers from the basic to the specialist are leaving the country. Why? Not just because of the salaries, but because someone will leave the country because they are worried about social security.
Zimbabwes 2010 Health System Assessment from USAID, a U.S. federal agency focused on foreign development, shows that there was a dramatic deterioration in Zimbabwes key health indicators beginning in the early 1990s. The current life expectancy for Zimbabwe in 2022 is just under 62 years, a 0.43 percent increase from 2021, according to projections from the United Nations.
With little hospital funding from the government, village health workers have to do their work with limited resources. Clinics likeChinenyangasin Makusha are poorly resourced and cannot accommodate patients with severe Covid-19 or other critical ailments, as there are no relevant medicines or oxygen tanks.
Even larger hospitals in Zimbabwe dont always provide oxygen to every patient, especially if the patient cant pay. You must have money upfront, Hadebe says. And how many people can access that? So, its a dire situation.
Itai Rusike, who heads the Community Working Group on Health in Zimbabwe, agrees that most rural health care facilities in the country were not equipped to deal with severe cases of Covid-19. In addition to the lack of oxygen tanks, he says, we also do not have intensive care units in our rural health facilities. Most of the rural facilities have no doctors, he adds, and the nurses who do work in rural areas may also not be well-equipped and skilled enough to deal with severe cases of Covid-19.
In November 2021, the Minister of Finance and Economic Development, Mthuli Ncube, announced that the country had acquired 20 million doses of vaccines. China reportedly committed in mid-January to donating 10 million doses over the course of 2022, which can be used for both initial and booster shots.
Rusike says that to ramp up the vaccination drive program, community outreach is needed, especially in rural areas. We need to take vaccination to the people, he says, rather than just wait for the people to come to the health facility and get vaccinated.
I think it is important, especially in remote locations, we come up with innovative strategies to take vaccination to the people, he adds. We know there are certain hard-to-reach areas where we can even use motorbikes to make sure that people can be vaccinated where they are, in their communities.
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In addition to resource shortages, Chinenyanga has experienced another serious challenge most days in her work: vaccine misinformation and disinformation.
The problem is common across rural Zimbabwe, according to Rutendo Kambarami, a communication officer at UNICEF, who says that the most common reason communities are not taking the vaccine is fear.
Even though much of Zimbabwes population lives in rural areas, they still are connected on social media through mobile devicesand the mobile devices and social media platforms allow for plenty of access to inaccurate information and outright conspiracies about vaccines. So we realized that we needed to give more information in order to dispel misinformation, she said at a December workshop on Covid and mental health for journalists in Zimbabwe.
Village health workers, as front line workers, and even the teachers were saying: We needed to do more interpersonal communication within those areas. So, front line workers play an incredibly huge role in terms of even misinformation and disinformation.
As Chinenyanga wraps up her day, after visiting several homes, she agrees that social media has contributed to misinformation. The people she serves in the Makusha community often share with her unproven remedies to treat Covid-19. She lists some of the misinformation that shes seen so far. People believe in steaming, that it helps. They also believe that eating Zumbani, a woody shrub that grows in the country, also prevents Covid-19, she says.
Still, she manages to smile as she leans against her bicycle. She says she loves her job and its usefulness to the community. As village health workers, our role is to share information we are taught by the Ministry of Health, she says. We prioritize prevention as the most effective tool against Covid-19.
Karen Topa Pilalooks around the windowless reception area in the small health care station of Hoja Blanca, Ecuador, its pale yellow walls stained with patches of mold. When did the electricity go out last night? Topa Pila, a doctor in this remote corner of the country, asks. Her co-workers shrug, throwing worried glances at a small container filled with ice packs. Its only 8:30 a.m. one morning in December 2021, but outside its already over 70 degrees.
Topa Pila closes a cooler containing 52 Covid-19 nasal swabs. Those tests need to be refrigerated and we only have one fridge, which is exclusively for vaccines, she says. Her team has nowhere to store the tests, she adds, and so to avoid getting them spoiled in the jungle heat, the clinic wants to use up all of them on the same day. The very next morning, a health care worker is going to take them to the laboratory in the district hospital.
Topa Pila, 25, and her team arrived in Hoja Blanca, a village of 600 located in the heart of Ecuadors Esmeraldas province, in September 2021. As freshly graduated health care professionals, they all are required to serve an ao rural, working one year in a rural community in order to get their professional license or advance into postgraduate courses in medicine. (The Ministry of Public Health implemented the ao rural in 1970, and the practice is also common across Latin America.) Topa Pilas team is the third deployed in Hoja Blanca since the start of the pandemic. The Hoja Blanca station is also responsible for six other communities, made up of mestizos, Indigenous Chachis, and Afro-Ecuadoriansabout 3,000 people in total. Some of the communities are so remote that to reach them, the health care workers traverse thick rainforest and then travel by canoe for a whole day.
Ecuador has suffered big losses from the pandemic. In the early months,corpseslittered the streets of the countrys biggest city, Guayaquil. By June 2020, the mortality rate from the virus reached8.5 percent, one of the highest in the world at the time. As of June 5, 2022, the countryrecorded35,649 official Covid deaths, although the real count is likely far higher.
Many public health experts agree that Covid-19 has also surfaced deep-rooted systemic problems in Ecuadors rural health care system. In 2022, Ecuador, the smallest of the Andean nations, reached more than 18 million inhabitants; an estimated 36 percent live in rural communities. As with private health care providers, the countrys public health care system is fragmented, divided among various social security programs and the Ministry of Public Health. There are about 23 physicians and 15 nurses per 10,000 people on average. But only a small portion of the countrys health care professionalsroughly 9,800, by the estimate of Dr. John Farfn of the National Association of Rural Doctors serve the more than 6.3 million rural Ecuadorians.
Although Ecuador is relatively financially stable, many Ecuadorians lack access to adequate medical care and the country has some of the highest out-of-pocket health spending in South America. In rural areas, access to hospitalas well as clinics like Hoja Blancasis hampered by bad infrastructure and long distances to facilities. Before the pandemic, Ecuador was undergoing budget cuts to counter an economic crisis; public investment in health care fell from $306 million in 2017 to $110 million in 2019. As a result, in 2019, around 3,680 workers from the Ministry of Public Health were laid off. Ecuador has also experienced long-standing inconsistencies in health leadership. Over the last 43 years, the country has had 37 health ministersincluding six since the start of the pandemic.
Before the Ministry of Public Healths selection system placed Topa Pila for her service, she had never been to Hoja Blanca, and it took her more than eight hours to get there. She says that when she first arrived at the modest health care station, she thought, This is going to collapse.
Early in the pandemic, Ecuador weathered shortages in everything: face masks, personal protective equipment, medications, and even health care workers. By April 2020, the government had relocated dozens of doctors and nurses from rural areas to urban hospitals and health centers, leaving many communities without medical attention.
At one point, says Gabriela Johanna Garca Chasipanta, a doctor who spent her ao rural in Hoja Blanca between August 2020 and August 2021, her team didnt even have basic painkillers like acetaminophen or ibuprofen. It was an infuriating experience, she says. I even had to buy medication out of my own pocket to give to some patients, the ones who really needed it and didnt have the economic means to get it. Some rural outposts had to resort to desperate DIY solutions during the worst months of the pandemic, says Esteban Ortiz-Prado, a global health expert at the University of Las Americas in Ecuadorjury-rigging an oxygen tank to split it between four patients, for instance, and using plastic sheets to create isolation tents in a one-room health center.
The pandemic has strained rural doctors in other ways, too. In 2020 and 2021, Ecuadors National Association of Rural Doctors received many complaints of delayed salaries, some more than three months late. There were rural health care workers who were even threatened by their landlords that they were going to be evicted, saysFarfn, a doctor and former association president.
Even under better conditions, remote health care outposts are only equipped to provide primary care. Anything more serious requires referral to the district hospital, which in Hoja Blancas case means a 300-mile round trip to the parish of Borbn.
The health administration used to take into account Ecuadors geographical and cultural diversity and the poor infrastructure in rural areas. But in 2012, the government restructured the system into nine coordination zones that public health experts say no longer follow a geographical logic. You cannot make heads or tails of it, saysFernando Sacoto, president of the Ecuadorian Society of Public Health. This is not just a question of bureaucracy, but also something that has surely impacted many peoples health.
Although there have also been significant developments in the health care sector in the past 15 yearsincluding universal health coverage and a $16 billion investment in public health from 2007 to 2016it mostly focused on the construction of hospitals, says Ortiz-Prado. But the countrys leadership didn't pay too much attention to prevention and primary health care, he adds. The system was not built to prevent diseases, but was built to treat patients.
In 2012, the government also dismantled Ecuadors Dr. Leopoldo Izquieta Prez National Institute of Hygiene and Tropical Medicinewhich was responsible for emerging diseases research, epidemiological surveillance, and vaccine production, among other things. (It was replaced by several smaller regulatory bodies, one of which failed completely, according to Sacoto.) The majority of a nationwide network of laboratories shut down as well. Sacoto and other experts believe that if the government had continued investing in the Institute rather than dismantling it, it would have lessened the severity of the pandemics impacts in Ecuador.
Initial plans to track and trace Covid-19 cases faltered; the country had barely any machines to process PCR tests, the gold-standard Covid-19 tests. During the first days of the pandemic, samples collected in Guayaquil were taken to Quito by taxi, Sacoto says, because that was the only place PCR tests were being analyzed. But public transportation to rural communities is limited, so even the few rural residents who had access to tests sometimes waited two weeks for test results.
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Topa Pilas team tries to convince everyone they cross paths withthe butchers wife, people waiting for the bus, men at the cockfighting arenato take a Covid-19 test. While the PCR results are faster than they used to be, they still take a week, as one of the health care workers has to personally shuttle the samples to Borbna 3-day roundtrip that involves a motorcycle, two different buses, and crossing a river with a shabby ferry. Up until yesterday, we had Covid-19 rapid tests. Today, the [district] leader took all the tests we had, says Topa Pila. The district hospital had requested the rapid tests, she adds, because theyve run out of tests and they need them.
Since Hoja Blanca is fairly isolated, the community has had very few Covid-19 cases, and all were mild. Topa Pila fears having any patients in a critical condition, Covid-19 or otherwise, because all she can do is ask the villagers and ferry operator for help with transport. There are no ambulances. We dont have oxygen because the tank we have over there is expired and you cant use it anymore, she says. Weve asked for replacement but nothing has happened.
The way Topa Pila sees it, its a lot to ask of the inexperienced health care workers on their ao rural. We start from zero without knowing anything every year, she says, recalling that the previous team had already left by the time she arrived in Hoja Blanca. And all of those patients whose treatments have been supervised by a doctor for a year lose their treatments, because they knew the doctor would come to their house, she says. We arrive and dont know where they live, since as you can see there are no addresses here. The Covid-19 pandemic has further distanced the rural doctors from their patients, she adds. Between the lockdowns and the coronavirus, other health matters like childhood vaccinations have been put off.
As in other parts of Latin America, the Covid-19 crisis in Ecuador also allowed corruption to fester. Sacoto says he believes the health care sector has become a bargaining chip among politicians. There really are mafias embedded in, for example, public procurement, he says, because the public procurement system is so convoluted that only the person who knows how the fine print works benefits. Between March and November 2020, the countrys Attorney Generals office reported196corruption cases related to the Covid-19 pandemic, including allegations of embezzlement and inflated pricing of medical supplies.
Lately, there have been signs of improvement. After taking office in May 2021, the government of Guillermo Lasso has accelerated vaccination efforts against Covid-19, approved a new program to tackle childrens malnutrition, and announced a Ten-Year Health Plan to improve health equity.
Sacoto says he remains skeptical whether these plans will translate to concrete and lasting actions. A good start would be decentralizing the health care system by building more rural clinics, he says, which could build up a network for preventative care for everything from childhood malnutrition to future pandemics. Ortiz-Prado says the country should better integrate its fragmented health care systems to make it easier for patientsand their recordsto move between them when needed. And it needs to improve the working conditions and salaries of rural health care workers to make the work more appealing, Farfn says, while also creating more permanent positions focused on rural communities. There is a lack of concern, lack of budget, he says, adding, Its a vicious circle, and sadly, governments are trying to apply Band-Aid solutions for the health issues here.
But all of that is in the future. Now, back at the Hoja Blanca health care station, the lights flicker back on in less than a day. The vaccines in the fridge are safe. But the 52 Covid-19 tests are still at risk: A health care worker must take the cooler to the lab in Borbn. There were heavy rains the night before, though, and water levels havent dropped enough for the river ferry to restart operations. Its just the first leg of what will ultimately be a 13-hour journey, and the icepacks are quickly melting amid the balmy equatorial heat.
Before Covid-19, there were no doctors in the village of Otego in central New York. Now there is one. During the pandemic, Mark Barreto quit his job at the Veterans Affairs hospital 89 miles away in Albany and opened a family medicine practice in his basement.
Just 910 people live in Otego, which sits along the Susquehanna River in Otsego County, a pastoral landscape of rolling hills and narrow creek valleys. Barreto lives on a dead-end road, a single street with pastureland on both sides. The downstairs waiting room looks like it could be anywhere in rural Americaa row of identical burgundy chairs against a pale beige wall, kids art hanging above.
In early December 2021, two of Barretos neighbors make an appointment. April Gates and her spouse Judy Tator are both in their 70s. They live around the corner. A friend joined them for Thanksgiving dinner and subsequently came down with Covid. Two weeks later, neither woman has symptoms and both got negative results with at-home tests. But theyre worried. Theyve come to take PCR tests, plus get a blood pressure check for Tator.
You dont have to be symptomatic. Its never bad to get tested if youve had a positive exposure, says Barreto. Are we being overly precautious? Maybe. But particularly with your cardiac history, youre at higher risk.
I worry most about giving it to someone else, Gates says. Thats the biggest thing.
New York State has an estimated 20.2 million residents. Two years into the pandemic, over one quarter of the population has had Covidmore than 5 million cases and more than 71,000 deaths, according to the state department of health. In the first six months of the pandemic, New York hospitals were overwhelmed with more Covid patients than beds. While they've continued to be overstretched, thelimiting factoris staffing. A similar situation has played out across the country: Medical personnel have quit in record numbers, according to the U.S. Bureau of Labor Statistics. Turnover rates were four times higher for lower-paid health aides and nursing assistants than physicians, peaking in late 2020, JAMA reported in April.
The problems are most acute in rural areas that were already chronically understaffed. We have a health care shortage in the county, in the region, says Amanda Walsh, director of public health for Delaware County, just across the river from Otego. Walsh and her nursing staff averaged 12 hour days, seven days a week, for all of 2020. It was an insane amount of time, she says. The hours only eased after the state established phone banks with remote contract tracers, and Walsh started sending her team home by six, even though the work wasnt done.
In Barretos office, after 40 minutes chatting with Gates and Tator about their health concerns, Barreto swabs both patients, walks them out, and then calls a courier to pick up the tests. While he waits, he pulls up the Otsego County webpage. The Covid dashboard shows 7,235 total cases, and the county recently broke its record for most active cases, at 386. Before December, that number had never climbed above 300.
Barreto swivels away from his desk. In the first months of Covid, he says, medical systems that were already dysfunctional simply fell apart. Commuting to Albany on empty highways, hed pass a digital DOT sign reprogrammed to read: Stay home, save lives. He took the message to heart, wondering, he recalls: What is my role as a health care provider? Because we're expected to put ourselves in harm's way to help people. The problem is we didn't know what to do to help them.
For 15 years working in hospitals, Barreto had been dissatisfied with how he saw patients treated. He notes two problems. One is getting access in a reasonable amount of time. And two is continuity of care, he says. The ongoing relationship is key, someone who knows your full story, he says, because thats what your medical history is, its a story.
When Covid hit, he adds, things only got worse.
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With each successive wave of Covid, the disease spikes in cities and then rolls out to rural areas. Towards the second half of 2020, both case rates and mortality rates were highest in rural counties, according to USDA researchespecially those only with communities of 2,500 people and under. The study pinpointed four contributing factors: older populations, more underlying health conditions, less health insurance, and long distances from the nearest ICU.
In December, omicron followed the same pattern, peaking in New York City two weeks before it really hit Otsego County, says Heidi Bond, who directs the countys department of public health. By early January, active cases in Otsego County shot up to 1,120 before the county abruptly stopped reporting the data. The health department was swamped, Bond says, and it was not possible to get an accurate number with the limited contact tracing and case investigation that is being done.
Sparsely populated regions like central New York, which have smaller health departments and hospitals, are easily overwhelmed during surges, says Alex Thomas, a sociologist at SUNY Oneonta who studies rural health care. Otsego County has fewer than 10 public health staff working on Covid, and 14 ICU hospital beds. Neighboring Delaware County has no ICUs.
In a 2021 study of New York public health staff, Thomas and his team found that 90 percent felt overwhelmed by work, and nearly half considered quitting their jobs. A survey from the Centers for Disease Control and Prevention of about 26,200 public health employees found similar results, with anxiety, depression, PTSD, and suicidal ideation among the fallouts. Thomas predicts dire consequences: We have a serious public health emergency, and there's nobody to take care of it.
Covid revealed long-term flaws in the system, and Barreto predicts the U.S. health care system will eventually collapse on itself. Bond has a more positive perspective: Health care is stronger now after the trial by fire, largely because we know a tremendous amount more than we did two years agoabout Covid, but also about how to help institutions adapt to evolving medical needs.
Before Covid, Bond adds, public health was certainly not a priority at the state or local level. Few elected officials wanted to invest enough or plan for providing robust care for a future crisis. Establishing better partnerships with community organizations let her team overcome these funding deficiencies. Having those in place moving forward, you know, things will happen much more quickly, she says, because we know who to reach out to, to just lend us a hand.
In Otsego County, dealing with the fallout of Covid became a community effort. Volunteers sent up a local Facebook group to share information and services; it quickly had more than 1,000 members. The local hospital organized an ad hoc County Health and Wellness Committee that met biweekly on Zoom. And between 50 and 100 locals representing medicine, public health, and social service agencies, non-profits, and churches exchanged information and ideas and then stepped up to help, says Cynthia Walton-Leavitt, a pastor at a church in Oneonta.
Still, Bond says she worries that public opinion will hamper her departments ability to prepare for the future. What I worry about is the fatigue, the kind of mental fatigue of Covid, she adds. We can't let our guard down.
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Before Christmas, Barreto drives about 15 minutes to Oneonta to see his own doctor. Oneonta is the biggest city in six counties with 13,000 residents and has the closest hospital to Barretos home practice.
Barreto brings a list of questions, knowing how hard it can be to squeeze out answers from his doctor in the allotted 15 minutes. There are always two agendas. There's your agenda as a doctor, why you wanted to see the patient, he says. And then there's a patient's.
After his appointment, Barreto grabs breakfast and then heads to his first house call of the day. He says he enjoys making home visits like an old-time country doctor. He crisscrosses three counties to see patients, 50 miles in any direction, and gives them his cell number, encouraging them to call whenever they need him. He sees two or three people per daycompared to eight to 15 in former hospital jobs.
Barreto guides his minivan to the interstate and then climbs out of the valley to visit Al Raczkowski, age 88. A former combat medic, Raczkowski still struggles with PTSD, has partial heart failure and some dementia, and requires weekly visits from nurses and therapists through a palliative care agency.
The family has no yardthe hemlocks grow right to the door. Barreto knocks then peeks in. Raczkowski stands in his semi-finished basement wearing a winter coat. Hes not wearing his hearing aid so Barreto shouts: Al, is Maureen here? Do you know why I came?
Raczkowski sits down on a futon. You're here to check on me, he says. With that, Barreto gets to work. The room is crowdedfirewood and tools jumbled by a woodstove, cardboard boxes, cases of soda and seltzer. A miniature Christmas tree stands on one table, an unfinished instant soup cup on another. Barreto unearths a stool and sets up his laptop beside the soup.
Do you remember why were wearing these masks? Barreto asks. Raczkowski isn't sure. Remember about Covid? Were wearing these masks to prevent spreading disease. Raczkowski nods.
Maureen, Al's wife, appears and shuffles to a seat. For the next hour, the three converse as Barreto performs his examination, mostly asking Raczkowski questions that Maureen answers. How are things with the care agency? Without their help I dont even think we would be here, Maureen tells him. Living on this mountain for 76 years. The nurses give Raczkowski showers, check his blood pressure and vitals, and keep him company.
Barreto asks how the medication is going. Its OK, Raczkowski says, but youd do better with a bottle of brandy.
Maureen complains about her husbands other health care. She drove him 80 miles to the Albany VA to try his new hearing aid, only to learn it had been mailed. As for the new psychiatrist? She closed our case, Maureen says. An appointment scheduled for September never happened, she adds, and no one ever answered her phone calls.
After Raczkowskis appointment, back in his car, Barreto vents frustration: If you look at a hospital system, and you count the number of medical personnel, versus the number of administration, there's a skew that shouldn't be there. All that oversight, he adds, doesn't help your relationship with your patient. It doesn't help them get the medicine.
Then he winds back down the mountain road to his next appointment.
The UK may be entering its third wave of coronavirus this year, researchers warn, as official figures show infections are on the rise again in England and Northern Ireland.
The Office for National Statistics said its latest analysis of swabs from households across Britain revealed a mixed picture with a small increase in positive tests in England and Northern Ireland, while the trend in Wales and Scotland remained unclear.
The ONS data, which give the most reliable picture of the state of the UK outbreak, suggest that the steady fall in infections over recent months may have gone into reverse as cases are driven up by the more transmissible BA.4 and BA.5 Omicron variants.
According to the ONS survey, an estimated 797,500 people in England and 27,700 in Northern Ireland would have tested positive for Covid in the week ending 2 June, up from 784,100 and 24,300 respectively in the week before.
The emergence in November last year of the first Omicron variant, BA.1, sparked waves of Covid around the world. This spring, a second UK wave was fuelled by a more contagious relative known as BA.2. While BA.2 is now in decline, it has two more transmissible descendants, namely BA.4 and BA.5, both of which are on the rise.
Public health officials are particularly concerned about BA.5 which is spreading faster than BA.4 and responsible for fresh spikes in cases in Europe, particularly in Portugal and Germany. At the end of May, BA.5 made up nearly 14% of Covid virus genomes analysed in England, nearly double that for BA.4.
The latest ONS report shows that the percentage of people testing positive for coronavirus increased in London, the south-east and the north-wwest, but fell in the east Midlands, and Yorkshire and the Humber. While infections had been falling in all age groups, rates have now either levelled out or started to rise, with clear increases evident in 35- to 49-year-olds.
Sarah Crofts, head of analytical outputs on the ONS Covid Infection Survey, said: Todays data shows a mixed picture for infection rates across the UK, with small increases in England and Northern Ireland, likely driven by increasing trends in Omicron BA.4 and BA.5 variants.
Dr Stephen Griffin, a virologist at the University of Leeds, said Jubilee celebrations might have contributed to the rise, but were only part of the large increase in mixing, travelling and interactions between large groups that continue unmitigated in the UK since all protections were dropped earlier this year.
He said a particular concern was the recent rise in Covid hospitalisations. This may be driven solely by a greater number of infections, but mutations in the newest Omicron variants could also play a role.
It is important to emphasise that we are better placed immunologically to counter much of the potential for severe disease than we were in 2020 or 2021 due to widespread vaccinations, Griffin said. As we enter, astonishingly, our third wave of 2022, a complex pattern of immunity exists induced by vaccines, boosters and prior infection.
The spring booster programme and further shots in the autumn should prevent much of the severe disease seen in earlier waves of Covid, but Griffin said concerns remain about the situation in schools, since less than 10% of under-12s are vaccinated. Given the lack of protections in schools, this will likely prompt further infections in children and staff, with predictable disruption across the board and further increases in long Covid, he said.
Bank voles are small rodents that mostly live in woodland areas.
Researchers from the Zoonosis Science Center at Uppsala University have identified a new coronavirus. Their study of approximately 260 bank voles caught around Grims, rebro County, shows that the virus is well established in Swedens red-backed voles. The finding has been published in the journal Viruses.
Bank voles (Myodes glareolus) are a species of small voles around 3.9 inches (10 cm) in length that live in woodland areas. Voles are small rodents related to hamsters and lemmings that are sometimes called meadow mice or field mice in North America. There are over 150 different species of vole.
Although still a mystery, SARS-CoV-2, the virus that causes COVID-19, may have originated in bats. However, other coronaviruses are known to originate in rodents including rats, mice, and voles. Scientists in Sweden have now discovered a new coronavirus, called Grims Virus, and found it in 3.4% of the voles tested.
Between 2015 and 2017, we consistently found what we have called the Grims Virus in 3.4 percent of these voles, which would suggest that the virus is widespread and common in Swedens bank voles, says ke Lundkvist, Professor in virology and head of the Zoonosis Science Center at Uppsala University. He led the study together with researchers Jiaxin Ling and Anishia Wasberg, a doctoral student and the first author.
Researchers from the Zoonosis Science Center (ZSC) map zoonotic viruses to increase the understanding of the interaction between viruses and host animals. Unlike the SARS-CoV and MERS coronaviruses that originate in bats, seasonal coronaviruses, such as HCoV-OC43 and HCoV-HKU1, appear to have spread to humans from rodents like rats, mice, and voles. The objective is to increase knowledge and develop methods that can effectively limit major virus outbreaks and avoid infection spreading from animals to humans.
Researchers
In a new study published on June 1, 2022, in the journal Viruses, researchers from ZSC examined red-backed voles caught around Grims in rebro County between 2015 and 2017 and tested them for coronavirus. Using an RNA sequencing method, they identified a new coronavirus known as the Grims Virus belonging to the betacoronavirus family that also includes SARS-CoV, MERS, and SARS-CoV-2.
Rodents already carry several zoonotic microorganisms, such as Hantaviruses and Tularemia, meaning they play a key role in how infectious diseases are spread. In recent years, there has been a dramatic increase in infectious diseases that can be linked to small mammals, like rodents, and research around the ecology of these host animals is an essential component in the work to prevent future outbreaks.
The bank vole (Myodes glareolus) is one of Europes most common rodents. Previous studies have found several coronaviruses circulating amongst animals in countries like the United Kingdom, Poland, France and Germany.
We still do not know what potential threats the Grims Virus may pose to public health. However, based on our observations and previous coronaviruses identified among bank voles, there is good reason to continue monitoring the coronavirus amongst wild rodents, says Professor ke Lundkvist.
Reference: Discovery of a Novel Coronavirus in Swedish Bank Voles (Myodes glareolus) by Anishia Wasberg, Jayna Raghwani, Jinlin Li, John H.-O. Pettersson, Johanna F. Lindahl, ke Lundkvist and Jiaxin Ling, 1 June 2022, Viruses.DOI: 10.3390/v14061205
As the COVID-19 pandemic continues to impact people across the globe, different groups experience the virus and related restrictions differently. Children and adolescents face specific challenges based on their phase of life and how both the COVID-19 disease and measures designed to contain the disease impact them.
Children and adolescents are generally at low risk of infection, and if they become infected it is likely to be mild. However, some children and young people have had severe experiences with the disease, and a few have died.
Children and adolescents of all ages and in all countries are seriously suffering from the consequences of the pandemic. COVID-19-related measures are having a profound effect on their health and well-being and for some the impact will be lifelong.
For example, COVID-19 has created the largest disruption of education systems in history, affecting nearly 1.6 billion students in more than 190 countries.
In addition, according to the WHO Pulse survey on continuity of essential health services during the COVID-19 pandemic, published in August 2020, 90% of countries report disruptions to essential health services since the COVID-19 pandemic started. The most frequently disrupted areas reported include services essential for children, such as routine immunization including 70% of outreach services and 61% of facility-based services.
The harmful effects of the pandemic have not been distributed equally. Children living in vulnerable situations continue to be disproportionately affected in relation to their long-term health outcomes.
WHO/Europe continues to show its commitment to children and adolescents and to leaving no one behind as the world continues to grapple with COVID-19. Three areas of work are particularly important to ensure that children access health and social services according to their needs.
WHO/Europe has been engaging with Europes decision-makers and targeting parents, teachers and school administrators to ensure safe schooling during the COVID-19 pandemic.
WHO/Europe has been working with countries across the WHO European Region to minimize the disruption of essential health systems for children. A collaborative project with Kazakhstan, Tajikistan and Romania, funded by the Bill and Melinda Gates Foundation, aims to limit the indirect impacts of the COVID-19 pandemic on maternal, newborn, child, adolescent and aging health (MNCAAH) services.
WHO/Europe has been providing technical guidance to safeguard the quality of care for children affected by COVID-19 or other respiratory infections.
