Nearly 15 million more people died during the pandemic than would have in normal times, the World Health Organization said on Thursday, a staggering measure of Covids true toll that laid bare how vastly country after country has undercounted victims.
In Mexico, the excess death toll during the first two years of the pandemic was twice as high as the governments official tally of Covid deaths, the W.H.O. found.
In Egypt, excess deaths were roughly 12 times as great as the official Covid toll.
In Pakistan, the figure was eight times as high.
Those estimates, calculated by a global panel of experts assembled by the W.H.O., represent what many scientists see as the most reliable gauge of the total impact of the pandemic. Faced with large gaps in global death data, the expert team set out to calculate excess mortality: the difference between the number of people who died in 2020 and 2021 and the number who would have been expected to die during that time if the pandemic had not happened.
Their calculations combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aimed to account for deaths that were missed.
Most of the excess deaths were victims of Covid itself, the experts said, but some died because the pandemic made it more difficult to get medical care for ailments such as heart attacks. The previous toll, based solely on death counts reported by countries, was six million.
Much of the loss of life from the pandemic was concentrated in 2021, when more contagious variants tore through even countries that had fended off earlier outbreaks. Overall deaths that year were roughly 18 percent higher an extra 10 million people than they would have been without the pandemic, the W.H.O.-assembled experts estimated.
Developing nations bore the brunt of the devastation, with nearly eight million more people than expected dying in lower-middle-income nations during the pandemic.
Its absolutely staggering what has happened with this pandemic, including our inability to accurately monitor it, said Dr. Prabhat Jha, an epidemiologist at St. Michaels Hospital and the University of Toronto, who was a member of the expert working group that made the calculations. It shouldnt happen in the 21st century.
The figures had been ready since January, but their release was stalled by objections from India, which disputes the methodology for calculating how many of its citizens died.
Nearly a third of the excess deaths globally 4.7 million took place in India, according to the W.H.O. estimates. The Indian governments own figure through the end of 2021 is 481,080 deaths.
But India was far from the only country where deaths were substantially underreported. Where excess deaths far outstripped the number of reported Covid fatalities, experts said the gap could reflect countries struggles to collect mortality data or their efforts to intentionally obscure the toll of the pandemic.
In some countries, flaws in government reports were widely known. Russia, for example, had reported roughly 310,000 Covid deaths by the end of 2021, but the W.H.O. experts indicated that the excess death toll was nearly 1.1 million. That mirrored earlier estimates from a Russian national statistics agency that is fairly independent of the government.
Aleksei Raksha, an independent demographer who quit the Russian state statistics service after complaining of the failure to count Covid deaths properly, said that informal orders had been given to local authorities to ensure that in many cases, Covid was not registered as the primary cause of death.
Excess deaths have established the true picture, Mr. Raksha said. Russia demonstrated a dismal performance in fighting the pandemic.
In other nations, W.H.O. experts used what limited data was available to arrive at estimates jarringly at odds with previous counts, though they cautioned that some of those calculations remained highly uncertain. In Indonesia, for example, the experts leaned heavily on monthly death data from Jakarta, the capital, to estimate that the country had experienced over a million more deaths than normal. That figure would be seven times as high as the reported Covid death toll.
Siti Nadia Tarmizi, a spokeswoman for the governments Covid-19 vaccination program, acknowledged that Indonesia had suffered more deaths than the government had reported. She said the problem stemmed in part from people not reporting relatives deaths to avoid complying with government rules for Covid victims funerals. But she said that the W.H.O. estimates were far too high.
In Pakistan, Dr. Faisal Sultan, a former health minister, defended the governments death reports, saying that studies of the number of graveyard burials in major cities did not reveal large numbers of uncounted victims of the pandemic.
For still other countries that suffered grievously during the pandemic, the W.H.O. estimates illuminated even more startling figures hiding inside already devastating death counts. In Peru, for instance, the expert estimate of 290,000 excess deaths by the end of 2021 was only 1.4 times as high as the reported Covid death toll. But the W.H.O. estimate of 437 excess deaths for every 100,000 Peruvians left the country with among the worlds highest per capita tolls.
When a health care system isnt prepared to receive patients who are seriously ill with pneumonia, when it cant provide the oxygen they need to live, or even provide beds for them to lay in so they can have some peace, you get what youve gotten, said Dr. Elmer Huerta, an oncologist and public health specialist who hosts a popular radio show in Peru.
In the United States, the W.H.O. estimated that roughly 930,000 more people than expected had died by the end of 2021, compared with the 820,000 Covid deaths that had been officially recorded over the same period.
In Mexico, the government has itself kept a tally of excess deaths during the pandemic that appears roughly in line with the W.H.O.s. Those estimates about double the countrys reported Covid death toll reflected what analysts there described as difficulties counting the dead.
We responded badly, we reacted slowly. But I think the most serious of all was to not communicate the urgency, the wanting to minimize, minimize, said Xavier Tello, a public health analyst based in Mexico City. Because Mexico wasnt or isnt testing for Covid, a lot of people died and we dont know if they had Covid.
The W.H.O.s calculations include people who died directly from Covid, from medical conditions complicated by Covid, or because they had ailments other than Covid but could not get needed treatment because of the pandemic. The excess death estimates also take into account expected deaths that did not occur because of Covid restrictions, such as reductions in traffic accidents or isolation that prevented deaths from the flu and other infectious diseases.
Calculating excess deaths is complex, the W.H.O. experts said. About half of countries globally do not regularly report the number of deaths from all causes. Others supply only partial data. In the W.H.O.s African region, the experts said that they had data from only six of 47 countries.
Scientists also noted that excess death rates were not necessarily indicative of a countrys pandemic response: Older and younger populations will fare differently in a pandemic, regardless of the response. And the W.H.O. experts said that they did not account for the effects of heat waves or conflicts.
Where death figures were missing, the statisticians had to rely on modeling. In those cases, they made predictions based on country-specific information like containment measures, historical rates of disease, temperature and demographics to assemble national figures and, from there, regional and global estimates.
W.H.O. officials used the release of their calculations to plead for greater investment in death reporting.
When we underestimate, we may underinvest, said Dr. Samira Asma, the W.H.O.s assistant director general for data, analytics and delivery for impact. And when we undercount, we may miss targeting the interventions where they are needed most.
W.H.O. officials cited Britain as an example of a country that had accurately recorded Covid deaths: Their analysis found that about 149,000 more people than normal had died during the pandemic, nearly identical to the number of Covid deaths Britain reported.
The disagreement over Indias Covid deaths spilled into public this week when the Indian government on Tuesday abruptly released mortality data from 2020, reporting an 11 percent increase in registered deaths in 2020 compared with average annual deaths registered over the two prior years.
Analysts saw the release as an attempt to force the W.H.O. to reconsider its calculations on the eve of publication. Indian health officials said their figures showed that the country had lost fewer people to Covid than outside estimates suggested.
But scientists believe that most of the countrys excess mortality occurred in 2021, during a grievous wave caused by the Delta variant. And even Indias 2020 figures gave additional credence to the W.H.O. estimates, said Dr. Jha, who has also studied excess deaths in India.
The Indian government wanted to deflect the news, he said, but theyre confirming, at least for 2020, the W.H.O. numbers.
Other experts said that Indias refusal to cooperate with the W.H.O. analysis was rooted in the countrys history of ignoring how data can inform policymaking.
Its natural to miss some of the Covid deaths, said Dr. Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who has been working with the W.H.O. to review the data. But, she added, Nobodys been this resistant.
The Ministry of Health in New Delhi did not respond to requests for comment. W.H.O. officials said that Indias 2020 death figures were released too late to be incorporated into their calculations but that they would carefully review the data.
Nations that report Covid deaths more accurately have also been at the center of disputes over the reliability of excess death estimates. In Germany, for example, the W.H.O. experts estimated that 195,000 more people than normal had died during the pandemic, a significantly higher toll than the 112,000 Covid deaths recorded there.
But Giacomo De Nicola, a statistician at Ludwig Maximilian University of Munich, who has studied excess deaths in Germany, said that the countrys rapidly aging population meant that the W.H.O. analysis might have underestimated the number of people who would have been expected to die in a normal year. That, in turn, could have produced overestimates of excess deaths.
He said that the W.H.O.-assembled experts had accounted for trends in mortality, but not directly for changes in the age structure of the population. While Germany experienced excess deaths, he said, the W.H.O. estimate for the country seems very high.
Overall, the W.H.O. calculations were more conservative than separate analyses released earlier by The Economist and the Institute for Health Metrics and Evaluation.
Some experts said that the W.H.O. analysis benefited from relying more heavily than other estimates on actual data, even where it was incomplete, as opposed to statistical modeling.
Oscar Lopez, Karan Deep Singh, Sofa Villamil, Christopher F. Schuetze, Ivan Nechepurenko, Richard C. Paddock, Muktita Suhartono, Mitra Taj, Julie Turkewitz, Merna Thomas and Salman Masood contributed reporting.
Health and medicine | Public Health | Science | UW News blog
May 6, 2022
This illustration represents the core theory in a new modeling study led by the University of Washington: The circles represent the immune systems aging, in which its ability to make new immunity cells remains constant until a person (represented by the human figures) reaches middle-age or older and then falls off significantly. The central blue figure represents an immune system T cell that attacks the virus.Michele Kellett and James Anderson/University of Washington
Your immune systems ability to combat COVID-19, like any infection, largely depends on its ability to replicate the immune cells effective at destroying the SARS-CoV-2 virus that causes the disease. These cloned immune cells cannot be infinitely created, and a key hypothesis of a new University of Washington study is that the bodys ability to create these cloned cells falls off significantly in old age.
According to a model created by UW research professor James Anderson, this genetically predetermined limit on your immune system may be the key to why COVID-19 has such a devastating effect on the elderly. Anderson is the lead author of a paper published March 31 in The Lancet eBioMedicine detailing this modeled link between aging, COVID-19 and mortality.
When DNA split in cell division, the end cap called a telomere gets a little shorter with each division, explains Anderson, who is a modeler of biological systems in the School of Aquatic and Fishery Sciences. After a series of replications of a cell, it gets too short and stops further division. Not all cells or all animals have this limit, but immune cells in humans have this cell life.
The average persons immune system coasts along pretty good despite this limit until about 50 years old. Thats when enough core immune cells, called T cells, have shortened telomeres and cannot quickly clone themselves through cellular division in big enough numbers to attack and clear the COVID-19 virus, which has the trait of sharply reducing immune cell numbers, Anderson said. Importantly, he added, telomere lengths are inherited from your parents. Consequently, there are some differences in these lengths between people at every age as well as how old a person becomes before these lengths are mostly used up.
Anderson said the key difference between this understanding of aging, which has a threshold for when your immune system has run out of collective telomere length, and the idea that we all age consistently over time is the most exciting discovery of his research.
Depending on your parents and very little on how you live, your longevity or, as our paper claims, your response to COVID-19 is a function of who you were when you were born, he said, which is kind of a big deal.
To build this model the researchers used publicly available data on COVID-19 mortality from the Center for Disease Control and US Census Bureau and studies on telomeres, many of which were published by the co-authors over the past two decades.
Assembling telomere length information about a person or specific demographic, he said, could help doctors know who was less susceptible. And then they could allocate resources, such as booster shots, according to which populations and individuals may be more susceptible to COVID-19.
Im a modeler and see things through mathematical equations that I am interpreting by working with biologists, but the biologists need to look at the information through the model to guide their research questions, Anderson said, admitting that the dream of a modeler is to be able to actually influence the great biologists into thinking like modelers. Thats more difficult.
One caution Anderson has about this model is that it might explain too much.
Theres a lot of data supporting every parameter of the model and there is a nice logical train of thought for how you get from the data to the model, he said of the models power. But it is so simple and so intuitively appealing that we should be suspicious of it too. As a scientist, my hope is that we begin to understand further the immune system and population responses as a part of natural selection.
Co-authors include Ezra Susser, Mailman School of Public Health, Columbia University; Konstantin Arbeev and Anatoliy Yashin, Social Science Research Institute, Duke University; Daniel Levy, National Heart, Lung, and Blood Institute, National Institutes of Health; Simon Verhulst, University of Groningen, Netherlands; Abraham Aviv, New Jersey Medical School, Rutgers University.
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For more information, contact Anderson at jjand@uw.edu.
MADRID, Spain Clinical experiences in approaching COVID-19 from different perspectives, results obtained by various therapeutic options and, above all, the challenges posed by a new healthcare reality long COVID were all the focus of a recent discussion at the 7th International Congress of the Spanish Society of Precision Health.
In this forum, titled Precision Health: A COVID-19 Professional Debate, Mayca Gonzlez, MD, a specialist in microbiology and an expert in age management medicine at the University of Granada, reviewed the most recent data regarding long COVID. "According to the latest evidence, 9 out of 10 COVID-19 patients (87%) discharged from hospital experience at least one symptom 60 days after illness onset, with 32% reporting one or two symptoms and 55% presenting three or more. Additionally, more than 50% of symptomatic cases have at least one symptom of the disease 1 year after infection."
Another study found that 12.8% of the infected study participants continued to have dyspnea after 6 months, even in the absence of a pneumonia diagnosis, Gonzlez added.
Research on this topic has also shed light on the main risk factors for developing long COVID. "First of all, gender, age, and even the number of symptoms" are risk factors, said Gonzlez. "Therefore, women and people between 40 and 54 years of age are more likely to suffer from long COVID. It is also known that the more severe the acute illness, the greater the number of symptoms that appear after post-infection.
"Having a body mass index equal to or greater than 25, reporting three to seven symptoms of COVID-19 in the acute phase, and patients with more than five symptoms during the first week of the disease are factors associated with being prone to suffer from long COVID. All this sets up a health problem that will undoubtedly be a major challenge from now on."
Gonzlez stressed that studies have shown that there are more than 50 long-term effects of COVID-19, the most prevalent being fatigue (58%), headache (44%), attention disorders (27%), and hair loss (25%).
Among all the research projects carried out on this topic, Gonzlez highlighted a study published in January that, in her opinion, is one of the most relevant to date "because it delves into the pathophysiologic circumstances behind symptoms at all levels, something that we did not fully know until now.
"For example, it has been shown that dyspnea, hypoxia, fatigue, 'ground-glass' opacities, and pulmonary fibrosis are due to damage to the lung parenchyma [primarily] mediated by the virus and secondarily due to immunological microvascular damage. On the other hand, at a cardiovascular level, up to 20 cardiovascular conditions can occur 1 year after overcoming COVID-19. This allows us to foresee that these patients will be a significant demand on health systems in the coming years."
Regarding the digestive and intestinal system, Gonzlez highlighted a hitherto unknown mechanism: the involvement of the vagus nerve and the intestinal microbiota.
"There are studies that suggest a pattern of persistent or recurrent viremia in some patients, causing a clinical evolution of nonspecific symptoms associated with personal limitations," she said. "This could lead us to think about the possibility that the virus would have a reservoir at this level. Along the same lines, research currently in progress points to a possible involvement of the vagus nerve as the cause of the manifestations of long COVID. We must not forget that this nerve connects the brain and the gastrointestinal tract, in addition to controlling heart rate, sweat production, and the gag reflex."
In her analysis of this pilot study carried out by a group of Spanish researchers, Gonzlez commented that two thirds (228) of the 348 participants involved had at least one symptom suggestive of vagus nerve dysfunction. Upon further evaluation of these 228 patients, in the first 22 subjects with vagus nerve dysfunction, 20 were women with a median age of 44 years.
"The study also reflects that the most frequent vagus nerve dysfunction related symptoms were diarrhea (73%), tachycardia (59%), dizziness (45%), dysphagia (45%), and dysphonia (45%); 86% of the patients had three different vagus nerve dysfunction related symptoms. Six of the 22 patients displayed alteration of the vagus nerve in the neck shown by ultrasound, including both thickening of the nerve and mild inflammatory reactive changes," she noted.
Another important fact of this research was that 10 of the patients showed abnormal breathing patterns and reduced maximum inspiratory pressures, which, according to Gonzlez, indicated the weakness of the respiratory muscles connected to the vagus nerve. "Seventy-two percent also had oropharyngeal dysphagia or difficulty swallowing, and eight patients showed reduced or impaired ability to move food from the esophagus to the stomach and acid reflux."
At the same conference, Wilson Martnez,MD, a specialist in sports and exercise medicine, addressed the role of physical exercise in the recovery of people who have suffered from COVID-19. "It should be kept in mind that many patients with mild or severe COVID-19 do not fully recover and have a wide variety of chronic symptoms for months or weeks after infection that are often neurological, cognitive, or psychiatric in nature. This is what is known as post-COVID-19 syndrome, reported by between 10% and 20% of patients."
In his presentation, The Value of Exercise in the Post-COVID Patient, Martnez reviewed the most recent studies that show the link between exercise and the benefits for health in general and against SARS-CoV-2 and its consequences in particular. "In these investigations," he told the audience, "exerkines are discussed, understanding as such the substances that are produced or generated with the practice of physical activity (including hormones and metabolites) with healthy benefits at different levels. There is a varied repertoire of exerkines in the systemic circulation, and it is known that the higher the intensity and momentum with which exercise is performed, provided it is done properly, that these exerkines manifest in a more positive way."
In the context of COVID-19, Martnez explained this positive impact "taking into account that SARS-CoV-2 affects the angiotensin-converting enzyme-2 receptor, and this in turn involves the appearance of fibrosis, inflammation, vasoconstriction, reduced neurogenesis, and cardiovascular damage. This activation of a series of vascular signaling chains that occurs with exercise makes it possible to counteract a good number of the symptoms of the post-COVID-19 syndrome, acting in a certain sense like a polypill."
Specifying the potential benefits of exercise in post-COVID-19 syndrome, Martnez highlighted that there is an improvement in the psychological component, since it reduces stress, which translates into an improvement in mood and a feeling of well-being.
"At the neurological level, it stimulates brain plasticity, improves cognitive abilities, decreases allostatic load and optimizes sleep quality," he explained. "As for the cardiovascular system, angiogenesis occurs, improving the vascular system and cardiovascular function, lowering blood pressure, normalizing dysautonomia, and notably increasing mitochondrial biogenesis.
"In the respiratory system, it decreases dyspnea and improves oxygen consumption and lung function. In muscles, it improves exercise tolerance, increases muscle strength and muscle mass, with better intramuscular coordination. In relation to the immune system, it decreases inflammatory cytokines and increases anti-inflammatory cytokines, generally improving immune function," Martnez continued.
Martnez stressed that there is no known drug that produces all these benefits. "Unfortunately, we are not taught or used to prescribing exercise. Based on all this evidence, it is obvious that it should be incorporated into the prevention of and approach toward not only COVID-19 and post-COVID-19, but in general, for the care of cardiovascular and metabolic health, both to prevent diseases and as an adjuvant in many pathologies."
Regarding what type of activity is most recommended in these patients, Martnez pointed out that "there is sufficient evidence to suggest that adapted and supervised training with aerobic and strength endurance exercises can be an effective multisystemic therapy for post-COVID-19 syndrome."
In this sense, Martnez stressed the need to value the importance of strength training. "Although a good part of the population practices aerobic activity, the percentage drops when it comes to strength routines, especially among women, since they associate it with the risk of excessive bodybuilding. In the case of post-COVID-19, this training is essential, since one of the most worrying signs of this syndrome is the loss of muscle mass.
"A little more research is required in this field, but without a doubt, it is a perfect tool to counteract and manage the multiple signs and symptoms that persist after having suffered from COVID-19," Martnez concluded.
Gonzlez and Martnez have disclosed no relevant financial relationships.
Follow Carla Nieto of Medscape Spanish edition on Twitter @carlanmartinez.
This article was translated from the Medscape Spanish edition.
For more news, follow Medscape on Facebook, Twitter, Instagram, YouTube, andLinkedIn
HONOLULU (KHON2) Officials are noticing an uptick in clusters associated with large school events that are happening just as prom season has begun for many schools.
The Hawaii State Department of Health had an investigation on outbreaks of COVID-19 and Influenza A in April that were associated with two high school proms on Oahu.
Check out more news from around Hawaii
DOH said the first investigation started after a school reported to the department that 37 students who attended the prom stated they were sick with common respiratory symptoms.
There were over 300 students and chaperones who attended the prom. Six attendees tested positive for coronavirus, said DOH.
Of the six that tested positive, one was unvaccinated, four had only completed their primary series and one was up to date on all vaccinations. There were four individuals that tested positive for Type A influenza, with one of them testing positive for both influenza and coronavirus.
Out of the 37 symptomatic individuals, 35 students said they received a COVID-19 test. However, the DOH believed that with limited influenza testing and home test reporting, the true number of infections could likely be higher than what was reported.
About 57% of the prom attendees had received a primary series of the coronavirus vaccine.
Attendees stated mask use and social distancing were not practiced or enforced at the event.
The second cluster had 16 COVID-19 cases at a high school prom with over 600 students and chaperones.
DOH said 10 attendees tested positive for coronavirus and three attendees were symptomatic and epidemiologically linked. Of the 13 primary cases, five had received a primary series only and five were up to date on all COVID vaccinations. The other three attendees vaccination status was unable to be determined.
Mask use was required indoors at the event except during food service.
Both schools required the attendees to be vaccinated with the primary series or submit a negative COVID-19 test. However, the DOH said that both proms being held indoors could have contributed to a higher risk of COVID transmission among the attendees.
Since April 1 the state of Hawaii investigated 27 clusters associated with schools and school-sanctioned events. Of the reported clusters, 30% were related to high school proms.
Get more coronavirus news: COVID vaccines, boosters and Safe Travels information
The DOH identified COVID-19 clusters when three or more confirmed or probable cases of coronavirus are linked to a particular site or event within one 14-day incubation period.
TOMPKINS COUNTY, N.Y.COVID-19 has claimed the lives of two more Tompkins County residents this week, the first two deaths from the coronavirus locally since the end of March.
Sadly, TCHD was notified of the death of a Tompkins County resident. Our condolences go out to the family of this individual, read a tweet from the Tompkins County Health Department Friday. A similar message was passed along earlier in the week with the first death.
The pandemic has been fairly quiet recently in Tompkins County, though that is partially because testing and contact tracing have been greatly reduced, either by the government or by peoples own level of caution. Over the last week or so, COVID-19 hospitalizations have hit double digits once again in Tompkins County, the first time since January 2022 that those numbers have sustained that level.
The health department is no longer publishing active case numbers, so it is difficult to tell how many people are currently ailing from COVID-19 in Tompkins County. Recent wastewater testing shows that COVID-19 is trending upward (more on that in a subsequent article), but exact numbers are nigh impossible to pin down. However, the health department lists the level of community transmission at 464 currently, meaning that the number of positive tests over the last week per 100,000 people (conveniently, Tompkins County has just about 100,000 people) is 464. That number is trending upward as well, though not nearly as high as this past December and January.
It is unclear whether or not the two people who passed away this week were vaccinated or not.
STATEN ISLAND, N.Y. Nearly eight months after the United States Food and Drug Administration (FDA) gave the green light to administer COVID-19 booster doses, the number of new supplemental vaccinations being given has fallen precipitously after a winter spike, federal data shows.
Now, around a month after a second booster was authorized, top doctors on Staten Island are urging eligible residents to consider bolstering their protection against severe disease.
The Centers for Disease Control and Prevention (CDC) previously backed a plan to provide second booster doses for people over the age or 50 and those who are 12 and older who also have underlying conditions that put them at greater risk for severe infection. The FDA approved those guidelines in late March.
However, while data indicated a second booster dose strengthened the bodys protection against severe infection after defenses created by an initial booster began to dissipate, research found that reinforced deterrent to severe disease quickly began to wane.
The rapid drop off in protection has caused controversy among experts over the strategy of continually using booster doses.
Still, as new infections have again begun to rise, forcing New York City into a yellow, or medium, alert level for community transmission, health officials continue to urge Staten Islanders especially those who are at higher risk to not underestimate the virulence of COVID-19.
FIRST BOOSTER VERY EFFECTIVE
The first booster dose has by far been shown to be very effective in terms of limiting ones ability to get very sick. Were not seeing people get as sick as opposed to those who are not boostered or have no vaccine, said Dr. Theodore Strange, chairman of medicine at Staten Island University Hospital (SIUH). The second booster has been more controversial.
Noting a diminished antibody response to a second booster dose, Strange still affirmed that the fourth shot was effective for people with depleted immune systems, including those who are going through chemotherapy or have diabetes, adding, it definitely did show a benefit to those at highest risk.
He is recommending his older patients get the latest booster dose and said he is also planning to get a fourth shot.
Dr. Philip Otterbeck, chairman of medicine at Richmond University Medical Center in West Brighton, said strong evidence supports the authorization of a second booster dose for older and immunocompromised people.
While federal health authorities recommend anyone over the age of 50 receive the additional shot, Otterbeck said people over 60 should especially consider it because that was the particular group that tended to benefit from the second booster in international studies.
Otterbeck said he has received the first booster dose and will get the second when he is eligible.
The exteriors of Staten Island University Hospital in Ocean Breeze and Richmond University Medical Center in West Brighton are shown in an undated composite. (Staten Island Advance/Jason Paderon)
MORE BOOSTERS IN FUTURE?
It remains unclear if more booster doses will be recommended in future months and years, if the virus will begin to be treated in a similar fashion to the way the common flu is handled with yearly shots or if the approach of continuing to administer booster doses will bring diminished returns over time.
Despite being more than two years into the pandemic, a litany of questions remain on the fronts of vaccine protection and long-term effects of the disease that has officially killed more than one million people in the United States and more than 2,300 Staten Islanders.
Anybody who thinks theyre an expert at this, theyre not an expert. Were all experts, but none of us are experts, said Strange, who added that additional research is especially needed to better understand how long protection from booster doses lasts.
I think we need to continue to watch it and follow the science, said Strange.
While highly infectious variants of the coronavirus, like omicron and its sub-lineage BA.2, have locally caused new spikes in positive cases, hospitals are not being strained as they were in earlier stages of the pandemic.
Just a few dozen people hospitalized on Staten Island had COVID-19, with some of those individuals admitted for reasons unrelated to their infection. Tools like vaccinations and therapeutics, along with improved understanding of how to manage the disease, have helped ameliorate COVID-19 treatment and prevent deaths.
FUTURE SURGES?
Still, Strange expressed concern that a noticeable shift in public attitude toward the pandemic, coupled with loosening restrictions, could create a recipe for future surges that claim the lives of more borough residents.
Im still concerned another variant will come along as we let our guard down with masking and other things, said Strange, who said that while he does not feel stringent lockdowns are needed, persistent testing and isolation strategies in condensed hotspots should remain.
Otterbeck echoed those sentiments and said the future phases of the pandemic will largely depend on the emergence and virulence of new variants.
COVID is probably not going to be going away, at least anytime soon, said Otterbeck. But, we need to learn to work with it and make sure were doing everything we can to protect the people of Staten Island and of course the people in this country.
The Pulitzer Center is seeking applications for enterprise and underreported stories about COVID-19 inequities and other U.S. and global health system failures. Were interested in systemic barriers to all sorts of care, including, but not limited to, COVID-19 vaccines and treatment. Were also interested in stories about misinformation and politicization that impede improved access to care and preparation for future health crises. This opportunity is open to all newsrooms and independent journalists in the United States and abroad.
COVID-19 laid bare what was clear to many already: With some exceptions, health systems around the world are woefully underresourced or inaccessible to many who arent wealthy.
COVID-19 spread rapidly among essential but often lower-paid U.S. workers who were unable to shelter and work at home. Despite lessons learned from the pandemic, even routine health care remains beyond reach for many in the worlds richest country. A disturbing number of U.S. residents also continue to shun vaccines, influenced by misinformation.
Globally, millions of people in low- and middle-income countries are unable to access vaccines. And some also harbor fear of inoculation. The pandemic and other crises have also contributed to a global surge in mental health problems, yet mental health care often remains taboo and unaffordable.
Were interested in reporting projects about underreported COVID-19 and non-COVID-19 health inequities, as well as solutions in the works.For inspiration, here are a few recent projects we supported:
We aim to support teams that reflect the communities they report on. We hope this grant can help our partner organizations advance their diversity, equity, and inclusion goals and commitments.
We accept grant proposals on a rolling basis.
Please refer to Tips for Writing a Successful Pulitzer Center Grant Proposal for more information on how to apply.
The COVID-19, Vaccines, and Global Health Inequities grant is funded by the Rockefeller Foundation and general operating support.
Who is eligible to apply?
This opportunity is open to U.S. residents and journalists around the world. We are open to proposals from freelance journalists, staff journalists, or groups of newsrooms working in collaboration with a project idea. We want to make sure that people from many backgrounds and perspectives are empowered to produce journalism. We strongly encourage proposals from journalists and newsrooms who represent a broad array of social, racial, ethnic, underrepresented groups, and economic backgrounds.
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We begin reviewing applications as soon as they are received and typically notify applicants within a month if they're being considered for support. If there is some urgency to the field reporting, the applicant should state the reason in the application.
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We do not have a budget range. We will consider projects of any scope and size, and we are open to supporting multiple projects each year.
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We expect news organizations to pay freelance journalists for their work, though in exceptional cases, we may consider stipends to cover a reporter's time, if provided in the budget with an explanation. It is OK to include costs of contractors, such as data researchers, illustrators, or data visualization/story designers in your proposal and budget. Please do not include stipends for journalists/team members who are in the employ of newsrooms or are being paid by a publisher.
Email Pulitzer Center Senior Editor Susan Ferriss at sferriss@pulitzercenter.org. We check emails daily and look forward to hearing from you.
LAS VEGAS (KTNV) Nevada Gov. Steve Sisolak will end the COVID-19 state of emergency that's been in place in the state since March of 2020.
The state of emergency will end on May 20, the governor's office announced on Friday. The state will work to make sure "there is no gap in services when the emergency ends," a press release states.
"The COVID-19 pandemic tried and tested our state on every level," the governor said in a prepared statement. "By working together across all levels of government and in every corner of the state, we kept prevented (sic) our healthcare system from becoming overwhelmed and continued to provide services to Nevadans in need."
The governor's office says the emergency declaration allowed officials statewide to respond to the "unprecedented" challenges of the pandemic as they came up.
That included an emergency directive that allowed the state to bring in additional health care workers and allowed some doctors, nurses, EMTs and medical students under proper supervision to help care for COVID-19 patients. According to the governor, those directives are still in place and the state will work with "appropriate" partners as Nevada puts a wrap on the emergency order.
"I am so grateful to all the Nevadans who worked through these trying times in service of the Silver State," Sisolak stated.
Importance of COVID-19 vaccine for kids in 2022
Melissa Marx, an assistant professor and epidemiologist at the Johns Hopkins Bloomberg School of Public Health, stressed the importance of vaccines for all ages, including kids.
LONDON - The World Health Organization is estimating that nearly 15 million people were killed either by the coronavirus or by its impact on overwhelmed health systems in the past two years, more than double the official death toll of 6 million. Most of the fatalities were in Southeast Asia, Europe and the Americas.
In a report released on Thursday, the U.N. agencys chief Tedros Adhanom Ghebreyesus described the figure as "sobering," saying it should prompt countries to invest more in their capacities to quell future health emergencies.
Scientists tasked by WHO with calculating the actual number of COVID-19 deaths between January 2020 and the end of last year estimated there were between 13.3 million and 16.6 million deaths that were either caused directly by the coronavirus or were somehow attributed to the pandemics impact on health systems, like people with cancer unable to seek treatment when hospitals were full of COVID patients.
The figures are based on country-reported data and statistical modeling. WHO did not immediately break down the figures to distinguish between direct deaths from COVID-19 and others caused by the pandemic.
ORANGE, CA - April 14: Nurse assistants prepare a room at Providence St. Joseph Hospital in Orange, CA on Thursday, April 14, 2022. (Photo by Paul Bersebach/MediaNews Group/Orange County Register via Getty Images)
"This may seem like just a bean-counting exercise, but having these WHO numbers is so critical to understanding how we should combat future pandemics and continue to respond to this one," said Albert Ko, an infectious diseases specialist at the Yale School of Public Health who was not linked to the WHO research. For example, Ko said, South Koreas decision to invest heavily in public health after it suffered a severe outbreak of MERS allowed it to escape COVID-19 with a per-capita death rate around a 20th of that of the U.S.
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Accurate numbers on COVID-19 deaths have been problematic throughout the pandemic, as the figures are only a fraction of the devastation wrought by the virus, largely because of limited testing and differences in how countries count COVID-19 deaths. According to government figures reported to WHO and to a separate count kept by Johns Hopkins University, there have been more than 6 million reported coronavirus deaths to date.
Scientists at the Institute of Health Metrics and Evaluation at the University of Washington guessed there were more than 18 million COVID deaths from January 2020 to December 2021 in a recent study published in the journal Lancet, and a team led by Canadian researchers estimated there were more than 3 million uncounted coronavirus deaths in India alone.
Some countries, including India, have disputed WHO's methodology for calculating COVID deaths, resisting the idea that there were many more deaths than officially counted. Earlier this week, the Indian government released new figures showing there were 474,806 more deaths in 2020 compared to the previous year, but did not say how many were tied to the pandemic. India did not release any death estimates for 2021, when the highly infectious delta variant swept through the country, killing many thousands.
MANHATTAN, NEW YORK, UNITED STATES - 2022/03/11: Participants seen holding signs with the number of COVID deaths in different countries during the die-in at a protest outside the New York Stock Exchange. (Photo by Erik McGregor/LightRocket via Getty
Yales Ko said better figures from WHO might also explain some lingering mysteries about the pandemic, like why Africa appears to have been one of the least affected by the virus, despite its low vaccination rates. "Were the mortality rates so low because we couldnt count the deaths or was there some other factor to explain that?" he said, adding that the crush of deaths in rich countries like Britain and the U.S. proved that resources alone were insufficient to contain a global outbreak.
Dr. Bharat Pankhania, a public health specialist at Britains University of Exeter, said we may never get close to the true toll of COVID-19, particularly in poor countries.
"When you have a massive outbreak where people are dying in the streets because of a lack of oxygen, bodies were abandoned or people had to be cremated quickly because of cultural beliefs, we end up never knowing just how many people died," he explained.
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Although Pankhania said the currently estimated COVID-19 death toll still pales in comparison to the 1918 Spanish flu pandemic when experts estimate up to 100 million people died he said the fact that so many people died despite the advances of modern medicine, including vaccines, is shameful.
He also warned the cost of COVID-19 could be far more damaging in the long term, given the increasing burden of long COVID.
"With the Spanish flu, there was the flu and then there were some (lung) illnesses people suffered, but that was it," he said. "There was not an enduring immunological condition that were seeing right now with COVID," he said.
"We do not know the extent to which people with long COVID will have their lives cut short and if they will have repeated infections that will cause them even more problems."
When Laura Martin tested positive for COVID-19 last month during an extended stay in California, she was prescribed Paxlovid, the highly touted antiviral drug created by Pfizer.
Just one day after her diagnosis, she started her five-day course of pills, which have been shown to dramatically reduce the risk of hospitalization and death.
Martin, a 63-year-old Boston native who now resides in Canada, said she was thrilled when her symptoms began to subside.
By the end of [the treatment], on Day 5, I was negative and feeling completely normal like without any symptoms, so I thought, 'Wow, this is really great. What a great drug, Martin told ABC News.
Martin resumed her normal activities, but a week later, she began to feel ill again. When her symptoms worsened, she tested again.
It came roaring back, and this round two has been much more severe than round one was," Martin said. "This is like four days of much more significant symptoms than round one.
Martin's case is part of a seemingly rare, but increasingly reported phenomenon of COVID-19 symptom recurrence after being treated with Paxlovid. While it is largely unknown what is causing the reported viral resurgence, scientists say they are investigating.
Pfizer says that it is taking the reported incidences of recurrence "very seriously," but that the rates mirror those who received a placebo in clinical trials. Experts urge that the benefits of the drug, in preventing hospitalization and death, outweigh the potential risk of a second positive test or symptom reemergence.
In additional analysis of the Paxlovid clinical trial data, the Food and Drug Administration (FDA) reported that most patients did not have symptoms at the time of a positive PCR test after testing negative, and, most importantly, there was no increased occurrence of hospitalization or death or development of drug resistance.
Company executives also reported, this week, that the use of Paxlovid continues to expand rapidly, particularly as infection rates across the country rise again. In the U.S., use of the treatment has increased by nearly ten-fold in recent weeks.
The number of locations in the U.S. with Paxlovid supply has grown to more than 33,000 sites now available, a four-fold increase since late-February. In addition, the company reported that there are now more than 2,200 Test to Treat locations now open.
Covid-19 treatment pill Paxlovid is seen in a box, at Misericordia hospital in Grosseto, Italy, Feb. 8, 2022.
'Game-changer'
Long heralded as a game-changer in the fight against COVID-19, the push to make Paxlovid available to Americans has ramped up in recent weeks, with the White House looking to increase supply of the treatment.
The drug, which was granted emergency use authorization by the FDA in December 2021 for people with mild to moderate COVID-19 at high risk of disease progression, is also strongly recommended by the World Health Organization. It has been shown to be highly effective, estimated to provide an 89% reduction in virus-related hospitalizations and deaths.
However, in recent weeks, a number of patients, who have taken the treatment, have taken to social media to disclose what they say is a perplexing phenomenon of COVID-19 symptoms reemerging after they finished the prescribed five-day treatment course.
Some individuals claimed on Twitter that after their initial symptoms dissipated, leading to a negative test, they are once again testing positive.
We're seeing people get better on Paxlovid, Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center, told ABC News. But then, when they stop at the end of five days, we're hearing stories of symptoms coming back and even, tests becoming either more positive, i.e. a darker line, or tests that had gone negative turning positive.
Studies have found that a dark line can indicates a strong positive with a high level of virus and is usually seen when people are at or near peak virus load.
Reports of these rebound symptoms are largely anecdotal so far but with an increasing number of questions about the puzzling viral recurrence, scientists across the country are trying to assess what may be happening in new research.
Pfizer taking reports of viral rebounds very seriously
In February, a 71-year-old man in Massachusetts who had been vaccinated and boosted recovered after being treated for COVID-19 with Paxlovid, Dr. Michael Charness, chief of staff at the VA Boston Healthcare System, who has been researching the phenomenon and recently put out a preprint study last week, told ABC News.
However, around nine days after his initial positive test, Charness said his patient developed cold symptoms and tested positive again for the virus.
Molecular testing soon revealed that the patients viral load had increased to an even higher point than when the diagnosis was first made, according to an analysis by Charness and his team.
We were interested in whether this was a new infection or whether this was maybe an adaptation or mutation that somehow changed the variant, Charness said, adding that gene sequencing demonstrated that this second positive test demonstrated a recurrence of the original infection in an individual who had no symptoms for a week.
We just were very struck by that, said Charness. I heard from people all over the country and some from other parts of the world, who had had the same experience.
Representatives from the FDA, the Centers for Disease Control and Prevention and the National Institutes of Health, told ABC News that teams of scientists are investigating the surprising relapse reports, and they will provide further recommendations, if appropriate.
The phenomenon of recrudescence reiterates the importance of following CDCs isolation guidance anyone who develops symptoms of illness during or after isolation should remain isolated, masked, and seek out testing and clinical care, a representative from the CDC told ABC News in a statement. Anyone who is concerned about having been exposed or who for any other reason wants to determine their infection status should test for COVID-19.
The FDA stressed that the reports do not change the conclusions from the Paxlovid clinical trial which demonstrated a marked reduction in hospitalization and death.
The viral recurrence had been observed and reported in Pfizers application to the FDA, last year, in which the company said several trial participants had appeared to have a rebound of COVID-19 around day 10 or day 14.
The drug Paxlovid against Covid-19 from the manufacturer Pfizer is stacked on a table in Berlin, March 1, 2022.
Pfizer executives said Tuesday that they are taking the reports very seriously, but they do not believe that it is related to the drug, given that the same rate of rebound was observed in people who took the placebo. Further, no connection was noted between the viral load increase and subsequent severe illness.
We've taken a preliminary look at our high-risk data, and so we've seen for example, that we have about an incidence about 2% of that viral load rebound, but we also see the same, or close to the same, percent in the placebo arm. So it's something that's not particularly associated with Paxlovid itself, but may have something to do with the virus itself, Dr. William Pao, Pfizers executive vice president and chief development officer said during an investors call on Tuesday. It's preliminary data so far, we again take it very seriously. But it's very current, and a very low incidence, and we continue to learn as we go.
A representative from Pfizer told ABC News that although it is too early to determine the cause, initial indications suggest an increased viral load is both uncommon and not uniquely associated with the Paxlovid treatment.
We remain very confident in its clinical effectiveness at preventing severe outcomes from COVID-19 in high-risk patients, the representative said.
Reports uncommon but happening frequently enough
Although official reports of these relapses still appear to be rare, such occurrences are happening frequently enough in those treated with Paxlovid that Charness said that it should be studied further.
I think the first step in studying something is to know that it exists, he explained, adding that it is particularly important for clinicians to be informed about potential rebounds, and for the public to know, so that people do not become unduly alarmed.
Thus far, researchers know very little about the reason for the recurring symptoms.
Of critical importance in the investigations is whether an individual, in the midst of such a rebound, remains infectious, Charness said.
We are sufficiently concerned about whether people can transmit, when they're on day 12 and 13 and 15, that we are essentially recommending that when people have a recurrence, a rebound, that they restart their isolation, and isolate until their antigen test is negative, Charness said. We're seeing people whose antigen test stays positive for a week after they rebound, which means that they're well outside the CDCs 10-day guidance.
Should you experience a viral rebound, the FDA is now recommending that health care providers and patients refer to CDC guidance, wear a mask and isolate if they have any COVID-19 symptoms regardless of whether or not they have been treated with an antiviral.
Charness and his team are also encouraging their patients to start their isolation period over again and stay away until their antigen test is negative.
It's important to exercise caution until you clear the virus the second time, Charness said, further urging people to notify their provider.
In terms of further treatments, Charness noted it is still largely unclear what patients should do. While there are no limitations, within the authorized label, around additional usage of the drug for a subsequent COVID-19 infection, according to Pfizer, the FDA said there is no evidence of benefit at this time for a longer course of treatment or repeating a treatment course of Paxlovid in patients with recurrent COVID-19 symptoms following completion of a treatment course.
Despite the reports of rebounding, health experts stress that Paxlovid is still largely achieving its original goal, to keep people out of the hospital, and severe disease at-bay.
The bottom line is if it prevents hospitalization, if it keeps you from progressing to severe disease, hospitalization and death, the fact that you might have a recurrence of some of the symptoms and even the recurrence of a positive test is sort of secondary, said Doron. The main thing is Paxlovid is to prevent progression to severe disease [and] hospitalization, and it does. So, it's still doing its job.
