BRAIN
Inflammation and low oxygen levels may cause cognitive problems.
LUNGS
Early evidence of oxygen limitations.
CIRCULATORY SYSTEM
Vascular damage and blood clots may trigger fatigue.
IMMUNE SYSTEM
Autoantibodies or viral remnants may set off a chain reaction.
BRAIN
Inflammation and low oxygen levels may cause cognitive problems.
LUNGS
Early evidence of oxygen limitations.
CIRCULATORY
SYSTEM
Vascular damage and blood clots may trigger fatigue.
IMMUNE SYSTEM
Autoantibodies or viral remnants may set off a chain reaction.
Millions of people continue to suffer from exhaustion, cognitive problems and other long-lasting symptoms after a coronavirus infection. The exact causes of the illness, known as long Covid, are not known. But new research offers clues, describing the toll the illness takes on the body and why it can be so debilitating.
Patients with severe Covid may wind up in hospitals or on ventilators until their symptoms resolve. Damage to the body from severe Covid pneumonia, low oxygen, inflammation typically shows up on traditional diagnostic tests.
Long Covid is different: A chronic illness with a wide variety of symptoms, many of which are not explainable using conventional lab tests. Difficulties in detecting the illness have led some doctors to dismiss patients, or to misdiagnose their symptoms as psychosomatic. But researchers looking more deeply at long Covid patients have found visible dysfunction throughout the body.
Studies estimate that perhaps 10 to 30 percent of people infected with the coronavirus may develop long-term symptoms. Its unclear why some people develop long Covid and others dont, but four factors appear to increase the risk: high levels of viral RNA early during an infection, the presence of certain autoantibodies, the reactivation of Epstein-Barr virus and having Type 2 diabetes.
Dang, why am I always so sick? Messiah Rodriguez, 17
Long Covid patients appear to have disrupted immune systems compared to post-Covid patients who fully recover. Many researchers believe chronic immune dysfunction after a coronavirus infection may set off a chain of symptoms throughout the body.
One possibility is that the body is still fighting remnants of the coronavirus. Researchers found that the virus spreads widely during an initial infection, and that viral genetic material can remain embedded in tissues in the intestines, lymph nodes and elsewhere for many months.
Ongoing studies are trying to determine if these viral reservoirs cause inflammation in surrounding tissues, which could lead to brain fog, gastrointestinal problems and other symptoms.
Start of small intestine (duodenum)
End of small intestine (terminal ileum)
Start of small intestine (duodenum)
End of small intestine (terminal ileum)
Researchers have also found evidence that Covid may trigger a lasting and damaging autoimmune response. Studies have found surprisingly high levels of autoantibodies, which mistakenly attack a patients own tissues, many months after an initial infection.
A third possibility is that the initial viral infection triggers chronic inflammation, possibly by reactivating other viruses in the patients body that are normally dormant. The reactivation of Epstein-Barr virus, which infects most people when they are young, might help predict whether a person will develop long Covid, one study found.
Inside the intricate world of the immune system, these explanations may coexist. And just as different long Covid patients may have different symptoms, they may also have different immune problems, too. Identifying the problems that are central to each patients illness will be critical for guiding treatment, said Dr. Akiko Iwasaki, an immunologist at Yale.
For instance, a patient with autoantibodies might benefit from immunosuppressive medication, while a patient with remants of the Covid virus should receive antivirals, Dr. Iwasaki said. Depending on what each person has, the treatment would be quite different.
Something as simple as climbing on a ladder all of a sudden became a mountain. Eddie Palacios, 50
Many long Covid patients struggle with physical activity long after their initial infection, and experience a relapse of symptoms if they exercise. Initial studies suggest that dysfunction in the circulatory system might impair the flow of oxygen to muscles and other tissues, limiting aerobic capacity and causing severe fatigue.
In one study, patients with long-lasting Covid symptoms had unexpected responses to riding a bike. Despite having apparently normal hearts and lungs, their muscles were only able to extract a portion of the normal amount of oxygen from small blood vessels as they pedaled, markedly reducing their exercise capacity.
One possible culprit: Chronic inflammation may damage nerve fibers that help control circulation, a condition called small fiber neuropathy. The damaged fibers, seen in skin biopsies, are associated with dysautonomia, a malfunction of automatic functions like heart rate, breathing and digestion that is very common in long Covid patients.
These findings demonstrate that people with long Covid are suffering systemic physical problems, rather than just being anxious or out of shape, said Dr. David M. Systrom, an exercise physiologist at Brigham and Womens Hospital who helped conduct the bike study.
You cant make up small fiber neuropathy by skin biopsy. That isnt in somebodys head, Dr. Systrom said. You cant make up poor oxygen extraction to this degree. All of these are objective measures of disease.
South African researchers found another circulation problem: Microscopic blood clots. Tiny clots that form during an initial Covid infection will typically break down naturally, but might persist in long Covid patients. These clots could block the tiny capillaries that carry oxygen to tissues throughout the body.
Inflammatory substances called cytokines, which are often elevated in long Covid patients, may injure the mitochondria that power the bodys cells, making them less able to use oxygen. Walls of blood vessels may also become inflamed, limiting the uptake of oxygen.
Whatever the cause, low oxygen levels may contribute to long Covids most common symptom, severe fatigue. Researchers studying patients with chronic fatigue syndrome (also known as ME/CFS), which shares many features with long Covid, found a similar pattern: A lack of oxygen triggered by circulatory problems puts enormous strain on the bodys metabolism, making simple activities feel like strenuous exercise.
I approach a red light, my brain knows that its red, but its not reacting to the rest of my body to put my foot on the brake. Do you understand how terrifying that is? Samantha Lewis, 34
Even people with mild cases of Covid can experience sustained cognitive impairments, including reduced attention, memory and word-finding. Possible long-term neurological problems from Covid constitute a major public health crisis, according to Dr. Avindra Nath, the clinical director of the National Institute of Neurological Disorders and Stroke.
Researchers found a wide range of dysfunction in the brains of long Covid patients. Although it is unclear how often the virus directly penetrates the brain, even mild infections appear to cause significant brain inflammation, according to the researchers, who included Dr. Nath, Dr. Iwasaki and Dr. Michelle Monje, a neurologist at Stanford.
Infections may trigger the over-activation of immune cells called microglia in a way that appears similar to the process that can contribute to cognitive problems in aging and some neurodegenerative diseases.
Healthy brain tissue (white matter)
Brain tissue in a Covid patient (white matter)
Healthy brain tissue (gray matter)
Brain tissue in a Covid patient (gray matter)
Healthy brain tissue (white matter)
Brain tissue in a Covid patient (white matter)
Another research group found that long Covid may significantly reduce the amount of blood that reaches the brain, a finding that has also been seen in patients with a similar condition, chronic fatigue syndrome.
I couldnt breathe. It literally felt like someone was sitting on my chest. Angelica Baez, 23
Shortness of breath is a frequent symptom of long Covid. But common lung tests including chest X-rays, CT scans and functional tests often come back normal.
Using specialized M.R.I. scans, a team of British researchers found preliminary evidence of lung damage in a small group of long Covid patients who had never been hospitalized. Detailed scans of their lung function indicated that most of the patients took up oxygen less efficiently than healthy people did, even if the structure of their lungs appeared to be normal.
The researchers cautioned that a larger group of patients will be needed to confirm the findings. If the results hold up, possible explanations for the observed shortness of breath include microclots in lung tissues or a thickening of the blood-air barrier that regulates the uptake of oxygen in the lungs.
Its really not something you can push through. Dr. Abigail Bosk
Many hospitals now offer post-Covid clinics or recovery programs, which bring together doctors with experience treating long Covid patients. Given the number of patients, some doctors and programs have long waits for appointments. It can help to plan ahead and try multiple options.
Survivor Corps keeps a directory of post-Covid clinics.
Dysautonomia International offers a list of doctors with experience treating autonomic disorders commonly seen in long Covid.
Body Politic hosts a Covid support group where thousands of long haulers share information and advice on Slack.
The Long Covid Support Group hosts a community on Facebook.
The Royal College of Occupational Therapists offers advice for managing post-Covid fatigue.
An essay from Maria Farrell offers advice on how to get well, and the importance of making time to rest.
Americans with long Covid may qualify for disability benefits, although without conclusive medical results, many people face roadblocks.
Three leading researchers into long Covid often share information about the latest findings on Twitter: Dr. Amy Proal, a microbiologist at PolyBio Research Institute; Dr. David Putrino, the director of rehabilitation innovation for the Mount Sinai Health System; and Dr. Iwasaki, the Yale immunologist.
Health Rising covers the latest research into long Covid, ME/CFS and other chronic illnesses in detail.
Gez Medinger, a video producer, interviews some prominent researchers into long Covid on YouTube.
A video interview with Dr. Svetlana Blitshteyn, a neurologist and the director of the Dysautonomia Clinic, offers advice for treatment and an overview of current research into autonomic disorders.
A detailed guide to understanding, treating and living with orthostatic intolerance is available from the Johns Hopkins Childrens Center.
The Times has written extensively about long Covid, including:
State-funded infection sampling
First reports suggested that this service was going to be withdrawn, but news agency reports on Saturday indicated it was now likely to be maintained. Officials were quoted as saying that the governments Living with Covid plan would maintain resilience against any future variants with ongoing surveillance capabilities.
The move comes after senior statisticians argued that some form of the Office for National Statistics coronavirus study should remain in place. Sir David Spiegelhalter of Cambridge University told BBC Radio 4s Today programme that the ONSs Covid-19 Infection Survey had been vital for monitoring behaviour. Lots of people are saying how important it is, particularly the statistical community.
This point was backed by Prof Sylvia Richardson, president of the Royal Statistical Society, who said: Throughout the pandemic, national surveillance studies have provided invaluable information to support decision making.
The legal duty to self-isolate after testing positive for coronavirus is expected to end this week. The prime minister is due to announce the move as part of his living with Covid plan, in which all pandemic regulations that restrict public freedoms in England will be terminated. Local authorities will be required to manage outbreaks with existing public health powers, as they would with other diseases. Downing Street said pharmaceutical interventions would continue to be our first line of defence, with the vaccine programme remaining open to anyone who has not yet come forward.
But the change worries many scientists. Removing the requirement for isolation in the face of high infection levels will inevitably result in increased spread of the virus, said Prof Lawrence Young, a virologist at Warwick University. This may give people a false sense of security. We must not let our guard down.
Free home-delivered lateral flow tests for all are likely to be scrapped in the near future. The move will save the government a great deal of money but will make it difficult to maintain mass surveillance of the virus, as scientists have warned.
Even though the pandemic may appear to be ending, it has not yet ended, said Jonathan Stoye, a virologist at the Francis Crick Institute. There are no guarantees that new, more pathogenic variants will not emerge. Despite the successes of vaccination, many people are still at risk. Any significant reduction in testing will jeopardise lives and compromise our ability to monitor the appearance of new variants.
A rapid antigen test shows a positive test result for COVID-19. Odd Andersen /AFP via Getty Images hide caption
A rapid antigen test shows a positive test result for COVID-19.
Each week, we answer frequently asked questions about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions." See an archive of our FAQs here.
I'm in my 50s. If I'm going to get COVID, it seems like it would be better to get it before I'm older and in a higher-risk category. So should I try to get COVID before I turn 60?
We spoke to three specialists and they all agree.
Definitely not, says Dr. Abraar Karan, an infectious disease physician at Stanford University.
"It's lunacy," says Dr. Sarah Fortune, professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health.
"There are very few times in medicine where we say go ahead and get the disease, because for the most part getting the disease is not good," says Dr. Fred Pelzman, associate professor of clinical medicine at Weill Cornell Medicine in New York City. "Once a vaccine became available for chicken pox, for example, no one was saying, go ahead and expose your child to chicken pox."
Now it is true that being infected confers a degree of natural immunity. There's growing evidence that a symptomatic infection likely offers protection against severe disease and death for a few years in the general population. But protection against a second infection wanes quickly, probably after about six months.
And there are huge cautionary notes that our experts sounded. Here are the reasons not to try and catch the disease as a pre-emptive measure.
"Someone saying they want to get the disease now [before] they turn 60 is based on population data that older people do worse with COVID," says Pelzman. "But we don't know that the person in their 50s isn't going to have a terrible outcome."
"Every time you get sick with COVID there is a small but not zero risk of bad things happening," says Fortune. For example, one study, published last week, analyzed who has been hospitalized during the delta and omicron surges. About half of the people hospitalized were over age 64, but nearly 30% of them were between ages 45 and 64.
No matter your age, you still have a risk of having symptoms linger for months or developing long COVID, Karan says. Right now, scientists don't know what that risk is for an infection with omicron.
What's more, he notes, there's "the chance that COVID-19 could exacerbate other underlying conditions given it causes a significant amount of inflammation in the body."
And if you are in contact with kids under age 5, for whom there is currently no vaccine approved in the U.S., you run the risk of spreading COVID to them as well as to immuno-compromised people you're in contact with.
"I'm 53, I'm pretty risk tolerant," says Fortune. "I'm going to take more risks in terms of reengaging with people than others might be comfortable with, but I'm not going to a COVID party."
Another point to consider: Both treatments and vaccines will likely improve as the years pass, Karan says. "And we will have a better understanding by then of what the long-term costs of getting infected are on human health."
"For all we know, by the time the person now in their 50s is in their 60s, we could have a single pill for treatment," says Pelzman. "So risking a severe case now or passing it to others who are vulnerable won't have been worth it."
As he sums it up: "There's no reason to put yourself in harm's way for something you'd say, 'I wish I hadn't done that.' "
Sheila Mulrooney Eldred is a freelance health journalist in Minneapolis. She has written about COVID-19 for many publications, including The New York Times, Kaiser Health News, Medscape and The Washington Post. More at sheilaeldred.pressfolios.com. On Twitter: @milepostmedia.
Fran Kritz is a health policy reporter based in Washington, D.C., who has contributed to The Washington Post and Kaiser Health News. Find her on Twitter: @fkritz
When Peter Coleman took a rapid antigen test just weeks after recovering from Covid-19, it was partially for the fun of it.
Peter and his husband first tested positive to the virus on 10 January, during the post-holiday period that saw a spike in cases hit Melbourne and much of Australia.
I was feeling really unwell but I didnt expect to be positive, I thought Id just double check, he says.
I was on the phone with my friend after I took the test, and then I looked over and I was just like I have to go like, what the hell?
Peter is one of the unlucky Australians to have been reinfected with Covid-19 after making a full or partial recovery from the virus.
No data on Covid-19 reinfections is currently being collated by the federal government. But a spokesperson from the Department of Health says the emergence of Omicron has seen a significant increase in the risk of reinfection compared with previous variants.
There is increasing evidence that there is little cross-neutralisation with Omicron, the spokesperson says.
Whether Omicron infection protects against another Omicron infection is unclear and there remains significant uncertainty about the durability of immunity following infection with the emergence of Omicron.
When Peter first acquired the virus, he was hit by brain fog so bad he forgot how to order food on Uber Eats, along with muscle aches and fatigue. The second time, though, symptoms were very different more akin to a common cold or flu.
Peter, who works from home, says he had no idea where he acquired the second infection, only that it happened just outside the 30-day period when he initially tested positive.
Fully vaccinated, Peter expects he had been hit by the Omicron strain, but has no way to know for sure.
Peter says the second bout was relatively minor. When a nurse rang to check on him, she asked if he was feeling depressed.
I said not depressed, unimpressed Ru Pauls Drag Race is really helping me through.
The Communicable Disease Network Australia continues to monitor the evidence on reinfection and whether the definition of reinfection in the national public health guidelines requires review.
If someone is re-exposed to the virus in the 28 days after being released from isolation, theyre exempt from further quarantine a decision last reviewed on 2 February.
A senior research fellow at the Kirby Institutes infection analytics program, Dr Deborah Cromer, says the likelihood of acquiring a Covid-19 infection twice is partially dependent on the variant and time since vaccination.
While two doses of the vaccine provides protection against symptomatic disease upwards of 80% or 90% with Delta, with Omicron it drops to about 70% for mRNA vaccinations and 40-50% for AstraZeneca.
Once receiving a booster, though, protection increases to 70-80%.
Very early on when the original strain was circulating, we were asking how much protection someone who has the disease had from getting the disease again, Deborah says.
The trials show people whove had the Pfizer vaccine primary dose have twice as much [immunity] as someone whos recovered from normal virus. But all vaccines are primarily giving you immunity targeted against the original strain.
Deborah says once someone has acquired the virus, they have specific immunity against that variant, as well as some general immunity against SARS-Cov-2.
Youre less likely to get the same variant again, but youre certainly not completely protected, she says. Nevertheless, we would expect it to be less severe. Protection will grow, like what we see with the flu now.
While Covid-19 has some key differences from the flu, Deborah says similarities exist, as it is possible to have both viruses without symptoms or with mild symptoms, and repeated exposure encourages the body to have good immunity.
Thats probably where [Covid-19] will eventually go, Deborah says.
Each time you experience a SARS-Cov-2 infection, your immunity will be boosted somewhat, which would mean the next time youll still have some immunity remaining.
Clancy Read first tested positive to the virus during Fijis second wave in August of last year. Living in Suva, her and her family had lived a relatively Covid-free life until shit hit the fan in April.
We were a close contact, and all went and got tested. My daughter, who was two at the time, was the only one who came back positive, she says.
We were moving houses it was just a disaster. So we isolated by ourselves, and as soon as we got to the new house, I got really sick.
It was in the chest, in my breathing, Id be laying there in the middle of the night thinking Oh God, at what point do you say I need to call it and seek medical attention?
Clancy thinks that if she had been in Australia, she would have admitted herself to hospital but feared being split from her husband and daughter and getting sicker alone.
The hardest part was not knowing how bad it was going to get, she says. The psychological symptoms were just as bad to the physical ones.
Then, after months of slow recovery, the Christmas period arrived and Clancy tested positive again.
We all got sick, and I assume it was Omicron, she says. I was flattened for two weeks, but it wasnt as frightening I wasnt in tears in the night thinking Oh my God, am I going to die?
Now the families that havent had Covid are nervous, they want to get it over and done with, whereas were happy to be out and about together Theres an element of relief.
Deborah says that as the pandemic continued, it wouldnt be particularly unlikely to be reinfected with the virus.
Weve had a relatively small time window for people to have repeated infections in Australia. It might be unlikely [now] because of that, she says. But from a theoretical point of view, having Covid is not special you get some level of immunity from having had the disease and some from vaccination. Both will boost your immunity.
Eleanor is still suffering from her exposure to the virus. She first tested positive to Covid at the start of January during the Omicron wave, after her housemate contracted the virus.
Eleanor, who did not want to use her surname, had a range of symptoms headaches, diarrhea, shortness of breath, insomnia which began to subside within a few days. But then her second housemate returned from work out of town weeks later, and tested positive upon his arrival. This time she had different symptoms.
Fever, chills, cough, swollen glands.
Eleanor is normally an active person she does rock climbing as well as regular workouts with a personal trainer.
Now I have shortness of breath, a racing heart, she says. I really struggle with exercise and get puffed really easily and I have an ongoing cough triggered by laughing.
I get frustrated by people saying its a minor cold or flu. Im a healthy 33-year-old and Ive had shortness of breath for over a month now. Getting Covid twice is more than enough.
No one wants their geographic region to be associated with a deadly disease. Unfortunately, this has happened in the past with diseases such as German measles, Spanish flu and Asiatic cholera.
It happens today, too, even though the World Health Organization advises against naming pathogens for places to minimize unnecessary negative effects on nations, economies and people. By Feb. 11, 2020, the WHO had announced that the official name for the novel coronavirus just starting its spread around the world would be severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2. The illness it caused would be called COVID-19, short for Coronavirus Disease of 2019.
Yet some politicians, conservative journalists and others persisted in calling the COVID-19 virus the Chinese virus, or some variant of this term, such as the China virus, Wuhan virus (after the Chinese city that first reported the virus), Chinese flu and Kung flu.
Does it matter?
Hateful behavior against Asians in the U.S. and many other countries rose after the start of the pandemic. According to the FBI, anti-Asian hate crimes increased by 73% in 2020.
Social scientists like me are investigating the kinds of repercussions racialized framing like calling the coronavirus Chinese can have.
The way media frame, depict and describe events can have a profound influence on the publics perception of those events. Researchers have found that audiences are prone to interpret media stories in the context of their biases, especially in relation to racial groups.
My colleagues Lanier Frush Holt, Sophie Kjrvik and I found that simply reading one media article calling the coronavirus the Chinese virus made people more likely to blame China for the pandemic.
We randomly split a diverse sample of 614 American adults into two groups. One read a fabricated news article that labeled the coronavirus as the Chinese virus. The other read an identical article except for labeling the coronavirus as the COVID-19 virus.
There were important differences in how the articles were perceived. For instance, Democrats and more liberal individuals judged the Chinese virus article much more negatively than did Republicans and more conservative individuals. But overall, we found that participants who read the Chinese virus article were 8.5% more likely to agree with the statement China is responsible for the current global pandemic than were those who read the COVID-19 virus article.
The effect of reading that one article with Chinese virus language was not huge, and we wouldnt expect it to be. The attitudes and beliefs that people brought with them before they read the story had a greater influence on their likelihood to blame China for the pandemic than did the framing language. But the fact that reading a single Chinese virus article did have an impact on readers with a range of political leanings shows the power of labeling a disease for a geographic region.
Other researchers have also found connections between the Chinese virus label and anti-Asian sentiments.
One study linked then-president Donald Trumps tweet on March 16, 2020, that referred to the Chinese Virus with a rise in anti-Asian hashtags.
When pressed on his repeated use of the term Chinese virus, Trump told reporters at a news briefing: Its not racist at all. Its from China. Thats why. It comes from China. I want to be accurate.
When researchers studied 1.2 million hashtags on Twitter in March 2020, they found that approximately 1 in 5 hashtags used in tweets along with #covid19 were anti-Asian, whereas half of the hashtags used alongside #chinesevirus were. Chinese virus wasnt just an innocent statement of reality, as Trump seemed to contend. It was often paired with racist sentiment.
As racially stigmatizing language like Chinese virus increased in the media in March 2020, so did the belief that Asian Americans are less American than their white counterparts.
Another study found that exposure to conspiracy theories and misinformation linking China to the spread and creation of the coronavirus was correlated with an increase in anti-Chinese sentiment and xenophobia.
Use of terms like Chinese virus by the media and political leaders is unlikely to change a persons beliefs or attitudes. But it can trigger negative stereotypes that can heighten prejudice and possibly even incite incidents of hate.
Just as biomedical researchers try to understand how pathogens spread through a population, social scientists are working to understand the spread of hate and prejudice. Unfortunately, in the case of the COVID-19 pandemic and anti-Asian bias, only a brief exposure to racially charged language can have negative impacts.
[Research into coronavirus and other news from science Subscribe to The Conversations new science newsletter.]
Two years ago this month, the World Health Organization (WHO) gave a name to the mysterious new disease caused by a novel coronavirus then about to rip through the world: Covid-19.
One year ago, the rollout of the vaccines created to fight Covid-19 was well on its way.
For all the frustrations over vaccine inequity and hesitancy, that one-year gap between the pandemics start and the rollout of the vaccines is nothing short of a historic success.
A new report underscores just how miraculous it was. The study, from the Center for Global Development (CGD), found that the Covid-19 vaccination campaign has been the most rapid in history, outpacing landmark achievements in vaccination for diseases like smallpox, measles, and polio.
The feat is even more impressive because while most global vaccination campaigns to date have targeted children specifically, Covid-19 vaccination efforts are aimed at the entire global population. Charles Kenny, a senior fellow at CGD and one of the co-authors of the report, told Vox that it was unprecedented for a global vaccine campaign to focus on every adult in a single year for the great majority of countries.
Still, there are caveats. The biggest one is that the speed of the Covid-19 vaccine rollout primarily applies to high- and middle-income countries. Our World in Data reports that while 61.9 percent of the globe has received at least one dose of a Covid-19 vaccine, only 10.6 percent of people in low-income countries have received at least one dose.
As the CGD report shows, this rate is actually slower than campaigns to vaccinate for diseases like tuberculosis and diphtheria in low-income countries. In other words, we know we can vaccinate at a faster rate in those areas we just havent been able to do it with Covid-19.
Josh Michaud, associate director for Global Health Policy at the Kaiser Family Foundation, said in an email, Our benchmark for success shouldnt necessarily be faster than what we did decades ago. Rather it should be, whats the best we can do right now with existing technology and know-how?
Kenny doesnt disagree, and argues that the report is a sign of optimism with an asterisk. Did we do as well as we could? is a separate question. I think no, not nearly as well as we should have, he said. It is still sort of interesting and important to recognize that we are in a better place than we have been historically with vaccine rollouts.
That progress is indeed encouraging. While the Covid-19 vaccine rollout highlights how inequities continue to leave the most marginalized populations of the world underprotected, the campaigns broader success is promising for both the current pandemic and for pandemics that may arise in the years and decades to come. Humanity now knows how fast it can get a global vaccination program up and running, and that sets a standard for the future.
Each week, we explore unique solutions to some of the world's biggest problems.
One lesson we have absorbed from Covid-19 is that when it comes to infectious disease, speed or the lack of it kills.
The longer a pathogen is able to spread through a population without being checked by a vaccine, the more people it can infect. The CGD study reports that prior to Covid-19, aside from smallpox, the average period between identifying the disease-causing pathogen behind a disease (such as poliovirus for polio) and development of a vaccine was 48 years. After the pathogen had been identified, the average time between vaccine development and vaccine rollout sufficient to reach 20 percent global coverage was 36 years; for 40 percent coverage, 42 years; and for 75 percent coverage, 53 years.
For the Covid-19 vaccines, however, the period between identifying the disease-causing pathogen and developing a vaccine was less than a year. And the time between vaccine development and 20 percent global coverage was just under eight months, while getting to 40 percent coverage took another three months.
The CGD report also put the Covid-19 vaccine development and rollout in the context of three major global vaccine initiatives: smallpox, routine childhood vaccinations (against diseases like pertussis and tetanus), and annual influenza.
There were lessons to be learned from each of them. With smallpox, the improved technology and vaccination strategies (particularly the use of disease surveillance and ring vaccination vaccinating those most likely to be infected) were crucial to its gradual eradication. Routine childhood vaccination against diseases like polio proved the necessity of having good financing and a global infrastructure for universal immunization. Global influenza vaccination efforts revealed the importance of building capacity for recurring vaccination.
Those and other lessons paved the way for the rapid development and distribution of Covid-19 vaccines.
It helped that much of the technology had already been primed and ready to go based upon a foundation of existing research, including the viral vector and mRNA vaccine platforms, Michaud said.
In addition, high- and middle-income countries alike had much more of the health financing and infrastructure today to develop, manufacture, acquire, and get shots into the arms of their populations. Before Covid-19, the annual influenza shot was the worlds largest regular vaccination program. Yet as of 2013, it reached only about 7 percent of the global population, with a majority of coverage in richer countries, according to the CGD report.
Meanwhile, the number of Covid-19 vaccinations delivered annually is 9.4 times that of influenza vaccines given in 2019, with much greater coverage in both higher- and lower-middle-income countries. (In this case, annual Covid-19 vaccinations are derived by taking the total Covid-19 doses delivered as of this publication and dividing by two, per the report.)
That doesnt mean there werent hiccups in the distribution of Covid-19 vaccines.
The campaign against smallpox is worth zooming into for one aspect in particular that has been in short supply during the Covid-19 pandemic: global cooperation.
The WHO, then as now, attempted to coordinate a joint global response. And crucially, despite the tensions of the Cold War, the two superpowers, the United States and the Soviet Union, engaged in vaccine diplomacy that would prove crucial to the global eradication of smallpox. This collaboration contributed to the vaccination of significant proportions of populations even in some of the worlds poorest countries within 18 months, the CGD study states.
That kind of global cooperation, especially between the US and China, hasnt been in evidence during this pandemic. The US and China certainly ought to have cooperated on vaccinating the world against Covid-19, as they had collaborated previously on crises like the 2014 West African Ebola epidemic.
However, relations between the two have only deteriorated during the Covid-19 pandemic. On top of this, countries with strong vaccine manufacturing capacity including the US engaged in vaccine nationalism, prioritizing their own populations over the global community, and failed to properly fund and support Covax, the primary vehicle for ensuring vaccine equity for both high-income and low-income countries.
In the end, as Kenny told Vox, no government did particularly well when it came to collaborating to make sure the world was equitably vaccinated to everybodys loss.
This leaves us with dueling assessments of the global response to Covid-19 astonishingly fast in the context of human history, but still wanting in the face of what we could have done. That we now know what were capable of, and what we need to work on when the next one rolls around, is one indisputable takeaway from humanitys response to this pandemic.
A version of this story was initially published in the Future Perfect newsletter. Sign up here to subscribe!
Confirmed cases of COVID-19 have passed 419.9 million globally, according to Johns Hopkins University. The number of confirmed deaths has now passed 5.86 million. More than 10.42 billion vaccination doses have been administered globally, according to Our World in Data.
The World Health Organization (WHO) said on Friday that six African countries Egypt, Kenya, Nigeria, Senegal, South Africa and Tunisia would be the first on the continent to receive the technology needed to produce mRNA vaccines. The technology transfer project, launched last year, aims to help low- and middle-income countries manufacture mRNA vaccines at scale and according to international standards.
Western Australia, the mining-heavy state that has held firm on strict border controls for two years, said it will reopen to triple-vaccinated visitors after deciding it can cope with the Omicron outbreak. Announcing a 3 March reopening, state Premier Mark McGowan told reporters: "Our hosts are ready, our workforce is ready, Western Australia is ready."
South Korea's new daily COVID-19 cases topped 100,000 for the first time amid an Omicron outbreak, with authorities saying social distancing measures would ease only slightly ahead of the 9 March presidential election. The authorities announced on Friday that they would move a curfew on restaurants and cafes from 21.00 to 22.00, in a nod to increasing criticism from business owners.
The US state of California's Governor, Gavin Newsom, presented a plan on Thursday to confront COVID-19 beyond its pandemic phase. This involves a focus on readiness, vigilance and vaccines as the nation's most populous state moves from a crisis approach to "living with this virus".
Israel has dropped a "Green Pass" policy requiring proof of vaccination, recovery from COVID-19 or a negative test to enter some public venues, further rolling back restrictions as a wave of infections recedes.
Hong Kong SAR, China, has identified more than 20,000 hotel rooms for quarantine accommodation, leader Carrie Lam said on Friday, with property developers piling in to show support as the global financial hub battles a surge in COVID-19 cases.
Lam said 21 hotels have expressed interest in turning their facilities into isolation venues, exceeding "by a large margin the government's original target of 7,000 to 10,000 rooms".
Quarantine facilities have reached capacity and hospital beds are more than 95% full as cases spiral, with some patients, including the elderly, left on beds outside in chilly, sometimes rainy, weather.
COVID-19 cases are spiking in Hong Kong.
Image: Our World in Data
The moves come as authorities report new cases have multiplied 60 times this month, and after Chinese President Xi Jinping said the city's "overriding mission" is to stabilise and control the outbreak.
Hong Kong SAR reported 3,629 new daily COVID-19 infections on Friday, with an additional 7,600 preliminary positive cases, authorities said.
Meanwhile, parents rushed children as young as 3 years old to vaccination centres this week as the government lowered the age limit for the shots.
Misinformation about science is increasingly prevalent and a significant public health threat that the US Food and Drug Administration (FDA) will focus on fighting, incoming Commissioner Robert Califf said on Thursday.
Califf, who was sworn in on Thursday, did not specify any particular misinformation the FDA should fight, but millions of Americans still refuse COVID-19 vaccines, with many conservative media outlets and Republicans in the US Congress spreading doubt about their effectiveness.
The first global pandemic in more than 100 years, COVID-19 has spread throughout the world at an unprecedented speed. At the time of writing, 4.5 million cases have been confirmed and more than 300,000 people have died due to the virus.
As countries seek to recover, some of the more long-term economic, business, environmental, societal and technological challenges and opportunities are just beginning to become visible.
To help all stakeholders communities, governments, businesses and individuals understand the emerging risks and follow-on effects generated by the impact of the coronavirus pandemic, the World Economic Forum, in collaboration with Marsh and McLennan and Zurich Insurance Group, has launched its COVID-19 Risks Outlook: A Preliminary Mapping and its Implications - a companion for decision-makers, building on the Forums annual Global Risks Report.
Companies are invited to join the Forums work to help manage the identified emerging risks of COVID-19 across industries to shape a better future. Read the full COVID-19 Risks Outlook: A Preliminary Mapping and its Implications report here, and our impact story with further information.
Healthcare workers say misinformation is the most important factor influencing people who refuse to get vaccinated. COVID-19 is killing around 2,200 Americans a day, the majority of whom are unvaccinated.
"These kinds of distortions and half-truths that find their way into the public domain do enormous harm, both by leading people to behaviour that is detrimental to their health and by causing them to eschew interventions that would improve their health," said Califf.
"A purely reactive mode is not appropriate, particularly in this new era of social media," he told FDA staff in a public letter outlining his priorities, adding that the agency will be more proactive in providing the public with health information.
The views expressed in this article are those of the author alone and not the World Economic Forum.
(THE CONVERSATION) In April 2020, tigers and lions at the Bronx Zoo made the news whenthey came down with COVID-19. In the months following these surprising diagnoses, researchers and veterinarians found SARS-CoV-2, the virus that causes COVID-19, innearly a dozen other species, both in captivity and in the wild.
How are so many animals catching the coronavirus? And what does this mean for human and animal health?
We areveterinary researcherswhoinvestigateanimal diseases, including zoonotic diseases that can infect both humans and animals. It is important, for both human and animal health, to know what species are susceptible to infection by the coronavirus. Our labs and others across the world have tested domestic, captive and wild animals for the virus, in addition toconducting experimentsto determine which species are susceptible.
The list ofinfected animals so farincludes more than a dozen species. But in reality, infections may be much more widespread, as very few species and individual animals have been tested. This has real implications for human health. Animals can not only spread pathogens like the coronavirus, but also can be a source of new mutations.
Which animals have caught the coronavirus?
As of February 2022, researchers and veterinary diagnostic labs have confirmed that31 speciesare susceptible to SARS-CoV-2. In addition to pets and zoo animals, researchers have found that a number ofnonhuman primates,ferrets,deer mice,hyenas,wood rats, striped skunks and red foxare among the animals that are susceptible to infection by SARS-CoV-2.
White-tailed deer and mink are the only two species of animals that have been found harboring the virus in the wild. Fortunately,most animalsdont appear to experience clinical disease like humans do, with the exception ofmink. However, even animals that dont appear sick may be able to transmit the virus to each other and, potentially, back to people. Still unanswered are many questions about which animals can contract the virus and what, if anything, that means for people.
How to look for a virus in animals
There are three ways to study zoonotic diseases: by looking at pets or captive species like animals in zoos, testing wild animals for the coronavirus or by exposing animals to the virus in a lab.
During early stages of the pandemic, when a few pet owners or zoo caretakers observed animals with breathing problems or coughing, they arranged with veterinarians to get them tested for the coronavirus. The U.S. Department of Agriculture andthe Centers for Disease Control and Preventioncoordinate COVID-19 testing and management in animals. The same process of taking a sample and running it through a PCR machine to test for the coronavirus works just as well for animals as it does for people, though swabbing the nose of a lion or even a pet cat requires a bit more training and finesse. Veterinary diagnostic laboratorieslike our ownrun hundreds of thousands of tests for animal diseases each year, so we were able toeasily begin testing for SARS-CoV-2.
Relying on previous research, scientists have been able to make some guesses as to which animals are susceptible and have been testing these hypotheses. Cats, hamsters and ferrets were all infected during thefirst SARS outbreakin 2002, so researchers suspected they would be susceptible to the new coronavirus. Sure enough, research showed that SARS-CoV-2readily infectedthese species inlaboratory experiments. Mink are closely related to ferrets, and during the summer and fall of 2020, mink farms across the U.S. becamesites of huge outbreaksafter people passed the coronavirus to the animals.
Using computer models, scientists were also able to predict that the coronavirus could easily infect some species of deer usingkey proteins on their cells. Based on these predictions, researchers began testing white-tailed deer for the coronavirus andfirst reported positivesin August 2021.
Most recently, on Feb. 7, 2022, researchers published a preprint paper showing that deer on Staten Island, New York, are infected with theomicron variant.Since this is the virus infecting most New Yorkers, this provides strong evidence that humans somehow transmitted the virus to deer. How deer in atleast six states and Canadainitially came in contact with SARS-CoV-2 remains a mystery.
Finally, to understand how the coronavirus affects animals, researchers have been conducting carefully controlled exposure experiments. These studies evaluate how infected animals shed the virus, whether they have clinical symptoms, and whether and how much the virus mutates in different species.
Risks of a species-jumping coronavirus
The risk of contracting SARS-CoV-2 from an animal is, for most people, far lower than being exposed to it by another human. But if the coronavirus is living and spreading among animals and occasionally jumping back to humans, this process known asspillover and spillback poses its own threats to public health.
First, infection of animals simply increases the concentration of SARS-CoV-2 in an environment. Second, large populations of animals that can sustain the infection can act as a reservoir for the virus, maintaining it even if the number of infections in humans decreases. This is particularly concerning with deer that live in high numbers in suburban areas and could transmit the virus back to people.
Finally, when SARS-CoV-2 spreads from humans to animals,our laboratorys own workindicates that the virus very rapidly accumulates mutations. Viruses adapt to the unique characteristics body temperature, diet and immune composition of whatever animal they are living in by mutating. The more species infected,the more mutationsoccur. Its possible that the new variants emerging in people could infect new animal species. Or its possible that new variants could initially arise from animals and infect humans.
The story of SARS-CoV-2 in animals isnt over yet. According to the CDC, six of every 10 human infectious diseases can be spread from animals to people, and around three-quarters ofnew or emerging infectious diseases in people come from animals. Research has shown that investing in the study of zoonotic diseases couldvastly reduce the costs of future pandemics, and this type of complex research hashistorically been underfunded. Yet despite this, in 2021, the CDC allocated only$193 milliontoward the study of emerging zoonotic infectious diseases less thana quarter of 1 percent of the CDCs total budget.
There are still many unknowns about how viruses transfer between humans and animals, how they live and mutate in animal populations and the risks of species-jumping viruses. The more researchers know, the better health officials, governments and scientists can prepare and prevent the next pandemic.
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Having Covid-19 puts people at a significantly increased chance of developing new mental health conditions, potentially adding to existing crises of suicide and overdoses, according to new research looking at millions of health records in the US over the course of a year.
The long-term effects of having Covid are still being discovered, and among them is an increased chance of being diagnosed with mental health disorders. They include depression, anxiety, stress and an increased risk of substance use disorders, cognitive decline, and sleep problems a marked difference from others who also endured the stress of the pandemic but werent diagnosed with the virus.
This is basically telling us that millions and millions of people in the US infected with Covid are developing mental health problems, said Ziyad Al-Aly, chief of research and development at the VA St Louis Healthcare System and senior author of the paper. That makes us a nation in distress.
The higher risk of mental health disorders, including suicidal ideation and opioid use, is particularly concerning, he said.
This is really almost a perfect storm that is brewing in front of our eyes for another opioid epidemic two or three years down the road, for another suicide crisis two or three years down the road, Al-Aly added.
These unfolding crises are quite a big concern, said James Jackson, director of behavioral health at Vanderbilt Universitys ICU Recovery Center, who was not involved with this study. He is also seeing patients whose previous conditions, including anxiety, depression and opioid use disorder, worsened during the pandemic.
Research like this shows the clear need to follow patients in the weeks and months after even mild Covid diagnoses and to seek quick treatment for any emerging disorders, the experts said. If we apply attention to it now and nip it in the bud, we could literally save lives, Al-Aly said.
More than 18% of Covid patients developed mental health problems, compared with 12% of those who did not have Covid, according to the study published on Wednesday.
The study followed more than 153,000 patients who tested positive for Covid in the Veterans Affairs health system between March 2020 and January 2021, and compared them with other health records: to 5.8 million people who did not test positive in that time, but lived through the same stresses of the pandemic, and with 5.6 million patients seen before the pandemic.
Among all patients who developed new mental health problems during the pandemic, the Covid patients were significantly more likely to develop cognitive problems (80%), sleep disorders (41%), depression (39%), stress (38%), anxiety (35%) and opioid use disorder (34%), compared with those who didnt have Covid.
The study looked only at patients with no history of mental health diagnoses in the past two years. It compared those hospitalized for Covid versus other illnesses, and compared outcomes to thousands of flu cases. The study also adjusted for factors like demographics, other health conditions and other factors.
The results were all clear: Covid has a marked effect on mental health.
Those with more severe cases of Covid, especially those who need to be hospitalized, tend to be at higher risk. But even those with mild or asymptomatic cases were more likely to receive mental health diagnoses.
People who were hospitalized had it worse, but the risk in non-hospitalized [patients] is significant and absolutely not trivial and that represents the majority of people in the US and the world, Al-Aly said.
The study did have some limitations: most of those analyzed were older white men. But controlling for race, gender and age found no changes in risk.
The coronavirus can be found in the brain, other studies have shown. We can actually see the virus in the amygdala, in the hippocampus the very centers responsible for regulating our moods, regulating our emotions, Al-Aly said.
The study adds to other research showing that mental health issues are a huge concern after Covid, Jackson said. And the results line up with what he sees among patients.
Were learning that Covid may be even more problematic and more impactful than we thought, Jackson said.
Early treatment of patients facing new or additional mental health challenges after Covid can make a crucial difference, the experts said.
The idea here is to identify patients data early to hopefully reduce this from becoming a much larger problem down the road, Al-Aly said. If you leave a disease unattended, it only gets worse.
But the longer the virus continues circulating, the more long-term problems it may create adding even greater pressure to health systems.
The wave of people with mental health disorders is going to be hitting the clinics in the next year or two or three, as a result of Covid and as a result of the pandemic, Al-Aly said.
And many mental health practitioners dont accept insurance, creating a large stumbling block for patients, while others have long waiting lists.
This is a gigantic problem, and Im not really sure what were going to do about it, Jackson said. The needs are vastly greater than the resources.
Jackson has set up peer support groups to offer counseling to patients dealing with long Covid brain fog, cognitive impairment, memory problems, feelings of inadequacy. The groups are held on Zoom, so patients can join from all over the country.
We need to pay attention to the long-term consequences of Covid, Al-Aly said. If we only pay attention to the short-term consequences, the first 30 days or the first 90 days, we really, really are missing the larger picture.
The pandemic itself caught the US unprepared, and were going to be caught unprepared again for long Covid, Al-Aly said. The reality is that Covid is producing long-term consequences, and we cannot just wish it away or sweep it under the rug or not deal with it.
