As the COVID-19 pandemic was raising anxiety levels around the world, psychologist David H. Rosmarin noticed something surprising: Patients being treated for anxiety werent reporting the worsening symptoms he expected.
Rosmarin, associate professor of psychology at Harvard Medical School and a clinical psychologist at McLean Hospital, decided to take a closer look. Now in work published this month in the journal PLOS One, Rosmarin and colleague Steven Pirutinsky of Touro University, showed that the two main therapies used, cognitive behavioral therapy and dialectical behavior therapy, appear to have been protective against pandemic-related anxiety in the cohort of 764 individuals being treated in McLeans clinic during the pandemic.
Rosmarin spoke with the Gazette to highlight an encouraging take-home message for those with the condition. The interview was edited for length and clarity.
How did this study get started? Did you see the chance for a natural experiment on anxiety when COVID struck?
It started with clinical observation. At the start of the pandemic, we had 500 active patients in our cognitive/dialectical behavior-therapy outpatient center, and I was expecting their mental health to plummet.
I actually felt anxious myself, thinking that it was going to be a total disaster. But disaster did not happen.
Our patients seemed to be fine. Many of my colleagues reported the same. We werent getting emergency phone calls from patients who were in treatment before March 2020. We didnt need to hospitalize a single one of those patients since they were not threatening suicide or decompensating.
About 18 months ago, I wondered if these clinical observations might map onto our data, because you dont know unless you take a look at the numbers. Working with my long-time colleague Dr. Steven Pirutinsky from Touro University we sorted our patients, based on when they commenced treatment, into four groups mapping onto recommendations from Yale University: prepandemic, pandemic onset, during the pandemic, and post-pandemic.
We then compared their treatment trajectories, from intake to discharge and at all points in between. This allowed us to compare not only whether they had the same levels of anxiety at the beginning and at the end of treatment, but whether the slopes of treatment change were the same.
We found that patients who initiated treatment before the pandemic prior to Dec. 31, 2019, or in the first months of 2020 did not have any bump in anxiety in mid-March through May, when the whole world was anxious.
In addition, the trajectories of patients in different groups were no different from each other, demonstrating that therapy was equally effective, even when patients initiated treatment during the pandemic. I believe this is a pretty cool finding, since it shows that CBT and DBT are powerful to protect against once-in-a-century levels of distress.
When people get the skills and the tools that they need specifically CBT and DBT skills they can be protected against surges in anxiety even in the context of wild uncertainty.
So the data came retrospectively, from questionnaires routinely filled out at each visit?
Yes, we administered the GAD-7 at intake and every subsequent visit. The measure contains seven questions to measure generalized anxiety disorder, and its the American Psychiatric Associations gold standard self-report measure.
What is the message that you get out of the apparent stability of anxious people during undoubtedly anxious times?
When people get the skills and the tools that they need specifically CBT and DBT skills they can be protected against surges in anxiety even in the context of wild uncertainty. We have known for many years that these are effective treatments, but to see it in the context of the pandemic is, I think, quite unique and striking.
The second message is that having anxiety can be a good thing and help us to thrive. When anxiety leads us to get the help we need, it can inoculate us against future distress. If you compare the trajectories of prepandemic patients from our sample all of whom had pre-existing anxiety disorders to the general public, you find that the patients did better.
An analogy might be someone whos overweight, and they finally say, I cant do this anymore. They diet, exercise, and even get a nutritionist and a trainer. They do what they have to do to lose weight and because of that, in the end, they may have a better trajectory in terms of metabolic syndrome and heart disease compared to others who were never overweight.
You see a similar trend in relationships. When couples hit a rough patch, and they say, We have to work on our dynamics, and they go and get the help they need, the resulting connection is often much stronger for many more years, as opposed to those who trudge through since it never got so bad that they needed help. There are plenty of other examples of this in behavioral health, but its the same concept.
Had any of these people completed therapy and were using tools learned in therapy on their own?
Thats a good question. The length of therapy depends on a number of different factors. One is how severe symptoms are at intake. Two is how much people are implementing these skills between sessions on their own. Sometimes people take to them quickly; sometimes people need to hear it several times before they are ready. So everybodys treatment trajectory was unique, but the mean average was just over seven sessions, which is not a high dose.
Outside of your cohort, how much did mental health issues rise among the general public during the pandemic?
In the first year of the COVID pandemic, anxiety and depression increased 25 percent among adults, according to the World Health Organization.
I should clarify something: Uncertainty does not cause anxiety. It is intolerance of uncertainty that causes anxiety.
Does this belie a general perception of people with anxiety, whether theyre in therapy or not, that they are very fragile or frail?
Yes, this is the core of the issue: This is the perception, but its not true. In fact, it was my assumption going into the pandemic that my patients wouldnt make it. But they were actually much more resilient because they had been taught what to do.
One of the things we teach our patients in CBT is to do things that make them anxious and learn that the feelings will subside. This is called exposure therapy, and it directly makes people more resilient to face uncertain situations, which tend to make us anxious.
You can have a lot of uncertainty in your life, but if youre able to tolerate that uncertainty, youre able to weather it. If you understand what to do, then youre not seeking to eliminate uncertainty all the time, you understand thats par for the course. Youre not judging yourself or catastrophizing about it. And when you have a higher tolerance for uncertainty, then it doesnt need to lead you in the direction of worsening anxiety.
And thats healthier simply because uncertainty is just part of life?
Definitely, and during the pandemic it was a part of everyones life. But I should clarify something: Uncertainty does not cause anxiety. It is intolerance of uncertainty that causes anxiety.
Would it be accurate to say that one of the core principles of cognitive behavioral therapy is to expose yourself in different ways to your fears and your anxieties?
Yes, this is a key strategy. It is fair to say that a core tenet of CBT is facing ones anxieties head-on.
And what about DBT?
DBT is similar, but it balances change and acceptance: Yes, I want to change. I want to face my fears, but I need to accept that Im not quite ready to do that. Im a little bit further away from where I really want to be.
In DBT, we are more attentive to this and gradually help patients to move in the direction they want, while accepting that were not always going to get there. Thats as opposed to CBT, which is like, You have OCD? OK, were sticking your hands in the toilet today. Were doing this!
Do patients start with DBT and then move to CBT?
Well, when it comes to anxiety disorders, often its the reverse. We first try to get patients to move forward, and if its not working, then well have to balance with acceptance. We move back, pause, stay where we are, or coast in neutral for a while.
Is there a take-home message for people who have anxiety?
Yes, use the opportunity of your anxiety to build your resilience and get the skills that you need, because you never know when youre going to need them. And they can make a massive difference when a crisis hits.
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COVID-19 illness may include symptoms such as a sore throat, fever, cough, and fatigue. In January, the United States Centers for Disease Control and Prevention (CDC) issued its most recent guidelines for the use of over-the-counter (OTC) drugs for COVID-19. Specifically, its guidelines state that most people with COVID-19 have mild illness and can recover at home while treating symptoms with OTC medicines such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil).
Researchers from Florida Atlantic University's Schmidt College of Medicine and academic colleagues say it's more complicated. They suggest that selecting an OTC medication to alleviate mild symptoms of COVID-19 should be based on the entire benefit-to-risk profile of the patient. Moreover, they say the health care provider should make clinical decisions for each of his or her patients.
In a review published in The American Journal of Medicine, researchers take a closer look at both the potential benefits and risks of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs)such as ibuprofen, as well as aspirin for the selection of OTC drugs to treat mild symptoms of COVID-19.
Traditional nonspecific NSAIDs, such as shorter-acting ibuprofen and longer-acting naproxen, have been used to treat COVID-19. These widely used OTC drugs reversibly and non-specifically inhibit both cyclooxygenase enzyme isoforms. This results in a systematic reduction in the synthesis of prostaglandins, resulting in anti-inflammatory and fever-reducing effects.
The researchers caution, however, that both ibuprofen and naproxen have similar but greater side effect profiles than aspirin, such as gastroenteritis and peptic ulcers.
Acetaminophen is one of the most frequently used OTC drugs in the U.S. and worldwide as a treatment for fever, allergic symptoms, headaches, myalgia, symptoms of the common cold, and, most recently, COVID-19. Acetaminophen was originally marketed as an alternative to aspirin for the treatment of mild to moderate pain based on reduced mucosal gastrointestinal side effects.
The authors caution that even at daily doses of 4,000 milligrams per day, generally accepted as safe for adults, acetaminophen can be toxic to the liver and may result in the onset of acute liver failure. In the U.S., acetaminophen is the leading reason for calls to Poison Control Centers, with more than 100,000 cases per year. These circumstances account for more than 2,600 hospitalizations and 450 deaths in the U.S. due to acute liver failure.
Aspirin, or acetylsalicylic acid, inhibits the production of prostaglandins, which are responsible for mediating pain, inflammation, and fever. The authors say that the beneficial effects of aspirin include anti-platelet, analgesic, antipyretic or anti-fever, and anti-inflammatory properties. Aspirin is rapidly absorbed when taken orally and has a half-life of around four hours, after which the kidneys mostly metabolize it.
The researchers note that the anti-inflammatory benefits of aspirin should provide symptomatic relief of fever and body aches during COVID-19. They underscore, however, that health providers should view these in the context of the increased risks of bleeding, principally gastrointestinal. Further, COVID-19 itself may already predispose individuals to bleeding as well as to clotting abnormalities.
"We believe that health care providers should make individual clinical judgments for each of his or her patients in the selection of OTC drugs to treat symptoms of COVID-19. This judgment should be based on the entire benefit-to-risk profile of the patient," said Charles H. Hennekens, M.D., Dr.PH, senior author, first Sir Richard Doll Professor, and senior academic advisor in FAU's Schmidt College of Medicine.
"It is our belief that the individual health care provider knows far more about each of his or her patients than anyone, including expert members of guideline committees."
The authors conclude that when the totality of evidence is complete, health care providers can make the most rational individual clinical judgments for their patients and policymakers for the health of the general public.
The authors believe that, at present, the totality of evidence is incomplete and requires reliable evidence from large- scale randomized trials designed a priori to do so, which is necessary to develop rational guidelines. They also believe that any guidelines should provide only guidance to health care providers. Currently, these considerations pose new clinical challenges for health care providers in prescribing OTC drugs to treat COVID-19.
"The astute and judicious individual clinical decision-making of health care providers for each individual patient based on all these considerations has the potential to do far more good than harm. Finally, guidelines should provide guidance to individual health care providers," said Hennekens.
More information: Gage Collamore et al, Guidance for healthcare providers on newest guidelines for over-the-counter drug treatment of mild symptoms of COVID-19. (word count=18; limit=20), The American Journal of Medicine (2024). DOI: 10.1016/j.amjmed.2024.03.003
Journal information: American Journal of Medicine
A sign announcing a face mask requirement is displayed at a hospital in Buffalo Grove, Ill., Friday, Jan. 13, 2023. COVID-19 hospital admissions are inching upward in the United States since early July 2023. It's a small-scale echo of the three previous summers. (AP Photo/Nam Y. Huh)
PORTLAND, Ore. (KOIN) Following the Center for Disease Control and Preventions lead, Washington health officials have laid out relaxed guidelines for those experiencing respiratory viruses.
The Washington State Department of Health has told the public they can return to normal activities after at least 24 hours if their symptoms have improved and if they havent had a fever without using medication to treat it.
The CDC previously advised people with COVID-19, influenza or the respiratory syncytial virus to isolate for at least five days after noticing symptoms. The national agency has since reduced its recommended isolation period, saying COVID-19 is still a threat to public health, but it is no longer an emergency.
According to the CDC, weekly hospitalizations for the disease have dropped by more than 75% since January 2022. COVID-19 deaths have also declined by more than 90% in the same time period.
This updated respiratory virus isolation guidance reflects that were in a better place now in the COVID-19 pandemic, Washington health department Chief Science Officer Tao Sheng Kwan-Gett said.
Even with the new guidance, Washington DOH notes that people with COVID-19 can be contagious for up to 10 days, people with the flu can be contagious for up to seven days and those with RSV can be contagious for up to eight days.
The health department advised people to take extra steps to protect themselves and others within the first five days of having a respiratory virus. Recommendations include wearing a mask, social distancing, and improving ventilation and air quality indoors.
DOH added that people who are sick should be especially cautious of staying away from those who are at a higher risk for severe diseases, such as young children and the elderly.
while life is returning to normal in many ways, we must remember that for many in our community with chronic conditions and weakened immune systems, respiratory virus infections such as COVID-19, flu, and RSV remain a deadly threat. Each week, more than a dozen people in our state lose their lives to COVID-19 each week. We must not rest until that number is zero, Sheng said.
Around 17.6 million American adults are grappling with Long COVID, according to a recent survey conducted by the US Centers for Disease Control and Prevention (CDC). The uptick comes as the CDC eases COVID-19 isolation guidelines, a decision that has divided experts.
The percentage of Americans with Long COVID now stands at 6.8% and has risen by 1.5% since the last estimate of 5.3% in October 2023. The rise follows the second-biggest surge of infections across the US this winter, in which some health facilities returned to mask and limited-visitation policies.
The proportion of US adults currently experiencing Long COVID has not been this high since November 2022. Globally, around 65 million people are estimated to have Long COVID, but that is likely to be an underestimate.
Up to one in five people with SARS-CoV-2 infection can go on to develop Long COVID symptoms, according to the World Health Organization. And CDC data published last month indicates that COVID-19 infection quadruples the risk that people will develop chronic fatigue.
Symptoms of Long COVID are varied, ranging from brain fog, depression and memory loss to insomnia, muscle ache and fatigue. There have been several hypotheses about the biological mechanisms underpinning the symptoms, from dysregulated immune systems to neurological dysfunction. Now, evidence is starting to emerge to support some of these theories and explain Long COVID symptoms.
There is no diagnostic test or treatment yet, however, and many people who have had their lives put on hold, at best, or, at worst, destroyed by the condition, have received very little support.
While Long COVID patients are suffering worldwide, those in high-income countries are likely to have access to some health care at least. In low- and middle-income countries, the situation is even more dire.
Dr Caroline Hilari, who coordinates a Long COVID study in children in Bolivia, said: "I think the fact that Long COVID has not been in the media here is basically because we have more deadly diseases. Just recently we've had kids dying of dengue and scorpion stings. When people die, that gets into the media. But chronic, disabling conditions do not and maybe that's the cruelty of being in a less developed country."
Brazil's Federal Police on Tuesday indicted former far-right President Jair Bolsonaro for falsifying his COVID-19 vaccination records.
The indictment said Bolsonaro tampered with a public health database to make it look as if he and several others in his circle were vaccinated.
Police detective Fabio Alvarez Shor signed off on the indictment, saying Bolsonaro and several others wanted to use fake COVID-19vaccination records to "cheat current health restrictions."
"The investigation found several false insertions between November 2021 and December 2022, and also many actions of using fraudulent documents," Shor explained.
Bolsonaro had expressed opposition to the COVID-19 vaccinewhile also downplaying the health impacts of the virus and the severity of the pandemic.
It's now up to Brazil's prosecutor-general to decide whether to file charges against Bolsonaro at the Brazilian Supreme Court.
Bolsonaro's attorney, Fabio Wajngarten, decried the police allegations as "absurd."
"While he served as president, [Bolsonaro]was completely exempt from presenting any type of certificate on his trips," Wajngarten said, while condemning "political persecution" towards the former Brazilian leader.
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It was the first indictment against the former Brazilian leader as more charges could potentially be broughton other issues as well.
The former president is currently being investigated over a possible military coup plot to stay in power after he was defeated by leftist Luiz Inacio Lula da Silva in the 2022 election.
On January 8, 2023, a mob of Bolsonaro supporters stormed buildings representing the three branches of government in the capital of Brasilia, several days after Lula's inauguration.Although their attempt to reinstall Bolsonaro's government failed, the event left a mark on Brazil's democracy and revealed the risks of polarization in South America's most populous country.
Bolsonaro also faces a probe over money he received from selling luxury watches he was gifted from Saudi Arabia during his time in office.
wd/sms (Reuters, AP, AFP)
A new study based on outcomes seen at European intensive care units (ICUs) suggests higher is not better when it comes to targets for supplemental oxygenation levels for COVID-19 patients experiencing low oxygen, or hypoxia.
The study is published today in JAMA, and looked at Pao2, the partial pressure of oxygen in the arterial blood, at supplemental levels of 60 and 90 millimeters of mercury (mm Hg), with the main outcomes being number of days alive without life support.
Lower risk of death in lower-oxygen group
The study included 726 adults with COVID-19 receiving at least 10 liters per minute (L/min) of oxygen or mechanical ventilation in 11 ICUs in Europe from August 2020 to March 2023. ICUs in Denmark, Switzerland, Norway, Iceland, and Wales participated in the trial.
Hypoxemic respiratory failure was defined as necessitating supplemental oxygen of at least 10 L/min in an open system or mechanical ventilatory support.
Patients were randomized 1:1 to receive either 60 mm Hg (lower-oxygenation group, 365) or 90 mm Hg (higher-oxygenation group, 361) and followed for 90 days. Oxygen levels were measured via arterial lines, which were place on all patients.
Sixty-eight percent of patients were men, and average patient age was 66 years.
At 90 days, the median time alive without life support was 80.0 days in the lower-oxygenation group and 72.0 days in the higher-oxygenation group. Death rate at 90 days was 30.2% in the lower-oxygenation group and 34.7% in the higher-oxygenation group (risk ratio, 0.86; 98.6% confidence interval, 0.66 to 1.13).
"The present result was hypothesized to occur due to more days alive without mechanical ventilation in the lower oxygenation group vs the higher oxygenation group," the authors wrote.
In an editorial on the study, Richard M. Schwartzstein, MD, of Harvard Medical School, writes that the less-is-more findings could be explained by a number of factors. More patients in the high-target group could have been intubated and started on mechanical ventilation because physicians could not achieve the target with noninvasive ventilation.
"The observation that initiation of mechanical ventilation to achieve a high target Pao2 may have occurred is less a failing of the study design than a consequence of using a high Pao2 target," Schwartzstein writes.
The observation that initiation of mechanical ventilation to achieve a high target Pao2 may have occurred is less a failing of the study design than a consequence of using a high Pao2 target.
Schwartzstein also suggests that high oxygen targets help patients in some ways, but may also cause inflammation, bronchial epithelial injury, and disruption of mitochondrial respiration in ICU patients.
He writes that the study "is one more piece in a growing collection of evidence suggesting that there is no clinical benefit and possibly harm associated with use of supplemental oxygen to achieve oxygen saturation of the blood beyond 90% to 93%."
The Department of Transportation (DOT) hasn't created a national aviation preparedness plan for infectious disease outbreaks, despite a 2015 US Government Accountability Office (GAO) recommendation to do so, according to a new report on lessons learned from the COVID-19 pandemic.
When tasked with identifying pandemic lessons for the report, the GAO reviewed more than 20 of its previous reports and documents from offices of inspectors general and aviation stakeholders and interviewed officials from the DOT and the Department of the Treasury.
"In April 2020, U.S. commercial airline traffic fell to 3 million passengers, a 96 percent decrease from April 2019," the GAO noted in the report. "The federal government responded in many ways, including by providing $132 billion in financial assistance to airlines, aviation and other businesses, and airports."
Yet a DOT plan to avert replication of the disjointed response seen early in the pandemic didn't materialize even after stakeholders told the GAO in 2020 and 2021 that confidence in air travel could have recovered faster if there had been greater federal coordination. In December 2022, at the GAO's behest, Congress passed a law requiring the DOT to develop the plan.
In July 2022, the GAO said that federal leaders needed to advanceresearchon disease spread aboard airplanes, including in real-world scenarios and on the efficacy of mitigation methods. While the GAO urged Congress to require the Federal Aviation Administration (FAA) to create a research strategy, as of this month, legislators haven't done so.
This year and in 2023, DOT and FAA officials said they are working on developing a preparedness plan and identifying a research agenda. "By implementing GAO's recommendations, DOT and other aviation stakeholders would be better positioned to address a communicable disease threat while minimizing unnecessary aviation disruptions, which were significant in the case of COVID-19," the GAO said in the report.
Lessons learned from GAO's work on COVID-19 aviation-assistance programs from the Department of the Treasury's Payroll Support Program (PSP), the Coronavirus Aid, Relief, and Economic Security (CARES) Act loan program, and the DOT's Airport Grants and Aviation Manufacturing Jobs Protection Program include:
DOT and Treasury quickly awarded funds but did not always have safeguards in place in a timely manner.
The GAO will continue to monitor the federal COVID-19 pandemic response, including the DOT's and Treasury's production of aviation lessons learned, it said.
Charleston County School District is trying to come up with tens of millions of dollars. The biggest challenge regarding the Fiscal Year 2025 budget is sunsetting ESSER funds COVID-19 funds. (WCIV)
Charleston, S.C. (WCIV)
The Charleston County School District is trying to come up with tens of millions of dollars.
The biggest challenge regarding the Fiscal Year 2025 budget is sunsetting ESSER funds COVID-19 funds.
All of which will be used by September.
The school district has $22 million of ESSER funds left.
Charleston%20County%20School%20District%20is%20trying%20to%20come%20up%20with%20tens%20of%20millions%20of%20dollars.%20The%20biggest%20challenge%20regarding%20the%20Fiscal%20Year%202025%20budget%20is%20sunsetting%20ESSER%20funds%20%E2%80%93%20COVID-19%20funds.%20(WCIV)
Now, the district is trying to come up with $90 million to sustain the programs and positions that are ESSER-funded.
Daron Lee Calhoun II said the district is working hard with their new chief financial officer to tighten up their expenditures and come up with the money.
Calhoun said he supports the weighted student-based funding model that was presented at the most recent budget workshop.
Superintendent Anita Huggins says this would allow the district to maintain effective programs and positions currently funded by ESSER.
Schools are funded based on enrollment but the new model would allow the district to follow a different ratio.
Students in poverty, those receiving special education services, and multilingual learners would be weighted higher and increase the allocation of funds to their schools.
With this model, we can sustain a lot of those programs and a lot of the full-time employees under the general operating fund. How do we do it over the next three or five years? Can we do it over the next three to five years? If we can't, then how do we scale back on the model a little bit? Calhoun said. How do we sustain it? That's where my biggest question would come from.
Another question he has: how would this work with school voucher programs the state is potentially expanding?
This model is flatly a racist model. The voucher systems came about in 1964 because of school integration, Calhoun said.
The state program is essentially public dollars going to parents, allowing them to choose their students school.
As long as you keep pulling money out of the schools, were already strained trying to balance this billion-dollar budget that we have," Calhoun said. "That money coming out of our schools is not going to help us at all. We need to keep our public funds and our taxpayer funds within the public schools."
Calhoun says they won't know how this will affect the suggested model or CCSDs budget until they know how many students are participating in the voucher program.
If 200 students take that $6,000, that's a lot of money coming out of our schools," Calhoun said. "That can go to teacher increases. That can go to projects that were funded by ESSER. Every little bit of money coming out of our district takes away something else."
While the district is busy building its budget, it is simultaneously having to watch the states budget
Calhoun hopes the state passes its budget by April so they can build those numbers into their plan.
It will truly affect everything we're doing," He said. "We need those numbers soon."
The House passed the budget last week and now heads to the Senate.
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World News
By Associated Press
Published March 19, 2024, 10:04 a.m. ET
BrazilsFederal Police have accused formerPresident Jair Bolsonaroof criminal association and falsifying his own COVID-19 vaccination data, marking the first indictment for the embattled far-right leader with others potentially in store.
The Supreme Court released the polices indictment on Tuesday that alleges Bolsonaro and 16 others inserted false information into the public health database to make it appear as though the then-president, his 12-year-old daughter and several others in his circle had received the COVID-19 vaccine.
During the pandemic, Bolsonaro wasone of the few world leaders railing against the vaccine, openly flouting health restrictions and encouraging society to follow his example.
His administration ignored several emails from pharmaceutical company Pfizer offering to sell Brazil tens of millions of shots in 2020 and openly criticized a move by Sao Paulo states then-Gov. Joo Doria to buy vaccines from Chinese company Sinovac when no jabs were otherwise available.
Brazils prosecutor-generals office will have the final say on whether to use the police indictment to file charges against Bolsonaro at the Supreme Court. It stems fromone of several investigations targeting Bolsonaro, who governed between 2019 and 2022.
Bolsonaros lawyer did not immediately respond to a request for comment from The Associated Press. The former president denied any wrongdoing during questioning in May 2023.
Police accuse Bolsonaro and his aides of tampering with the health ministrys database shortly before he traveled to the U.S. in December 2022, two months after he lost his reelection bid to Luiz Incio Lula da Silva.
Bolsonaro needed a certificate of vaccination to enter the U.S., where he remained for the final days of his term and the first months of Lulas term.
If convicted for falsifying health data, the 68-year-old politician could spend up to 12 years behind bars, and as little as two years, according to legal analyst Zilan Costa. The maximum jail time for a charge of criminal association is four years, he said.
Bolsonaro retains staunch allegiance among his base, as shown by an outpouring of support last month with anestimated 185,000 people clogging Sao Paulos main boulevardto decry what they and the former president characterize as political persecution.
Brazils top electoral court has already ruled Bolsonaroineligible until 2030, on the grounds that he abused his power during the 2022 campaign and cast unfounded doubts on the countrys electronic voting system.
Other investigations include one seeking to determine whether Bolsonaro tried tosneak two sets of expensive diamond jewelryinto Brazil and prevent them from being incorporated into the presidencys public collection.
Another relates to hisalleged involvement in the Jan. 8, 2023 uprisingin capital Brasilia, soon after Lula took power, that resembled the Capitol riot in Washington two years prior.
He has denied wrongdoing in both cases.
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OLYMPIA The Washington State Department of Health has updated their guidance for what to do when someone is sick with COVID-19, the flu, RSV or other respiratory viruses.
In a press release, the DOH says the new guidance recommends people sick with COVID-19 return to normal activities "when their symptoms are getting betteroverall,and they have not had a fever (without having to use fever-reducing medication) for at least 24 hours."
Previous COVID-19 guidance recommended people isolate for at least 5 full days after symptoms appeared.
The department reminds people that even if their symptoms have improved, they can still be contagious for several days:
Dr. Tao Sheng Kwan-Gett, DOH chief science officer, said that the updated respiratory isolation guidance "reflects that we're in a better place now in the COVID-19 pandemic."
While life is returning to normal in many ways, we must remember that for many in our community with chronic conditions and weakened immune systems, respiratory virus infections such as COVID-19, flu, and RSV remain a deadly threat,"Kwan-Gettsaid."Each week, more than a dozen people in our state lose their lives to COVID-19 each week. We must not rest until that number is zero.
The new respiratory illness guidance recommendsstaying away from high-risk people until receiving a negative COVID-19 antigen test for people who tested positive, for 10 days after symptoms of infection start, or for 10 days since testing positive for COVID-19 for people who never develop symptoms.
DOH also recommends taking extra precautions during the first 5 days after resuming normal activities after COVID-19, flu, RSV, or other respiratory viruses, including:
The department says their new guidance "is meant to provide baseline recommendations, Washington residents are asked to follow any local health jurisdiction, workplace, business, or school policies that may provide more protective guidance specific to their setting or community."
