A new M Health Fairview clinic is confronting an exhausting disorder that has afflicted more children since the pandemic and caused alarming spikes in heart rate, blood pressure and breathing.
Dr. Matthew Ambrose said it is disheartening to see so many more cases of the condition known as POTS. But the increase at least spurred awareness, and accelerated plans for a clinic in Minneapolis that can better diagnose and treat children who in the past were dismissed.
"Sometimes they're being told outright that they are making it up, that it's all in their head," said Ambrose, a pediatric cardiologist and a leader of the clinic. "It's really dispiriting to hear. They can't even be at school because they are too tired."
POTS emerged prior to the pandemic in about one in 500 children and young adults, usually after infectious diseases triggered aggressive responses by their immune systems. So doctors weren't shocked when POTS became more of a problem during the pandemic. An estimated 96% of Minnesota children had been infected by the end of 2022 with the coronavirus that causes COVID-19, based on a federal review of pediatric blood samples, creating a huge risk pool for the development of the disorder.
The condition bears similarities to long COVID, the lingering cognitive and physical problems that people experience after coronavirus infections, but with at least one distinguishing characteristic. POTS is short for postural orthostatic tachycardia syndrome, and it is defined by a severe and immediate increase in heart rate whenever people switch positions by sitting or standing up.
Anna Burt, 14, was a bubbly dancer, skier and cheerleader from Sioux Falls, S.D., when she was diagnosed with COVID-19 in October 2020. The resulting exhaustion left her struggling to walk, and often was marked by a pounding heartbeat that raced up to 160 beats per minute.
"Its like a big drum," the girl said.
Burt was first taken to M Health Fairview's clinic for long COVID, because she was experiencing the characteristic "brain fog," along with stomach pain and dizziness. She struggled to sit up, even to ride in the car to the doctor's office.
"She really was trapped in the house," said her mother, Jody Burt.
Her POTS diagnosis became clear after the family met Ambrose, who had observed cases prior to the pandemic and had taken a clinical and research interest in the condition. Just finding a clinician who believed Anna and her family was vital, her mother said. "We weren't getting that. Most of the time, we were getting, 'its just constipation.'"
Depression and anxiety often occur alongside POTS, so much that they are often mistaken as the causes of children's lethargy, research has shown.
Drinking water can reduce POTS flareups, and exercise and physical therapy can help patients regain function, Ambrose said. But patients often need poorly understood and even controversial medication regimens. Naltrexone treats opioid addiction but appears in low doses to reduce POTS-related fatigue. Steroids regulate water, and sodium levels and can prevent or reduce attacks.
Beta blocker drugs that lower blood pressure were thought to worsen POTS, but recent studies suggest they help. POTS is related to the autonomic nervous system, or the portion of the nervous system that controls subconscious functions such as heart rate and body temperature.
The drugs temper the body's reaction to signals from that system, Ambrose said. "It's like being at a rock concert but wearing hearing protection."
The clinic's goal is to package together treatments that families struggle to access separately, and to keep tabs on patients through online check-ups and counseling. By following patients over time, the clinic also hopes to prove which treatments work best and how much progress children with POTS can make.
"When I tell people I think we can get them to a place where they are fully functional, I mean it," Ambrose said. "But it does take work and time and trial and error ... and an Avengers team of physical therapists."
The clinic sometimes looks for little successes, Ambrose added, giving fluid infusions to one patient so she had the energy just to go to prom.
Anna Burt has progressed from a wheelchair to crutches to walking, but she still can't run without exhaustion. She has replaced old pursuits, trying swimming and archery. She tried playing with slime toys to alleviate boredom, but they irritated her skin. So she invented a non-irritating version that she plans to sell under the brand Rainbow Slimes.
She said her pain and symptoms are under better control, as long as she keeps up with therapy exercises and remembers her medication. She rides a recumbent bicycle for exercise and has returned to school for art class. Changes day to day are imperceptible, but Anna said she has made long-term improvements and dreams of being active.
"Sometimes I get sad. I'm just tired of doing this over and over and over again, but I wouldn't change the experience I had," she said. "Definitely a lot of parts suck, like most of it, 99% sucks. But I wouldn't be who I am now without it."
A Riverside resident receives his first dose of the COVID-19 Pfizer vaccine on Friday, Jan. 14, 2022. As respiratory illnesses are on the rise, experts say vaccination is one tool that can help prevent serious symptoms and community spread. (File photo by Will Lester, Inland Valley Daily Bulletin/SCNG)
For the last three years, this editorial page has marked the anniversary of Gov. Gavin Newsoms stay-at-home order with commentaries reflecting on the lessons learned from the coronavirus pandemic. We continue this tradition, as we believe its important for people to critically engage with what happened, what went right, what went wrong.
Presented today are wide-ranging commentaries from our in-house columnists and editorial board members, as well as contributors from across Southern California.
Columnist and editorial board member Steven Greenhut helpfully reminds readers that we in this Opinion section were calling balls and strikes throughout the coronavirus pandemic in ways not seen in most of the California press.
Noted economist James Doti presents in clear language and with robust data the reality that Californias heavy-handed approach to the pandemic ultimately did no better than less restrictive approaches to the pandemic.
Dr. Houman Hemmati shifts through the good, the bad and the ugly of national, state and local public health responses to the coronavirus pandemic. Hint: There was a lot more bad than good.
Former state Sen. John Moorlach shares his perspective as a state lawmaker who saw firsthand the inept decision-making processes that would change our lives forever.
Longtime columnist Doug McIntyre takes a step back and puts the frankly nutty pandemic period into perspective.
Columnist Rafael Perez applies his philosophical training to clarify how to think through the appropriate response to a public health crisis like COVID-19.
Columnist and editorial board member Larry Wilson cuts through the conspiratorial nonsense about the life-saving coronavirus vaccines and tells it like he sees it.
Newport Beach Mayor Will ONeill was an early critic of Gov. Gavin Newsoms top-down, draconian approach to the pandemic. ONeill recounts how his city took responsible, respectable actions during the pandemic, and contrasts that with Newsoms imprudent beach closures.
Columnist and editorial board memberSusan Shelley details an interview between President Donald Trump and journalist Bob Woodward in the early days of the pandemic. Her takeaway? Trump was right.
Education policy expert Lance Christensen breaks down the horrific consequences of coronavirus school closures on the youth. The consequences of putting kids last, Christensen argues, will be with us for years to come.
Former Riverside County Supervisor Jeff Hewitt, once one of the highest-ranking Libertarian elected officials in the nation, offers his insights into what went right and wrong during the coronavirus pandemic.
Columnist and editorial board member John Seiler writes on the good things, yes, the good things, that came from the pandemic years.
As always, you may agree or disagree with the pieces presented. But we hope you consider what they have to say. We encourage you to offer your thoughts on them at opinion@scng.com.
DUBLIN, March 19, 2024 /PRNewswire/ -- The "Monkeypox Vaccine and Treatment Market: Global Industry Analysis, Trends, Market Size, and Forecasts up to 2030" report has been added toResearchAndMarkets.com's offering.
The globalmonkeypox vaccine and treatment market was valued at USD 8.19 billion in 2022 and is expected to reach USD 19.68 billion in 2030, with a CAGR of 10.14% during the forecast period 2023-2030.
The report on the global monkeypox vaccine and treatment market provides qualitative and quantitative analysis for the period from 2021-2030. The study on monkeypox vaccine and treatment market covers the analysis of the leading geographies such as North America, Europe, Asia Pacific, and RoW for the period of 2021-2030.
The monkeypox vaccine and treatment market refer to the commercial landscape associated with products and services aimed at preventing and managing monkeypox infections. This includes the development, production, and distribution of vaccines and treatments designed to mitigate the impact of monkeypox outbreaks. Companies operating in this market focus on research, manufacturing, and strategic partnerships to provide effective solutions, addressing the demand for medical interventions in regions susceptible to monkeypox infections. The market plays a crucial role in public health by offering preventive measures and therapeutic options for individuals and communities affected by monkeypox.
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The injectables segment stands out as the fastest-growing category in the monkeypox vaccine and treatment market. This notable growth is attributed to various factors such as the efficacy and rapid response associated with injectable formulations. As the demand for effective monkeypox prevention and treatment options rises, the injectables segment gains prominence due to its convenience, efficiency, and potential for widespread application. This trend underscores the increasing importance of injectable solutions in addressing the challenges posed by monkeypox, contributing significantly to the overall expansion and advancement of the market.
North America is poised to hold the most prominent market share. This prominence can be attributed to the region's robust healthcare infrastructure, advanced research capabilities, and strategic investments in the field of infectious disease management. The heightened awareness and proactive approach of North American healthcare authorities in addressing emerging health threats further contribute to this dominance.
Additionally, collaborations between pharmaceutical companies, research institutions, and government agencies in North America are fostering innovation and accelerating the development of effective monkeypox vaccines and treatments. The region's pivotal market position signifies lucrative opportunities for industry players and underscores its commitment to tackling public health challenges with cutting-edge solutions.
Report Findings
Drivers
Restraints
Opportunities
Company Profiles
The companies covered in the report include
Segment Covered
The Global Monkeypox Vaccine and Treatment Market by Product
The Global Monkeypox Vaccine and Treatment Market by Gender
The Global Monkeypox Vaccine and Treatment Market by Route of Administration
The Global Monkeypox Vaccine and Treatment Market by End-use
For more information about this report visit https://www.researchandmarkets.com/r/l8oifj
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I was there, where no one wanted to be in 2020.
Right about this time four years ago, my colleague Sharon Cantillon, a longtime Buffalo News photographer, reached out to ask if I would accompany her into hospital intensive care units, which would soon be overrun with people suffering and dying from the then-novel coronavirus, which we would all soon be calling Covid-19.
Journalists go places where others cant and then tell the story. Sometimes thats on a red carpet or into the White House. This time, it was on the front lines of the battle against the
I said yes, quickly but not easily. Covid was new, hot and scary. No vaccines existed, nor did any significant immunity. If our bodies were exposed to the virus, our immune systems could respond with confusion and alarm, slamming into overdrive and leaving us deathly ill. (You can interpret deathly to be figurative or literal. Depending on the person, either is true.)
Doctors hadnt yet learned how to handle it. Elected leaders were warning us to stay home. Stay safe was a common refrain. We would soon be socializing over video calls. Ordering takeout was chic. Grocery workers were noted for their bravery on the front line. Doctors, nurses, pharmacists and respiratory therapists in hospitals? We started calling them heroes and meaning it.
When Sharon asked me to join her, I felt the only natural answer was yes. The charge from my editors when I took this job with The News five years earlier was to spend time with people and in places that are hard to reach, to spend time digging for stories and taking readers into places they arent likely to go.
In early 2020, I thought to myself: This might be the most important writing you ever do.
Achieving understanding during the age of Covid is an elusive endpoint. The pandemic didnt simply change us. It transformed us in ways well be unraveling for decades. It altered our relationship with work, school and each other. It sometimes changed where we live, how we live and how we socialize. Researchers have studied and debated how the pandemic has affected our mental health on a broad scale: Look closely, and youll find reports showing the tripling of depression rates juxtaposed against a major review of more than 12 dozen studies claiming the impact is little.
But mental health is both an individual and ever-changing dynamic, so the question is: Are you, or the people closest to you, handling stress differently? Do people seem a little less patient or understanding? That may be because our collective empathy has dropped. According to a study conducted in 2022 by the United Way of the National Capital Area, Americans considered themselves less empathetic a couple years into the pandemic than we were in 2019. The national average was a 14% drop from 2019 to 2022, with millennials reporting the steepest fall (19%).
Everyday medical decisions like vaccination often mutated into political statements, with blue voting blocs embracing the shots while red states and regions resisted it, even though the vaccines were developed under the leadership of the Trump administration, and former President Donald Trump himself was vaccinated. A study published in September 2022 by the National Bureau of Economic Research analyzed Covid-19 death rates in Ohio and Florida and found that more Republicans died than Democrats.
The pandemic is done, but Covid-19 is here to stay. How do we make sense of that? We spoke with a series of experts to find out.
From March 2020 to the end of 2021, the average excess death rate for Republicans was 76% higher than for Democrats. (Excess deaths is a term epidemiologists use to describe the number of deaths above what is statistically expected.) The gap in excess death rates between Republicans and Democrats is concentrated in counties with low vaccination rates and only materializes after vaccines became widely available, wrote researchers Jacob Wallace, Paul Goldsmith-Pinkham and Jason L. Schwartz.
The deeply red state of Mississippi had the highest childhood vaccination rate pre-pandemic, but ranked among the lowest states for Covid-19 vaccinations.
Here they are, doing great on vaccination, pre-Covid, said Gale M. Sinatra, who is co-author with Barbara K. Hofer of Science Denial: Why it Happens and What to Do About It. Then Covid becomes politicized.
Nurse Eman Omar cares for a patient in the Covid intensive care unit at Buffalo General Medical Center in April 2020, when medical science was struggling to control the often-deadly virus.
Sinatra, a psychology professor at the University of Southern California, pointed out in an interview last year that the Los Angeles region has a lot of liberal and progressive people who are into eating organic and no genetically modified foods and all of that. They were very anti-vax for childhood vaccination and some of them were also anti-vax for Covid, but some of them flipped in the other direction because it became this politically divided issue, and they took the Covid vaccine.
Though politics underlined many peoples choices, the more pervasive and frightening issue became misinformation and disinformation. The electorate has a voice and politicians change. We can choose our leaders. Thats how its supposed to be.
But during the pandemic, people started choosing their facts.
We didnt know a lot about Covid in the beginning, Sinatra said. There were serious questions about it that infectious disease doctors didnt know yet. So without good information, everybody turns to the internet because everybody is home. That combination was like throwing gasoline on an already blazing fire of misinformation on the internet, and it just exploded.
In this installment of Pandemic Lessons, we explore the state of our yearslong battle against Covid-19 and examine whether weve managed to recapture normalcy.
The kindling of that forest fire of misinformation was crackling years before anyone knew of Covid-19, but the onset of the pandemic ignited an explosion.
When I told my wife four years ago about my plan to report from inside hospitals, she was supportive. A bit hesitant? Maybe, but she didnt show it. More than anything, she was practical. We made a plan similar to what medical professionals were doing at the time: When I came home, she would open and then close the garage; I would strip off my outer layers, toss them in the laundry, then immediately shower. I wrapped my hand-held recorder in plastic and left my notebook in the garage, trying to minimize any chance of those threatening, mysterious Covid particles from getting into the house and infecting my wife or daughter.
Looking back, and knowing the facts we do now, not every bit of that was necessary. My recorder was unlikely to be a vessel for transmission, for example, and my notebook was unlikely to contaminate my entire house. But we were operating on what we knew, and what we knew was this: I was meeting medical professionals who were resolved but worn, and patients who were very sick. I watched a woman die. I met a man who was hospitalized for more than a month, had nightmarish visions of moaning corpses after being kept alive on a ventilator, and only wanted to make it home for his sons third birthday. (He did.)
Nurse Shawn Covell hangs sedatives and pain medication for a Covid patient as respiratory therapist Nick Logiudice, right, stands by at Buffalo General Medical Center in April 2020. The spread of misinformation became a frightening issue during the pandemic.
I met a nurse who kept newspaper clippings of her patients obituaries, a husband-wife duo who both worked as respiratory therapists, meaning they spent every working day close to peoples noses and mouths, where Covid camped out. I met doctors who made it their personal mission to bring vaccines to neighborhoods, communities and even countries where they werent easily accessible. I spent time with the secretary of Health and Human Services. I began a texting relationship with the former U.S. surgeon general. People like Dr. Tom Russo and Dr. John Sellick, the two Buffalo-based infectious disease experts whose voices have been most prominent in these parts, were (and remain) on speed dial.
I wrote about masks and shots, and have a collection of emails and voicemails in which people who didnt like facts masked their own identities and took shots at me. I gained readers. I lost friends.
I hope to never have to do it again. I would, but who would ever want to go through that again?
And honestly, now that most of the world (including me) lives life unmasked and gathers freely, it feels like a fever dream. That either means were all adaptable and able to move back into our old ways comfortably, or we all forget quite easily.
Follow Tim OShei on Twitter @timoshei .
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significantly affect odds of survival and treatment options. (Photo: Getty) getty
The Covid-19 pandemic and the botched handling of it have been tragic in many different ways. One of the still emerging tragedies has been delays in the diagnoses of and care for other types of medical conditions because people werent being seen in clinics and hospitals as regularly as they should have. Thats probably left a lot of people shoulding all over themselves as in shouldve, couldve, wouldve gotten treatment earlier. For example, a study recently published in BJU International estimated that the pandemic led to 20,000 missed prostate cancer diagnoses in England alone, in the words of the study authors.
Thats just England, which has a population of around 56 million, about a fifth of the U.S. population. Now handled it well wouldnt be the first words that you may think of when it comes to the U.S., the U.K., and the Covid-19 pandemic. The U.S. has had the most deaths (over 1.18 million) from Covid-19 in the world while the U.K. has had the sixth most (over 233,00). Both countries had leaders claiming that they pandemic was rounding the corner or we can turn the tide in 2020 when guess what neither happened.
Lets assume then that the U.S. had a similar rate of missed prostate cancer diagnoses as England did. The 20,000 in England number would mean that potentially well over a 100,000 men in the two countries have been or will be left wondering, What if? What if the U.S. and U.K. had better functioning healthcare systems during the pandemic? What if their prostate cancer had been detected one, two, or three years earlier? What if their disease had been detected before it had spread and potentially become less treatable?
To get the 20,000 number, investigators from the University of Surrey (Agnieszka Lemanska), the University of Oxford (Colm Andrews, Louis Fisher, Seb Bacon, Amir Mehrkar, Peter Inglesby, Simon Davy, Ben Goldacre, Brian MacKenna, and Alex J. Walker) and the OpenSAFELY Collaborative conducted analyzes on the OpenSAFELY-TPP dataset of 24 million patients, which comprised about 40% of Englands population. They graphed the monthly rates of prostate cancer incidence, prevalence, and mortality per 100,000 adult men that were reported from January 2015 through July 2023. Then they used statistical methods to extrapolate what the rates from March 2020 and beyond could have been had the Covid-19 pandemic not occurred.
These analyses showed a lot of shouldve, couldve, wouldves. The year 2020 saw a 4,772 (31%) drop in the reported incidence of prostate cancer while 2021 saw a 3,148 case drop. The patients average age at diagnosis moved up too from 71.3 in 2019 to 71.6 in 2020 and 71.8 in 2021. Adding the 4,772 and the 3,148 case numbers gives you about 8,000. Dividing that by 40% leaves you with around 20,000 cases.
Now its not as if some kind of miracle prostate cancer prevention method emerged in 2020. More people wearing denim, tiny glasses, and bucket hats in 2019 probably didnt help decrease the risk of prostate cancer in ensuing years. Therefore, you wouldnt have expected the actual incidence of prostate cancer to have dropped in 2020 and 2021. Or the age at which prostate cancer emerged to have risen either. Thus, these changes were probably for the most part due to delays in men getting proper prostate cancer screening such as their prostate-specific antigen (PSA) levels in the blood being checked and their getting digital rectal exams. In the end, this led to a whole lot of missed diagnoses.
The American Cancer Society recommends that men start screening for prostate cancer at age 50 if they have average risk of developing prostate cancer, age 45 if they are at high risk (e.g., African American men or men who have a first-degree relative diagnosed with prostate cancer before age 65) and age 40 if they are at even higher risk (meaning that they have had one first-degree relative diagnosed with prostate cancer before age 65). An elevated PSA, finding a nodule or mass on a prostate/rectal exam or both in many cases should prompt further evaluation such as magnetic resonance imaging (MRI) or biopsy of the prostate or both. Shawn Dason, MD, an Assistant Professor of Urology at The Ohio State University College of Medicine, described how the biopsy will help identify definitively whether there is cancer in the prostate and how aggressive the prostate cancer is. Delays in any of those possible steps could in turn delay diagnosis of prostate cancer.
And the timing of diagnosis is key in the treatment of any type of cancer and your odds of survival. Dason described prostate cancer as treatable but emphasized that a delay in diagnosis does increase the chance of it spreading to other parts of the body. This in turn influences treatment. Spread of the cancer beyond the prostate can significantly reduce your chance of survival and increase the scope and types of treatments that you need. So, unfortunately, a lot of men may now have to deal with worse odds and worse treatment effects.
It would be easy for political and business leaders to blame the severe acute respiratory syndrome coronavirus 2 (SARS-COv-2) and simply say, No one expected the pandemic. But the pandemic wasnt like The Spanish Inquisition in that Monty Python skit. Many people were indeed warning political and business leaders about the threat of a pandemic in the decade preceding the Covid-19 pandemic. For example, in 2017, I wrote for Forbes about how our society is woefully underprepared for a bad pandemic and how Bill Gates was warning leaders about the possibility of a pandemic within the next 10 to 15 years. But as the chaos in the pandemic response in 2020 showed, not enough political and business leaders heeded such warnings.
Preparing for the next pandemic whenand not ifit comes should include shoring up the healthcare system so that it can continue to function at full capacity even when a pathogen is spreading all around. This means making sure that all clinics and hospitals have plentiful personal protective equipment (PPE) on hand, the appropriate infection control procedures in place, enough personnel to compensate for surges in demand and telehealth options implemented in a well-organized fashion as opposed to the meerkats-in-a-mosh-pit chaos of 2020 that spilled into subsequent years. Meanwhile, dealing with the Covid-19 pandemic present should include ways to make up for the delays in the care that have occurred and giving thousands upon thousands of patients what they havent had: proper healthcare.
I am a writer, journalist, professor, systems modeler, computational, AI, and digital health expert, medical doctor, avocado-eater, and entrepreneur, not always in that order. Currently, I am a Professor of Health Policy and Management at the City University of New York (CUNY) School of Public Health, Executive Director of PHICOR (@PHICORteam) and Center for Advanced Technology and Communication in Health (CATCH), and founder and CEO of Symsilico. My previous positions include serving as Professor By Courtesy at the Johns Hopkins Carey Business School, Executive Director of the Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Associate Professor of International Health at the Johns Hopkins Bloomberg School of Public Health, Associate Professor of Medicine and Biomedical Informatics at the University of Pittsburgh, and Senior Manager at Quintiles Transnational, working in biotechnology equity research at Montgomery Securities, and co-founding a biotechnology/bioinformatics company. My work has included developing computer approaches, models, and tools to help health and healthcare decision makers in all continents (except for Antarctica). This has included serving as the Principal Investigator of over $60 million in research grants from a wide variety of sponsors such as the National Institutes of Health (NIH), Agency for Healthcare Research and Quality (AHRQ), National Science Foundation (NSF), the Centers for Disease Control and Prevention (CDC), UNICEF, USAID, the Bill and Melinda Gates Foundation, and the Global Fund. I have authored over 250 scientific publications and three books. In addition to covering health, healthcare, and science for Forbes, I maintain a blog "A Funny Bone to Pick" for Psychology Today, a Substack entitled "Minded by Science"and have written articles forThe New York Times, Time, The Guardian, The HuffPost, STAT, the MIT Technology Review and others. My work and expertise have appeared in leading media outlets such as The New York Times, ABC, USA Today, Good Morning America, Tamron Hall Show, BBC, The Los Angeles Times, Newsweek, CBS News, Businessweek, U.S. News and World Report, Bloomberg News, Reuters, National Public Radio (NPR), National Geographic, MSN, and PBS. Follow me on Twitter (@bruce_y_lee) but dont ask me if I know martial arts.
Four years ago this month, schools nationwide began to shut down, igniting one of the most polarizing and partisan debates of the pandemic.
Some schools, often in Republican-led states and rural areas, reopened by fall 2020. Others, typically in large cities and states led by Democrats, would not fully reopen for another year.
A variety of data about childrens academic outcomes and about the spread of Covid-19 has accumulated in the time since. Today, there is broad acknowledgment among many public health and education experts that extended school closures did not significantly stop the spread of Covid, while the academic harms for children have been large and long-lasting.
While poverty and other factors also played a role, remote learning was a key driver of academic declines during the pandemic, research shows a finding that held true across income levels.
Theres fairly good consensus that, in general, as a society, we probably kept kids out of school longer than we should have, said Dr. Sean OLeary, a pediatric infectious disease specialist who helped write school reopening guidance for the American Academy of Pediatrics in June 2020.
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United Arab Emirates United Kingdom of Great Britain & N. Ireland Uruguay, Eastern Republic of Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam, Socialist Republic of Wallis and Futuna Islands Western Sahara Yemen Zambia, Republic of Zimbabwe
Our study provides first results on how the COVID-19 pandemics reshaping of the U.S. population is expected to repercuss into the future. Despite the general perception that the COVID-19 pandemic mainly affected old populations, our projections show that population pyramids will exhibit consequences of the pandemic until at least 2060. These rippling effects are expected when modeling the consequences of COVID-19 pandemic-induced changes in all three processes: mortality, fertility, and migration. We highlight three of the most important results from our study.
First, among the three demographic processes, the loss of net migration during the COVID-19 pandemic years is expected to have the biggest long-term impact on the size of the U.S. population. In light of concerns about below-replacement fertility and baby boomer cohorts reaching retirement age, migration represents one important mechanism for slowing down population aging. The number of resettled people in the U.S. has been declining since 1980 but declined even more dramatically after the Trump administrations 2017 Executive Order titled Protecting the Nation from Foreign Terrorist Entry into the United States6,28. Then, after the enactment of Title 42 in March 2020, immigration and resettlement to the U.S. reached the lowest level of the past forty years. Title 42 was harmful for hundreds of thousands of people and ultimately resulted in the expulsion of over 1 million migrants and asylum seekers at the U.S. border, a decision that had no clear statistical relationship with reducing COVID-19 cases19,29. Our results show that the decline in migration resulted in the loss of U.S. population at all ages, but especially at working and reproductive ages. This result highlights that the COVID-19 pandemics effect on migration is more consequential for population size than its effect on mortality, a finding that is consistent with a similar study on Spain8. Government policy responses during crises can have profound effects on the population, through entirely different channels than their desired effect.
Second, in the next four decades there is projected to be fewer reproductive-aged (1549 years old) people in the U.S. This is a result of fewer migrants in childbearing ages, as well as, to a lesser extent, COVID-19 pandemic deaths and second-order implications of migration and mortality for never-born children. Our estimates are likely conservative, as the effects of long COVID, or the prevalence of COVID-19 symptoms long after infection, remain to be seen. Long COVID is similar to other post-acute infections in its ability to cause health complications and disabilities30,31. While less is known about its mortality consequences, it stands to reason that long COVID will be a future contributor to premature deaths.
Third, the high mortality rates of the older age population during the COVID-19 pandemic have led to a small reduction in the U.S. dependency ratio. The magnitude of this reduction is attenuated by missing migration, which by itself would likely increase the dependency ratio. In 2025, almost one half of the reduction in the dependency ratio due to mortality is projected to be balanced out due to missing migration. The balance between population health and national economic stability remains a point of discussion in the U.S.32,33,34. The economic stimulus for COVID-19 pandemic relief and public health policies were important for alleviating the individual economic burden brought on by the COVID-19 pandemic and for aiding in the reduction of COVID-19 cases and mortality, but also placed extraordinary fiscal burden on the U.S. Our dependency ratio projections provide indicators for how demographic changes brought about by the COVID-19 pandemic might continue to affect public finances in the long-term. It should also be noted that, while the dependency ratio is projected to remain slightly smaller as an effect of the COVID-19 pandemic, dependence on working-age individuals may increase due to higher healthcare needs among the older population following the COVID-19 pandemic. Additionally, we note that our calculations of dependency ratio are relatively simplistic. More nuanced calculations of dependency ratios (e.g., the non-working-aged dependency ratio) necessitate estimations of the number of working vs. non-working people at each age35,36,37, and this data are not available in projected form from the UNWPP.
Although the UNWPP data represent a gold standard in terms of population projections, our counterfactual analysis is subject to three limitations. First, our findings are based on UNWPPs medium scenario, i.e., not the most aggressive or the most conservative estimate. As the baseline mortality, fertility, and migration rates and counts represent forecasts themselves, they are subject to uncertainty, which is carried over to our counterfactual estimates. We attempt to mitigate this by focusing on the difference between baseline and counterfactual scenarios. Thus, because mortality, fertility, and migration conditions are set to equal after 2024, there is little room for forecasting errors to compound over time, as these will mostly cancel out. Moreover, the published UNWPP forecasts for the year 2022 correspond well with preliminary estimates of mortality, fertility, and migration4,6,18, generating further trust in our baseline and counterfactual estimates for the COVID-19 pandemic period. Additionally, due to the nature of counterfactual analyses, it is not possible to truly know what observed rates and counts would have been in the absence of the COVID-19 pandemic. While we estimate these to the best of our ability, all analyses must be considered with this limitation in mind.
Second, our finding that changes in migration during the COVID-19 pandemic are projected to exert the biggest long-term effects on population size may partially be driven by the lack of adequate age- and sex-specific migration counts for the U.S. and the application of model migration schedules38 for both the baseline and the counterfactual scenario. We assume a family migration schedule, with migrants concentrated in young and working ages. This also means that the second-order effects of migration through never-born children are particularly large in our study. Immigration to the U.S. has traditionally been concentrated in working ages39 and it is plausible that the largest declines in migration during the COVID-19 pandemic occurred in these age groups. Although it is entirely possible that migration decreased more in other age-groups, including ages older than reproductive ages, existing data on foreign-born immigration to the U.S. indicate that different types of migration (i.e., refugees/asylum seekers, students, work visas, immigrant visas) were similarly affected during the COVID-19 pandemic6. Moreover, the enactment of Title 42 during the COVID-19 pandemic contributed to declines in migration to the U.S. and targeted a broad range of countries19,20,21,22. Thus, our decision to use similar migration schedules for our baseline and counterfactual scenario appears justified. While we are limited by the lack of migration data at smaller temporal windows (e.g., month or week), future work with better data availability might consider analyzing this to gain a more nuanced understanding of how these processes vary across other temporal dimensions.
Third, following UNWPP, we assume that mortality, fertility, and migration return to their pre-COVID-19 pandemic trajectories after a few years. There is inconclusive evidence about what signals the end of a pandemic or epidemic40, so it is possible that the assumptions from UNWPP are incorrect. Should that be the case, and mortality continue to remain higher than expected, and fertility and/or migration continue to remain lower than expected, then our estimates represent an underestimation. The indirect consequences of the COVID-19 pandemic may continue to negatively affect the U.S. mortality, fertility, and migration environments well into the future, and we are not able to measure these indirect consequences here. First, long COVID and unmet healthcare needs during the COVID-19 pandemic may increase the risk of mortality in the long run. Other consequences of the COVID-19 pandemic, such as the loss of next of kin41, learning loss42, or racist and xenophobic behavior against Asians and Asian-Americans43,44 may also exert negative effects on population health and mortality for generations to come. Second, the experience of economic uncertainty and stress related to the balancing of work and childcare obligations during the COVID-19 pandemic may have raised doubts among some couples about having (additional) children in the future45,46. Finally, migration to the U.S. may remain below expected levels in the future, as some individuals who would have migrated to the U.S. may have died during the COVID-19 pandemic, or established families in their country of origin or other countries with less restrictive migration policies. Based on these reflections about the potential long arm of the COVID-19 pandemic, the findings presented in this manuscript, which assume a short pandemic shock, most likely represent a lower bound.
Despite these limitations, our approach is valuable because it considers the interacting effects of changes to population processes. The U.S. will face a variety of public health challenges in the coming years that may have long-lasting effects on the population size and structure, and the COVID-19 pandemic is just one of these challenges. The maternal health and midlife mortality crises are likely to affect the U.S. population through multiple avenues. Demographic predictions warn that a total abortion ban could lead to excess pregnancy-related deaths of nearly 25%47,48, while other work suggests that it may have consequences for in-vitro fertilization rates, contributing to a decline in number of births49. Additionally, if the midlife mortality crisis in the U.S. persists50,51, and if rising mortality rates from the opioid epidemic are not curtailed, then deaths among reproductive-aged people will continue to rise, resulting in fewer people at young adult and midlife ages. Applying the cohort component projection method to these crises will be valuable for understanding the magnitude of their consequences for the U.S. population. It will also be valuable to apply this approach to other countries (beyond Spain and Australia8,9), as the COVID-19 pandemic unequally affected each nation.
The consequences of the COVID-19 pandemic are not over. They ripple beyond immediate, independent changes to mortality, fertility, and migration to affect the population structure of the United States for decades to come. It is thus important to move from process-specific models to a broader and more informative approach that accounts for co-occurring disruptions in mortality, fertility, and migration. As this paper shows, such a design is a powerful tool for quantifying the relative size of different effects of the COVID-19 pandemic and for projecting their effects over time. Because the United States is known for having exceptionally high COVID-19 mortality52, it is important to note that COVID-19 pandemic-induced migration changes are projected to have a comparatively large and longer-lasting effect on population size.
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A rogue governor who seized power despite repeated attempts by the legislature to stop him. Reckless and politicized government scientists who ran a media smear campaign against peers and citizens who challenged their policies. Carnage to the mental health, well-being, and financial fortunes of millions of Americans, especially children.
Four years ago, former Democratic Gov. Tom Wolf ordered all non-life-sustaining businesses in Pennsylvania to close their doors to slow the spread of COVID-19. The week prior, he shut down all Pennsylvania schools. The governor was empowered to take these unilateral actions under the Proclamation of Disaster Emergency he signed on March 6, 2020.
Wolfs actions seemed sensible at first. A deadly virus was sweeping the world, killing even the young and healthy. The government scientists at the Centers for Disease Control and Prevention said it would just take 15 days to flatten the curve of COVID and save lives. Who wouldnt want to save lives? A two-week shutdown seemed right.
But Wolf would not stop at two weeks. After his initial 90-day emergency declaration was set to expire, he extended it for over a year. During that time, Wolf ignored his own legislatures votes to limit his power. He defied a federal judges ruling that his actions were unconstitutional. After 15 months, Pennsylvanians ended Wolfs authoritarian reign through a successful ballot initiative, limiting a governors ability to use emergency powers.
It was a rare instance where citizens were able to exert control over a chaotic, dangerous, and powerful government bureaucracy that politicized a pandemic and upended lives.
Pennsylvanians could rein in politicians but entrenched federal bureaucracies they could not. No bureaucracy eroded public trust during the pandemic quite like the CDC. The health agency made and directed policies that were based on faulty information and, as whistleblowers would report, refused to change course, even when presented with truthful information.
To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing, to data, to communications, said CDC director Rochelle Walensky. None more so than the CDCs dogmatic insistence on the six-foot social distancing requirement that upended American society. Despite evidence presented by scientists that three feet would suffice for social distancing, then CDC head Anthony Fauci refused to change protocols.
Of course, the CDC was going to make missteps in a fast-moving pandemic. The problem is that when presented with evidence to counter their policies, the CDC became dogmatic and political.
That entrenched bureaucracy led by Fauci and aided and abetted by the Biden administration sought to undermine, silence, and discredit dissenters. Independent journalists were able to scour Twitters (now Xs) files after Elon Musk bought the company. What those journalists uncovered was more akin to 1950s Moscow KGB tactics than what we would expect in a free society.
Thanks to Musk, independent journalist Matt Taibbi was able to uncover the Biden administration pressuring with success Twitter executives to elevate or suppress information that, Taibbi said, was true but inconvenient.
But the worst act of Faucis attempts to discredit and undermine those opposing him was his response to the Great Barrington Declaration. In October 2020, three epidemiologists Martin Kulldorff of Harvard, Sunetra Gupta of Oxford, and Jay Bhattacharya of Stanford challenged the CDC and called for a more balanced and measured approach.
Time would prove the Barrington doctors right. But at the time, Fauci and Francis Collins, the head of the National Institutes of Health, had an email exchange in which they discussed a devastating takedown to undermine and discredit Bhattacharya and the others as fringe doctors. What followed was a slew of coverage in the Washington Post, the New York Times, ABC News, and other outlets undermining the Barrington doctors credibility.
The disinformation campaign against Kulldorff, Bhattacharya, and others led them to file a lawsuit against the federal government and public health leaders. In the lawsuit, the plaintiffs contend that Fauci coordinated directly with Facebook and/or other social-media firms to suppress disfavored speakers and content of speech on social media.
Our children were the most impacted. In 2021, 42% of high school students reported persistent sadness and hopelessness. Depression and despair were highest among female and LGBTQ students. During the same time, the Mayo Clinic reported higher rates of suicidal ideation, self-harm, eating disorders, and substance abuse among minors than in previous years.
For science to be trusted, it requires questions and doubts. So, too, for the government. Many Americans raised objections and questioned the CDCs data and its use of it to infringe on civil liberties. Those people were demonized and discredited. Fauci said those who challenged the CDC were ignoring science. Ugly smear campaigns against the people who had the courage to speak truth to power should not be forgotten.
While COVID-19 may no longer be a global threat, an increasingly authoritarian government still is.
