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When the COVID-19 pandemic arrived, it brought with it fear and plenty of befuddlement. While it let some get away with a sniffle, it landed many in the hospital. And turns out, this diabolicity extends to all of the infernal coronaviruses in the trouble-making family.
The COVID-19-causing SARS-CoV-2 is easily the most popular of the coronaviruses, for very obvious reasons, with SARS and MERS being other note-worthy names in the family. While these troublemakers can cause serious illness, there are plenty that cause the harmless common cold. But why the vast difference? A new AI study might have finally cracked the code, and it has everything to do with "zombie" virus bits.
Zombie viruses are exactly what they sound like fragments of the once lethal virus left after it was slayed. Now, a UCLA study used AI to track how SARS-CoV-2 gets broken down in the body. And turns out, when it comes to SARS-CoV-2, the broken bits of this particular virus look suspiciously like human immune system molecules. Then, these tiny impostors fool the body into overreacting, leading to that out-of-control inflammation we see in severe cases!
These zombie fragments are unique to SARS-CoV-2, and not found in its harmless cold-causing cousin. They even trigger similar gene expression as the whole virus, even though it's just tiny bits! This suggests they might be the culprits behind the variable severity of COVID-19, explaining why some people barely notice it while others are left fighting for their lives.
Interestingly, the study also points to individual differences in enzyme efficiency as another key player. How well you break down foreign particles can determine how mild or severe your illness is. Some people are enzyme ninjas, dismantling the virus effortlessly, while others struggle, leaving harmful fragments to wreak havoc.
While this study is a major breakthrough, there's still much to uncover. What exactly do these "zombie" fragments do? Can we target the enzymes responsible for creating them? Could this lead to new treatments for COVID-19 and other diseases? Only time and more research will tell.
However, this research offers a fascinating glimpse into why COVID acts so differently in different people. It also opens exciting possibilities for future treatments that target these "zombie" fragments and prevent them from causing harm.
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An estimated 5.8 million children nationwide have dealt with theeffects of long COVID,from common symptoms such as fatigue and cough to neurological and autoimmune conditions,according to a new report from Columbia University's Irving Medical Center.
While the majority of young people who get COVID-19 recover quickly, some experience symptoms that can persist for months and even years, although the data on these cases, experts say, is still emerging.
We're behind in people understanding and really recognizing that [long COVID] does actually happen in children, saidDr. Melissa Stockwell, a pediatrician and chief of the Division of Child and Adolescent Health at Columbia, whoco-authored the report. As pediatricians, we're really concerned about that because, for some kids, it could be mild. But for others, there's highly debilitating symptoms that are really affecting their quality of life. It's hard to attend school or focus when they're in school. It's impacting their ability to play with their friends and do all the activities that we know are really important for their development.
The Centers for Disease Control and Prevention defines long COVID as ongoing health problems four or more weeks after initial infection.
The estimate of 5.8 million with long COVID is based on the fact that nearly 20% of adultswho reported contracting the virushad symptoms three months later, and about 18% of all COVID cases were children, according tofederal surveys analyzed by the CDC.
There are no definitive blood tests or bio markersthat allow doctors to test for long COVID, nor is there data on how many New Yorkershave dealt with the condition,although Stockwell suspects the number is sizable.
The scientific community has acknowledged an urgent need to understand more about [long COVID] in children, according to the report, which will be published Wednesday in the Journal of the American Academy of Pediatrics.Although [long COVID] can affect any individual, populations deserving specific focus include children with intellectual and developmental disabilities, children with medical complexity, andthose with prolonged debilitating symptoms.
The majority of published research on long COVID has focusedon adults, with limited information on the pediatric population. Ongoing research, Stockwell said, will examine why some children develop the long-term ailment and others do not.
There are only about a dozenpediatric post-COVID-19 programs nationwide, including one in Brooklyn. Stony Brook University's post-COVID Clinic in Lake Grove has seen roughly 1,500 adult patients, officials said, but does not see children.
The Columbia study indicates that fatigue and malaise are the most common manifestations of pediatric long COVID, along with shortness of breath, respiratory andgastrointestinalissues, difficultyconcentratingand mental health concerns.
But the study also finds that children living withlong COVID can face less common conditions, including type 1 diabetes; brain fog; chronic fatigue syndrome; autoimmune diseases such aslupusand multisystem inflammatory syndromein children, which results from a hyperinflammatory response to the virus observed two to six weeks after infection.
Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Childrens Hospital,said it's likely the virusjump-starts the potential for severe illness in manylong COVID patients.
I don't think of it as one illness, she said. I think you have a potential to have a problem in your future, perhaps an autoimmune or arthritis problem or a neurological problem. And this virus jump-started that potentiation for illness into a real illness.
Concetta Van Winckel, of Fort Salonga, said her 9-year-old daughter, Evelyn, has finally recovered after suffering with the symptoms of long COVID for about seven months.
When Evelyn tested positive for COVIDin October 2021, she had pain in several parts of her body, along with fatigue, her mother said. The fatigue failed to immediately subside and the pain, which went away for about a week, returned worse than before, preventing the fourth-grader from being touched at all, she said.
After monthsof physical and occupational therapy, acupuncture and massage treatment,Van Winckel said, Evelyn isnow 100%, although I think sometimes emotionally she's a little bit different.
And while Evelyn, who is taking part in an ongoing Columbia study on pediatric long COVID patients,is now healthy enough to play soccer goalie, the fear of a re-emergence is ever-present.
We don't know what will happen if she gets COVID again,Van Winckel said. We still live in fear of that.
Robert Brodsky is a breaking news reporter who has worked at Newsday since 2011. He is a Queens College and American University alum.
For four years now, either as a physical virus or as a looming threat, the COVID-causing pathogen SARS-CoV-2 has been the elephant in every roomsometimes confronted and sometimes ignored but always present. While once we dreamed of eradicating COVID, now much of society has resigned itself to SARS-CoV-2s constant presencea surrender that would once have been unthinkable.
Worldwide, there were more than 11,000 reported deaths from COVID between mid-December 2023 and mid-January 2024, and more than half of those deaths occurred in the U.S. In that same time frame, nearly one million cases were reported to the World Health Organization globally (although reduced testing and reporting means this is likely a vast undercount). In particular, epidemiologists are monitoring the newest variant of SARS-CoV-2, JN.1, and looking for any signs that it may be more severe than previous strains.
Although the WHO declared an end to the COVID public health emergency in May 2023, the organization has emphasized that the pandemic isnt overits just entered an endemic phase, which means that the virus will continue to circulate indefinitely. Throughout the past four years, Maria Van Kerkhove, now interim director of the WHOs Department of Epidemic and Pandemic Preparedness and Prevention, has helped lead the agencys response to COVID. Scientific American spoke with Van Kerkhove about entering the fifth year of a pandemic that many want to ignore despite its permanent impact on lives around the world.
If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.
[An edited transcript of the interview follows.]
How would you describe the overall state of COVID at this point in the pandemic?
COVIDs not in the news every day, but its still a global health risk. If we look at wastewater estimates, the actual circulation [of SARS-CoV-2] is somewhere between two and 20 times higher than whats actually being reported by countries. The virus is rampant. Were still in a pandemic. Theres a lot of complacency at the individual level, and more concerning to me is that at the government level.
Lack of access to lifesaving tools such as diagnostics, therapeutics and vaccines is still a problem. Demand for vaccination is very low around the world. The misinformation and disinformation thats out there is hampering the ability to mount an effective response. So we feel theres a lot more work to do, in the context of everything else[we no longer have a] COVID lens only, of course, but using masks for respiratory pathogens that transmit through the air is a no-brainerplus vaccination, plus distancing, plus improving ventilation. People are living their life; were not trying to stop anyone from doing anything, but were trying to work with governments to make sure they do that as safely as possible.
We dont know everything about this virus. Even in year five, theres still a lot of research that needs to be done.
Whats it like emotionally to be so deep in trying to understand and respond to the pandemic?
Its pretty incredible. I mean, I cant believe were entering year five of COVID.
There are some massive mental health impacts, globally, that were not dealing with. Im dealing with my own, which Im only now starting to reflect upon. I didnt give it a chanceI didnt have the opportunity to give time to itbut now Im actually taking some time because this is not normal. The COVID pandemic was not normal. This amount of death is not normal. It didnt have to be this way.
Instead of What should we have done differently? I say, What can we do differently today? I feel so determined to really keep this marathon up. Maybe its not in the news, but our work hasnt stopped. Its heavy, I would say. Its a lot, and I dont want to sugarcoat it.
You mentioned the mental health impacts that were neglectingwhat would you like to see the world do on that front?
I am very pleased to see the global focus on mental health and really recognizing the unintended consequences of the interventions that many countries put in place [to contain the virus]. Theyve had massive impacts: societal impacts, social impacts, economic impacts and mental health impacts. Access to mental health services is improving, but it has a long way to go. The wait lists to see mental health professionals are very long, and these experts are not available in every country. I think the stigma associated with mental health is decreasing, and I think thats important. The isolation and the loneliness that weve seen, the social anxiety people have [when] coming back togethera lot of this needs to be evaluated. Theres a lot of room for improvement.
I also dont think weve mourned the loss of the more than seven million livesthat we know of. [The figure is] probably three times higher. This virus has touched every single person and family, and its changed the trajectory of peoples lives. People who were forced to remain home and in violent situations, children who were out of school, some of whom will never go back, especially young girls who were married off or have children nowthis has changed futures. People are resilient, but I dont think weve really mourned the loss.
Do you have advice for people looking to strike that balance between taking preventative measures but also living their life, particularly amid governmental complacency?
Were asking you to stay home if youre unwell but also seek medical care if you need to seek medical care. Get tested so that you can get the right treatment course. Wear masks when youre in crowded places. If youre going to be around older people, test yourself before you go; use a self-testthings such as that.
But thats not enough. Governments need to provide tests, and those tests need to be available either at a reduced cost or free. Masks need to be available. If I say, Get a test, where are you going to get one? Can you afford one? If I say, Make sure you get treatment, where are you going to get that?
Its not enough for me to tell individuals [these things]. What I tell my own family, what I say publicly, is Take measures every day as a precaution. But its also our work as WHO to work with governments to ensure that they keep up the surveillance [of viral threats], that they keep up good communication, that they provide treatments, that they provide tests, that they provide vaccines and that they improve ventilation.
So its a two-sided coin, what we want individuals to do and what we want governments to do.
Do you have any predictions for COVID in the coming year?
We dont do predictionswhat we do is we plan for scenarios. Our concern is a variant thats highly transmissible, that is more severe and that has significant immune escape, which [would mean that people would] really need to get revaccinated right away. And thats one of the scenarios that we plan for, which is why systems have to be in place that you can scale up or scale down.
And of course, the worry is complacency. The worry is reduced fiscal space, mental space and political space to talk about COVID in the context of everything else. I am not suggesting that the world drop what its doing and focus [only] on COVID. That is not what WHO is suggesting. Were saying, Please dont drop the ball. The virus is here. Its evolving. its killing. Its causing post-COVID conditions [also called long COVID]. And we dont know the long-term effects. Its a virus that is here to stay.
I read that half the global population has a major election this year. How does that play into the COVID landscape?
Its always an election year. Absolutely elections play a role because [theres a risk of] outbreaks, and certainly COVID has been politicized. This has been a major factor in the past four years. But pandemics outlive any election cycle.
All of the COVID interventions have been politicized and with huge amounts of misinformation and disinformation that spreads faster than viruses. And misinformation, disinformation and politicization kill.
Are there any other things youd like people to know about COVID right now?
I think its important that we continue to talk about it. We understand you dont want to hear about it. I dont want to talk about it. But we need to because theres more we can do. We cannot prevent all infections. We cannot prevent all deaths. But theres a hell of a lot more that we can do to really keep people safe and save them from losing a loved one.
Following the emergence of SARS-CoV-2 in 2020 there are now seven different coronaviruses known to infect humans. Four of those are associated with generally harmless common respiratory infections, but the other three (SARS, SARS-CoV-2 and MERS) are much more dangerous.
Why some coronaviruses are relatively harmless while others are incredibly lethal is still a bit of a mystery. Some answers lie in the proteins each individual virus uses to enter human cells, but what exactly makes SARS-CoV-2 so severe in some people and innocuous in others is unclear.
An impressive new study led by researchers from UCLA is offering a novel hypothesis to explain SARS-CoV-2 severity. Using an AI-driven machine-learning system the researchers discovered SARS-CoV-2 is broken down into fragments in a human body, and this viral debris can uniquely resemble endogenous peptides that overstimulate the immune system. This may play a significant role in the strange variable severity of disease from person to person.
The textbooks tell us that after the virus is destroyed, the sick host wins, and different pieces of virus can be used to train the immune system for future recognition, says corresponding author Gerald Wong.
But the story of a virus isnt exactly as simple as that. After a virus is neutralized by the immune system it is rapidly broken down, or dissolved, into tiny fragments. It has generally been assumed this stage of viral degradation was innocuous, but recent research has suggested some of these smaller viral fragments could trigger innate immune responses that account for severe disease associated with hyper inflammation.
To investigate this idea in the context of COVID, the researchers tracked all the possible peptide combinations that could be created through the degradation of SARS-CoV-2 proteins. They used a machine-learning system to measure the pro-inflammatory characteristics of all these potential peptides and discovered several of these viral fragments closely resemble molecules our immune system uses to heighten inflammatory responses.
We saw that the various forms of debris from the destroyed virus can reassemble into these biologically active zombie complexes, explains Wong. It is interesting that the human peptide being imitated by the viral fragments has been implicated in rheumatoid arthritis, psoriasis and lupus, and that different aspects of COVID-19 are reminiscent of these autoimmune conditions.
The researchers then directly compared these SARS-CoV-2 viral fragments to debris that comes from a more harmless common-cold-causing coronavirus (HCoV-OC43). The fragments were very different, and the OC43 debris was found to not at all stimulate the immune system in the same way as SARS-CoV-2.
Even more interestingly, the researchers looked at what kinds of gene expression were stimulated by these SARS-CoV-2 viral fragments. These novel peptides were found to trigger similar patterns of expression to the full virus.
Whats astonishing about the gene expression result is there was no active infection used in our experiments, Wong notes. We did not even use the whole virus rather only about 0.2% or 0.3% of it but we found this incredible level of agreement that is highly suggestive.
So these findings may somewhat account for why SARS-CoV-2 triggers more severe disease than its common-cold coronavirus counterparts. But the study can only speculate as to why the viruss effects are so variable from person to person.
Here the researchers indicate the striking uniqueness in each individual persons enzyme efficiency could likely account for why some people dont even notice they have COVID, while others end up struggling in hospital. Essentially, each of us break down foreign particles differently, and these unique differences may be responsible for how mild our illness is.
... proteolytic degradation of SARS-CoV-2 is likely to be heterogeneous, as individual hosts display distinctive patterns of enzyme efficiencies varying routinely by fourfold to 50-fold, with protein expression being 'noisy' even at the single cell level, the researchers write in the new study. That proteolytic degradation of SARS-CoV-2 is expected to be drastically different among hosts may explain why the infection outcomes of SARS-CoV-2 are so heterogeneous, ranging from asymptomatic hosts to fatalities.
The idea that viral fragments can linger in the body and cause persistent longer-term health problems is still relatively new. Over the last few years there has been emerging evidence showing viral debris from influenza causing long-term lung disease in some people, for example. But what these findings actually mean for potential future treatments is still unknown.
Wong does speculate the possibility that diseases such as COVID could be treated by inhibiting the actions of certain enzymes that are responsible for breaking the virus down into its more harmful components. Of course, to get to that point there will need to be lots more work done to systematically study exactly how certain viral fragments are created.
The new study was published in PNAS.
Source: UCLA
By Katheryn Houghton February 5, 2024
ITS BEEN REVEALED THAT FAUCI BROUGHT COVID TO THE MONTANA ONE YEAR BEFORE COVID BROKE OUT IN THE U.S!
An ad from the Matt Rosendale for Montana campaign
A fundraising ad for U.S. Rep. Matt Rosendale (R-Mont.) shows a photo of Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, behind bars, swarmed by flying bats.
Rosendale, who is eyeing a challenge to incumbent Sen. Jon Tester, a Democrat, maintains that a Montana biomedical research facility, Rocky Mountain Laboratories in Hamilton, has a dangerous link to the pandemic. This claim is echoed in the ad:
Its been revealed that Fauci brought COVID to the Montana one year before COVID broke out in the U.S!, it charges in all-caps before asking readers to Donate today and hold the D.C. bureaucracy accountable!
The ad, paid for by Matt Rosendale for Montana, seeks contributions through WinRed, a platform that processes donations for Republican candidates. Rosendale also shared the fundraising pitch on his X account Nov. 1, and it remained live as of early February.
Rosendale made similar accusations on social media, during a November speech on the U.S. House floor, and through his congressional office. Sometimes his comments, like those on the House floor, are milder, saying the researchers experimented on a coronavirus leading up to the pandemic. Other times, as in an interview with One America News Network, he linked the labs work to covid-19s spread.
In that interview clip, Rosendale recounted pandemic-era shutdowns before saying, And now were finding out that the National Institute of Health, Rocky Mountain Lab, down in Hamilton, Montana, had also played a role in this.
Rosendales statements echo broader efforts to scrutinize how research into viruses happens in the United States and is part of a continued wave of backlash against scientists who have studied coronaviruses. Rosendale is considering seeking the Republican nomination to challenge Tester, in a toss-up race that could help determine which party controls the Senate in 2025. Political newcomer Tim Sheehy is also seeking the Republican nomination for the Senate.
Rosendale proposed amendments to a health spending bill that would ban pandemic-related pathogen research funding for Rocky Mountain Laboratories and cut the salary of one of its top researchers, virologist Vincent Munster, to $1. The House has included both amendments in the Health and Human Services budget bill that the Republican majority hopes to pass. A temporary spending bill is funding the health department until March.
We contacted Rosendales congressional office multiple times with emails, a phone call, and an online request asking what proof he had to back up his statements that the Montana lab infected bats with covid from China before the outbreak. We got no reply.
Kathy Donbeck, of the National Institute of Allergy and Infectious Diseases Office of Communications and Government Relations, said in an email that the ads claims are false. Interviews with virologists and a review of the research paper published shortly before Rosendales assertions support that position.
Where This Is Coming From
Rosendales statements seem to stem from a Rocky Mountain Laboratories study from 2016 that looked into how a coronavirus, WIV1-CoV, acted in Egyptian fruit bats. The work, published by the journal Viruses in 2018, showed that the specific strain didnt cause a robust infection in the bats.
The study did not receive widespread attention at the time. But on Oct. 30, 2023, the study was highlighted by a blog called White Coat Waste Project, which says its mission is to stop taxpayer-funded experiments on animals. Some right-wing media outlets began to connect the Montana lab with the coronavirus that causes covid.
Rosendales office issued an Oct. 31 news release saying the Wuhan Institute of Virology in China shipped a strain of coronavirus to the Hamilton lab. Our government helped create the Wuhan flu, then shut the country down when it escaped from the lab, Rosendale said.
Its a Different Virus
Rocky Mountain Laboratories is a federally funded facility as part of NIAID, the nations top infectious disease research agency, which Fauci led for nearly 40 years.
According to the study and Donbecks email, the Montana researchers focused on a coronavirus called WIV1-CoV, not the covid-causing SARS-CoV-2. Theyre different viruses.
The genetics of the viruses are very different, and their behavior biologically is very different, said Troy Sutton, a virologist with Pennsylvania State University who has studied the evolution of pandemic influenza viruses.
In a review of media reports on the Montana study, Health Feedback, a network of scientists that fact-checks health and medical media coverage, showed the viruss lineage indicated that WIV1 is not a direct ancestor or even a close relative of SARS-CoV-2.
Additionally, the description of the coronavirus strain as being shipped suggests that it physically traveled across the world. Thats not what happened.
The Wuhan Institute of Virology provided the WIV1 viruss sequence that allowed researchers to make a lab-grown copy. A separate study, published in 2013 by the journal Nature, outlines the origins of the lab-created virus.
According to the studys methodology, the researchers used a clone of WIV1. An NIAID statement to Lee Enterprises, a media company, said the virus was generated using common laboratory techniques, based on genetic information that was publicly shared by Chinese scientists.
Stanley Perlman, a University of Iowa professor who studies coronaviruses and serves on the federal advisory committee that reviews vaccines, said Rosendales claim is off-base.
He said Rosendales focus on where the lab got its materials is irrelevant and serves only to make people wary and scared.
Rosendales efforts to prohibit particular research at Rocky Mountain Laboratories appear ill-informed, too. Rosendale targeted banning gain-of-function research, which involves altering a pathogen to study its spread. In her email, NIAIDs Donbeck said the Rocky Mountain Laboratories study didnt involve gain-of-function research.
This type of research has long been controversial, and people who study viruses have said the definition of gain of function is problematic and insufficient to show when research, or even work to create vaccines, could cross into that type of research.
But both Sutton and Perlman said that, any way you look at it, the Rocky Mountain Laboratories study published in 2018 didnt change the virus. It put a virus in bats and showed it didnt grow.
And it had no effect on the covid outbreak a year later, first detected in Washington state.
Our Ruling
Rosendales ad said, Its been revealed that Fauci brought COVID to the Montana one year before COVID broke out in the U.S! The campaign ad and Rosendales similar statements refer to research at the Rocky Mountain Laboratories involving WIV1, a coronavirus that researchers say is not even distantly close in genetic structure to SARS-CoV-2, the virus that caused covid-19.
Rosendales claim is wrong about when the scientists began their work, what they were studying, and where they got the materials. The researchers began their work in 2016 and, although they were studying a coronavirus, it wasnt the virus that causes covid. The Montana scientists used a lab-grown clone of WIV1 for their research. The first laboratory-confirmed case of covid was not detected in the U.S. until Jan. 20, 2020. Rosendales ad is inaccurate and ridiculous. We rate it Pants on Fire!
Viruses, SARS-Like Coronavirus WIV1-CoV Does Not Replicate in Egyptian Fruit Bats (Rousettus aegyptiacus), Dec. 19, 2018
White Coat Waste Project, Horror Show: Shady Zoo Sent Bats to NIH to Be Infected With a Wuhan Lab Coronavirus, Oct. 30, 2023
MattForMontana X post, Nov. 1, 2023
Campaign ad, accessed Dec. 14, 2023
Rep. Matt Rosendale, House floor speech, Nov. 14, 2023
One America News Network, interview, accessed Dec. 14, 2023
Rosendale congressional office, Rep. Rosendale Reacts to Reports That Wuhan Lab Shipped Coronavirus to Fauci-Run Lab in Hamilton Prior to Pandemic, Oct. 31, 2023
National Institute of Allergy and Infectious Diseases, History of Rocky Mountain Labs (RML), accessed Dec. 14, 2023
Email exchange with NIAID, beginning Dec. 14, 2023
Statement from NIAID provided to Lee Enterprises, accessed Jan. 2, 2024
Nature, Isolation and Characterization of a Bat SARS-Like Coronavirus That Uses the ACE2 Receptor, Oct. 30, 2013
Ravalli Republic, Rosendale Moves to Strip Rocky Mountain Lab Research Funding, Nov. 17, 2023
Interview, Troy Sutton, assistant professor of veterinary and biomedical sciences at Pennsylvania State University, Jan. 5, 2024
Interview, Stanley Perlman, professor of microbiology and immunology and professor of pediatrics at the University of Iowa, Jan. 13, 2024
FDA, Roster of the Vaccines and Related Biological Products Advisory Committee, accessed Jan. 16, 2024
Health Feedback, 2018 Coronavirus Research in NIAID Montana Lab Is Unrelated to the COVID-19 Pandemic, Contrary to Claim by Fox Newss Jesse Watters, last accessed Jan. 17, 2024
Email exchange with OpenSecrets, an independent research group tracking money in politics, beginning Jan. 30, 2024
CDC Museum COVID-19 Timeline, accessed Feb. 2, 2024
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Many people with COVID-19 seem able to move on with their lives with relative ease after a few uncomfortable days, or maybe a couple weeks.
But sleep issues in the months following COVID-19 may be a bigger issue than has been reported in earlier long COVID research.
For a study published on February 4, 2024, in Frontiers of Public Health, scientists in Vietnam surveyed more than 1,000 people who had recovered from COVID-19 that did not require hospitalization; none had a prior history of insomnia or psychiatric conditions.
Just over 76 percent reported experiencing insomnia within six months after their initial infection, the researchers found. Of those patients, nearly 23 percent said their insomnia was severe.
The results of the current study confirm the high prevalence of insomnia in COVID-19 survivors with none or mild symptoms who did not require hospitalization, wrote Huong Thi Xuan Hoang, an investigator at the school of nursing at Phenikaa University in Hanoi, Vietnam, and her study coauthors.
Hoang and her research team noted that among the study participants, those with depression or anxiety were more than 3 times as likely to have insomnia. They also observed a statistically higher rate of insomnia in the nearly 12 percent of study subjects who had preexisting chronic conditions, such as cardiovascular disease, diabetes, and cancer.
For the analysis, 1,056 adults (average age 33 and just over two-thirds were female) completed a survey between June and September 2022 asking how well they slept, how long they slept, and how easy it was to fall asleep in the last two weeks compared with before contracting COVID-19.
The survey also measured symptoms of anxiety, depression, and stress, and captured patient characteristics, including age, sex, chronic conditions, and severity of COVID illness.
Half the participants said they woke more often in the night post-infection, while one-third said they found it harder to fall asleep, slept worse, and slept for less time.
Hoang and her collaborators highlighted that the severity of infection did not seem to correspond with the severity of sleep disruption.
They also recognized certain limitations in the study; for instance, it was based on data reported by participants (versus data from researchers direct observations). They also point out that the research didnt prove that COVID-19 causes insomnia, but simply that there is an association.
If youre having trouble with insomnia in the wake of COVID-19, dont ignore it, experts say: Get help.
The whole point [of the study] is that COVID, even if its mild, may be linked with insomnia, saysAbhinav Singh, MD, medical director of the Indiana Sleep Center in Greenwood and clinical assistant professor at Marian University College of Medicine in Indianapolis. People who have had COVID need to be aware of this and seek help early for their insomnia. Dont let this problem germinate. Dont sleep on your sleep problems. Seek action early and get back to sleeping well.
Dr. Singh, who was not involved in the study, confirms that addressing sleep problems may be especially pressing for those with mental-health issues such as depression and anxiety, who can be more prone to insomnia. Priorresearch has demonstrated that optimal sleep is connected with high levels of well-being.
In cases of mild insomnia, Hoang and her study co-authors wrote in their paper, better sleep may result from simple actions, such as taking a warm shower before bedtime, shutting your phone down at least one hour before going to bed, doing 30 minutes of exercise per day (but not close to bedtime), and avoiding caffeine after 4 p.m.
Over-the-counter sleep aids may help, but if insomnia persists, a person should see a doctor or sleep therapist.
For those seeking help from a medical professional, Singh calls cognitive behavioral therapy (CBT) the gold standard of insomnia treatment. CBT focuses on identifying thoughts, feelings, and behaviors that are contributing to symptoms of insomnia.
Sleep is life, Singh says. Your body needs sleep to survive. If youve lost it, that means something has come in the way and we have to find what it is and remove it.
Although the current COVID-19 wave of infections with the JN.1 subvariant of Omicron peaked on the eve of the new year, the latest data on SARS-CoV-2 wastewater concentration reported byBiobot Analyticsindicates rates have plateaued at around 821 copies per milliliter, which is considered a very high level. A second peak is anticipated in mid-February before infection rates begin to decline for the winter.
Modeling by clinical psychologist Dr. Mike Hoerger of Tulane University, who also teaches statistics and research methodology to medical professionals, through hisPandemic Mitigation Collaborative, estimated that this corresponds to more than 1.2 million daily infections, 8.5 million infections for the preceding week with anticipated Long COVID cases among these numbering from 426,000 to 1.7 million.
The total cumulative number of infections in 2024 is projected at approximately 41 million people. Given almost 100 million were infected by the end of December in the winter wave, it is reasonable to assume that by the end of the winter wave at least half of the country will have been infected at least once. It would also be reasonable to assume that a majority of these are reinfections. Hoergers estimates place the average number of infections in the US at around 3.2 times per person.
Despite these horrific figures, hardly any news media, let alone the Centers for Disease Control and Prevention (CDC) or White House, is offering any semblance of a warning to the population let alone the scale of the public health crisis that is sweeping over the population.
The infected have to go it their own relying on family or friends and neighbors, if at all, to care for themselves. All the while they will be negotiating with their employers for time off that will be deducted from their paid time off, if they have any. But even these limited measures to protect oneself and others are being curtailed by the demands of industry and not on any objectively scientific or clinical recommendations.
For example, Californias Department of Public Health, aligning their practice with other respiratory viruses, issued newrulesin January that eliminated isolation requirements for asymptomatic COVID-positive students and most workers and limited isolation periods to 24 hours for those with mild symptoms. These regulations make a mockery of any basic idea of infection control with a virus that has a propensity to infect every organ in hosts whose immunity is limited to a brief few weeks after previous vaccination or infection and then against severe disease.
Lisa Wilson, a mother of a disabled student at Berkeley Unified High School, upon hearing of the states January 9 recommendations which many public-school districts across the state have readily adopted, told the local press, The departments recommendations have no basis in public health epidemiology infected but asymptomatic students are still contagious. Their politically driven policies will only lead to more disability and death.
The impact of the ending of the emergency phase of the pandemic last May is coming into view. This meant a rapid turn to abandoning all public health measures and defunding of the ability of health agencies and health systems to respond to public health threats. As a consequence, not only is COVID continuing to cause significant harm to the population, but previously checked diseases that had nearly been forgotten are once more erupting on the world stage. In particular, the emergence of measles should stand as a disturbing development and a warning that priorities need to be redirected to protecting populations.
One must ask, is Californias Department of Public Health correct to lump COVID with other respiratory viruses such as the flu? It would bear reviewing the clinical data between these two pathogens during the Pirola phase of COVID.
Biobot Analytics data also showed that wastewater concentrations for both influenza A and B peaked at the same time as SARS-CoV-2.
According to the CDCs Weekly US Influenza SurveillanceReport, since the flu season began in early September, there were nearly 160,000 people hospitalized for influenza infection. There were more than 460,000 COVID admissions in the same period. The peak of flu deaths occurred on the last week of 2023 with 771 deaths reported. During the same week, the CDC registered 2,250 COVID deaths, or a figure almost three times higher.
While the 2023/2024 flu-season has claimed 5,434 people, COVID-19 has killed 27,671 in the same time frame. Also, very compelling data from Greg Travis, who maintains the onlyexcess death trackerfor the United States, showed that between 2022 and 2023, around 960 children 17 years old and under died from COVID. By comparison, 248 children died in the last two flu seasons.
However, given the lifting of mandates for reporting by health systems to the CDC on COVID admissions and deaths, even these horrific figures can be construed as under-counts, underscoring the dangers posed by COVID to the elderly and infirm, who are effectively being euthanized by the inhuman policies that have prioritized finances over survival.
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Additionally, the low rates of death from the flu during the first two years of the COVID pandemic, a byproduct of near universal masking and social distancing during the first phase of coronavirus, demonstrates that these respiratory pathogens can be eliminated and lives protected. But these need to be stated goals of states and governments to protect life. The resurgence of the flu to previous levels only further confirms the Socialist Equality Partys analysis that the malign neglect of the ruling elites has caused life expectancy to decline for the working class, for whom the social benefits of public health services cant be understated.
And still, rates of uptake of theCOVID vaccinesremain abysmal. As of January 20, 2024, little more than one in five adults have received the updated COVID boosters. Among those in rural communities, the rate was under 17 percent. Among children, little more than one in ten have received the vaccines. By comparison, the national coverage for theflu vaccinesis about one in two.
These figures do not even begin to take into consideration of the impact of Long COVID, which has been described as a mass-disabling event and a pandemic within a pandemic. A recentstudyconducted byHelpAdvisor,a health advisory group, found that nearly one-quarter of Americans 18 years of age and older, who previously had been infected with SARS-CoV-2, went on to experience symptoms of Long COVID. Adults in Oklahoma had the highest rates of Long COVID, which affected one-third of the states population. Nationally, almost one-third of those with previous COVID infections reported having post-acute symptoms that impacted their ability to carry out daily activities.
Those with health conditions who are older have a higher propensity for displaying long-term manifestation of chronic illnesses associated with their COVID infections. For instance, studies in cancer patients have shown that up to half of them have persistent symptoms, most commonly associated with fatigue, sleep disturbances and body aches. These have considerable ramifications as they have multiple co-morbidities and higher need for healthcare access which may be compromised by Long COVID.
A recent telephone survey study conducted by Canadian Cancer Survivor Network (CCSN) studying Long COVID had 1,505 respondents, of whom 50 percent had developed COVID, or their caregivers did.Of those surveyed, 16 percent developed Long COVID. Nearly half of these infections occurred more than a year before the survey and half reported that the severity of their infections was moderate. As to vaccination status, 81 percent had noted having received at least one to two boosters and 12 percent had two doses of the vaccine.
Of those who developed Long COVID, 72 percent had fatigue, while 57 percent had difficulty breathing and 53 percent had memory, concentration, or sleep disturbances. Only 38 percent had symptoms lasting less than six months while a quarter of respondents had symptoms for more than one year. Yet, when asked how long it took to feel completely recovered from Long COVID, nine in 10 admitted they still had residual symptoms of Long COVID that were like their initial Long COVID symptoms. Many with Long COVID were frustrated by the health systems unfamiliarity with or hesitancy to treat their condition.
The saying that the best way to avoid Long COVID is to avoid COVID in the first place remains undeniably true.
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A substantial amount of study has been undertaken on vaccine hesitancy and the various elements influencing an individuals decision to accept or not accept a vaccine. SAGE developed three categories based on experience in various countries and comprehensive literature reviews to analyze these issues, referred to as the 3Cs model: complacency (not considering diseases as high-risk and vaccination as crucial), convenience (practical obstacles), and confidence (a lack of trust in vaccine safety and effectiveness) [2, 5]. This model was later revised in 2018, emphasizing the importance of more than just the concept of confidence, and emerged as the 5Cs model (Table1): confidence, complacency, constraints (modification of the term convenience to now include both structural and psychological barriers), calculation (individuals engagement in extensive information searching), and collective responsibility (communal orientation to protect others) [18, 19].
In 2016, Thomson et al. introduced a different taxonomy to explain vaccine uptake determining factors, known as the 5As. They identified five categories regarded as access (the ability of an individual to reach or be reached by vaccination), affordability (the capacity of an individual to afford vaccines either financially or non-financially), awareness (personal knowledge about the importance of vaccination as well as its objectives and risks), acceptance (the degree to accept or refuse vaccination), and activation (motivation/encouragement to receive vaccination) [20].
In the Indonesian context, there have been no studies specifically dedicated to assessing or exploring hesitancy regarding routine vaccination using the 5Cs approach. However, a recent study conducted by Sujarwoto et al. [21], which investigated COVID-19 vaccine hesitancy in a district in Indonesia, revealed that respondents held low levels of confidence and complacency beliefs about the vaccine. Furthermore, the study identified more general sources of mistrust within the community, particularly concerning health providers and vaccine developers. However, these factors may vary depending on individual, cultural, and societal contexts. By comprehending these elements, healthcare providers and public health officials can formulate precise strategies to tackle vaccine hesitancy and enhance vaccine acceptance and utilization, as presented in Table 1.
Misinformation and conspiracy theories are widely recognized as critical drivers of vaccine hesitancy. False information about the safety and efficacy of vaccines can spread quickly and easily through social media and other channels, which leading to fear and skepticism about vaccination [22, 23]. One prominent example of vaccine misinformation is the claim that the measles, mumps, and rubella (MMR) vaccine causes autism. As a result, some parents have refused to have their children vaccinated, which in the long term, could lead to outbreaks of measles in specific populations [24, 25].
During the COVID-19 pandemic in Indonesia, misinformation and hoaxes have contributed to vaccine hesitancy among parents and caregivers, especially concerning vaccines that require multiple injections as part of routine immunization [26, 27]. The proportion of children who received their primary measles and rubella immunizations experienced a decline from 95% in 2019 to 87% in 2021. Moreover, there has been a substantial increase in the percentage of children who were not administered the diphtheria, pertussis, and tetanus (DPT) immunizations, rising from 10% in 2019 to 26% in 2021 [27]. This situation poses a significant risk to children, as it increases their susceptibility to a range of preventable diseases.
Beside misinformation and conspiration theories, lack of trust in government and healthcare institutions could impact the vaccine hesitancy. For instance, the case of Tuskegee Syphilis Study, which was conducted by unethically on African American men, has resulted in Black communities [28] enduring mistrust of government and healthcare institutions. Similarly, in Indonesia, the lack of trust in the government has been triggered by various factors, including past conflicts in certain provinces [29] and the governments response to the COVID-19 situation [30]. This lack of trust is exacerbated by existing disparities in healthcare access and delivery, which could lead people to be hesitant about getting the vaccine due to concerns about unequal distribution and difficulty of access [31, 32].
Next, vaccine safety and adverse effects is commonly stimulating vaccine hesitancy [33]. People may be unwilling to get immunized out because they are worried about adverse reactions, especially if they have a history of allergies or prior medical disorders [19, 33]. In the past, there have been questions about the safety of the HPV vaccine due to claims made by certain people that it can result in chronic discomfort, seizures, and even death [34]. The vaccine is safe and effective, but scientific evidence has shown that these allegations are mainly baseless [34, 35].
Similarly, concerns about the safety of the COVID-19 vaccine have been expressed, particularly in light of its rapid development and emergency use authorization [36]. Clinical studies and real-world data have consistently shown that these vaccines are highly effective with minimal risk of severe side effects [37]. However, a national survey on COVID-19 vaccine acceptance conducted by the Ministry of Health of Indonesia, which included 112,888 participants, revealed some concerning results. It showed that 64.8% were willing to take the vaccine, 7.6% were unwilling to take it, and 26.6% were unsure about whether to get vaccinated. Furthermore, participants in the survey expressed various concerns about COVID-19 vaccines. Specifically, 30% were uncertain about the vaccines safety, 22% had reservations about its effectiveness, 12% expressed fears of potential side effects, 8% cited religious or belief-related reasons, and 15% cited other factors [38].
In the social context, previous studies showed that cultural and religious beliefs may also play a role in vaccine hesitancy [39]. Some individuals may be hesitant to get vaccinated due to religious or cultural beliefs that conflict with vaccination, such as the belief that illness is Gods punishment or that alternative remedies are more effective than modern medicine [40].
Concerns about the use of fetal cells in vaccine development and the belief that illnesses are divine punishment have contributed to vaccine reluctance in some Orthodox Jewish communities, for instance [41, 42]. Correspondingly, in Indonesia, a country where approximately 87% of the population is Muslim, concerns have arisen over the use of non-halal components obtained from pork in vaccine formulations. These concerns have the potential to increase vaccine hesitancy in the country [43].
In addition, vaccine hesitancy may be influenced by socioeconomic variables such as low income, educational attainment, and limited healthcare accessibility [44]. Individuals residing in financially disadvantaged conditions may encounter obstacles in accessing vaccinations, such as financial constraints or scheduling conflicts that prevent them from receiving the vaccine promptly, or they may opt not to receive it [44, 45]. Individuals with lower education levels may have a restricted understanding of vaccines and their advantages, rendering them more vulnerable to misinformation [46]. In addition, inadequate healthcare accessibility may impede individuals from obtaining vaccinations on time, while restricted access to precise health information may result in misconceptions or skepticism regarding vaccines [47].
Behavioural scientists have investigated how heuristics, including vaccination, might influence judgement and decision making. Heuristics, a mental shortcut that enables people to solve problems quickly and make intuitive decisions, can be helpful when initiated by the correct variables [48, 49]. However, the influence of wrong circumstances such as misinformation and disinformation, and anti-vaccine movement, can lead to systemic errors or cognitive biases. For example, omission bias occurs when people tend to view harms from the act commission (actions) as more excellent than harms from omission (inactions); confirmation bias refers to the finding that strong initial beliefs are resistant to change because they influence how subsequent information is interpreted; and the Dunning Krueger effect, in which people who lack expertise fail to accurately assess their knowledge in comparison to experts on the subject [49].
Notwithstanding the unwillingness of specific individuals to receive vaccines, it is important to acknowledge the existence and impact of the anti-vaccine movement. They engage in campaigns against vaccines, frequently disseminating inaccurate information and instilling apprehension regarding their safety and efficacy [50]. The current campaign has the potential to generate vaccine hesitancy among individuals who had previously placed their trust in the healthcare system and vaccination initiatives. The outcome is an escalating count of individuals who hesitate or deliberately decline vaccination, resulting in decreased vaccination rates and heightened susceptibility to diseases that vaccines can prevent [50, 51]. Consequently, it is fundamental to acknowledge the apprehensions of individuals who are hesitant towards vaccines and furnish precise information to refute the misinformation propagated by the anti-vaccine movement.
Vaccine hesitancy has been found to be associated with a range of socio-economic and demographic variables. The prevalence of concerns regarding the safety and effectiveness of vaccines is observed to be higher in high-income countries (HICs), as opposed to low- and middle-income countries (LMICs), where factors such as cultural and religious convictions, unfavorable past encounters with foreign medical interventions and vaccination initiatives, and challenges within healthcare systems are more prevalent [52]. Common factors between the two categories encompass a lack of trust in medical institutions and governmental bodies, the spreading of conspiracy theories, and the dissemination of misinformation through social media [19, 52].
Parents who declined to vaccinate their children or held a pessimistic outlook towards vaccination were found to be more susceptible to demonstrating such apprehensions [53]. The primary rationale cited by parents in India, Nigeria, and Pakistan for abstaining from vaccinating their children was the perceived risk of adverse effects associated with immunization. The apprehension regarding severe adverse effects may stem from prior encounters with unfavorable incidents after immunization, which may be attributed to the vaccination process [54,55,56]. This, together with the belief that vaccines may cause harm, has led to the perception that vaccinations result in adverse reactions such as fever. Furthermore, a commonly reported conjecture was that the polio vaccine administration was linked to adult sterility, leading to a significant number of parents declining to immunize their children with the vaccine [56].
In the Indonesian context, vaccine hesitancy can be attributed to various factors, given the countrys middle-income status. The complexity of the issue presents a significant challenge [26]. Vaccine hesitancy in Indonesia is a multifaceted problem that requires tailored and collaborative efforts across various sectors. Despite the governments initiatives to improve vaccination rates, there remains a substantial gap in our understanding of the factors influencing vaccine acceptance and hesitancy [26, 57].
Furthermore, it is critical to highlight the significant disparities in vaccine coverage observed across Indonesias nationwide measles and rubella (MR) immunization program. Coverage rates vary widely among districts, ranging from as low as 2% to as high as 100%. Notably, more than one-third of districts report coverage rates below the established threshold of 70%. The link between the discontinuation of vaccination programs due to hesitancy and the subsequent decline in coverage rates is well-established [26].
Moreover, the hesitancy to receive the COVID-19 vaccine in Indonesia has been found to be highly correlated with various socio-demographic characteristics, including age, residential location, educational attainment, employment status, and family economic situation. Participants from Indonesia, Myanmar, Thailand, and Vietnam exhibited a higher degree of hesitancy towards receiving COVID-19 vaccines compared to their counterparts from the Philippines [58].
Additionally, concerns about vaccine safety have played a substantial role in shaping public discourse. Negative perceptions of vaccine safety, including anxieties about the rapid pace of vaccine development, have been identified as a primary driver of hesitancy. In low- and middle-income countries (LMICs) like Indonesia, where documented COVID-19 cases and fatalities have been relatively lower, individuals may perceive the disease as less severe, leading to reduced willingness to accept any potential risks associated with vaccination [59].
Finally, it is worth emphasizing that confidence in routine vaccinations has declined amid the ongoing COVID-19 pandemic. This trend has been observed in numerous countries, with some experiencing a significant decrease of up to 44 percentage points. The diminishing confidence level, coupled with the unique challenges faced by LMICs, has further exacerbated vaccine hesitancy in Indonesia [60].
In high-income countries, vaccine hesitancy could originate from complacency, as vaccine-preventable diseases have declined in these regions. In 2019, there were more than 1200 reported measles cases across 31 states in the United States [61]. This trend can be partially attributed to vaccine hesitancy [62]. Certain parents resisted vaccinating their children because of concerns regarding vaccines safety and probable negative consequences. Meanwhile, a few others declined vaccination due to their religious or philosophical convictions. The epidemic underscored the necessity for enhanced instruction and consciousness regarding the importance of immunizations, alongside endeavors to counteract the dissemination of false information concerning immunizations and enhance immunization availability. In Europe, there have been recent outbreaks of vaccine-preventable diseases such as measles and mumps [27, 63], which have been attributed to vaccine hesitancy. Vaccine hesitancy in certain nations is linked to a dearth of confidence in governmental and healthcare establishments, alongside a conviction that vaccines are superfluous owing to advancements in sanitation and hygiene. These outbreaks have led to demands for heightened vaccination rates and initiatives aimed at addressing vaccine hesitancy through public awareness drives and improved availability of vaccines.
Moreover, a contentious issue exists regarding the administration of the human papillomavirus (HPV) vaccine, which further exacerbates hesitancy [34]. Although the vaccine has demonstrated effectiveness in preventing cervical cancer and other diseases associated with HPV, some parents in developed countries are unwilling to immunize their children due to worries regarding the vaccines safety and potential negative consequences. The safety concerns surrounding the HPV vaccine were subject to investigation in Denmark [64]. The media initiated coverage of purported unfavorable occurrences concerning Danish females, encompassing a documentary that portrayed a cohort of girls exhibiting diverse incapacitating symptoms that were presumed to have been induced by HPV vaccination. The findings indicate a rapid decline in the utilization of HPV vaccination in the specified nation during the period spanning from 2009 to 2014 [64]. In certain instances, the reluctance has been intensified by inaccurate information propagated through social media and other communication platforms. As a result, the vaccination rates for HPV in certain high-income nations have persisted below the recommended levels set by public health authorities, leading to a continued susceptibility to HPV-associated illnesses among those who have not received the vaccine.
In the United States, nearly 1 in 4 female adolescents and young adults test positive for sexually transmitted infections (STIs) annually, a statistic made even more troubling by the fact that these young women often avoid health care due to cost, transportation, and confidentiality concerns. With more than 33% of adolescents reporting no primary care provider, this demographic often relies on emergency departments (EDs) and inpatient (IP) settings for their health care needs.
STI test / jarun011 - stock.adobe.com
With the COVID-19 pandemic having decreased healthcare access in the United States, adolescents at risk for sexually transmitted diseases were further compromised. At the time, health experts warned of adverse outcomes on sexual and reproductive health (SRH) for adolescents.
Recently, a study published in Hospital Pediatrics compared changes in STI diagnoses during adolescent visits at childrens hospitals during the COVID-19 pandemic to diagnoses before the pandemic.1 Investigators conducted the retrospective cohort study using the Pediatric Health Information System database comparing adolescent (aged 11 to 18 years) hospital visits with an STI diagnosis by the International Classification of Diseases, 10th revision, during COVID-19 from 2020 to pre-COVID-19 (2017 through 2019).
A total of 2,747,135 adolescent visits from 44 hospitals in the United States were studied, of which 10,941 resulted in an STI diagnosis. The majority (54.5%) of the STI diagnoses were the primary diagnosis: an STI was the primary diagnosis for 36% of IP visits and 66% of ED visits. Where an STI was a secondary diagnosis, the most common primary diagnoses included urinary tract infections, sepsis, acute vaginitis, and unspecified abdominal pain.
READ MORE: COVID-19 Vaccination Effective at Preventing Long COVID in Children, Adolescents
During the summer of 2020, compared to the pre-COVID-19 period, there was an increase (30.4%) in median inpatient weekly visits overall with an STI diagnosis, as well as an increase in visits in fall 2020 (27.3%). Investigators also acknowledged that other recent studies have shown decreased STI testing and increased STI diagnoses in various clinical settings during COVID-19 periods of 2020.
Our findings may be partially driven by changes in health care utilization (eg, loss of primary care access and school-based sexual education) and increased reliance on nontraditional settings for SRH care, including hospital-based care, noted the authors.
Researchers concluded that as a result of this increase in adolescent inpatient visits with an STI diagnosis in 2020, further work is needed to improve STI care, particularly for this demographic. In the study, the authors noted, Given our findings and recent literature on SRH care of adolescents during COVID-19, efforts are needed to optimize SRH care and offset risk for increased STIsto prepare for future pandemics. To optimize STI testing and treatment, innovative efforts are needed, including virtual and in-person outreach, to increase adolescent access to SRH education and care. These efforts are instrumental to reduce the risk for STIs among adolescents cared for in the hospital with the potential to improve related health outcomesin future health care crises.
READ MORE: COVID-19 Resource Center
This article originally appeared in Contemporary OB/GYN.
