Category: Covid-19

JACKSON Republican Gov. Tate Reeves is ending the state of emergency order put in place during the coronavirus pandemic in Mississippi.

The emergency order was first put into effect on March 14, 2020, a few days after the state reported its first coronavirus case. It enabled the governor to mobilize the Mississippi National Guard to help with COVID-19 testing and vaccination sites. The order also authorizes the states COVID-19 System of Care Plan, which allows for transfers of patients throughout Mississippis health care systems.

It did not implement lockdowns or mask mandates.

Reeves tweeted Thursday that the order would expire Nov. 20.

With more than 3,000,000 doses of the COVID-19 vaccine having been administered in Mississippi and with COVID-19 infections and resulting hospitalizations being effectively managed, it is time to end the State of Emergency in Mississippi, he wrote.

Mississippi, a state with a population of roughly 3 million, has reported close to 10,190 deaths from COVID-19 since the start of the pandemic. A total of 46 percent of Mississippi residents are fully vaccinated against the virus, compared to 58 percent of all Americans, according to the state department of health.

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Mississippi governor ending COVID-19 state of emergency - The Dispatch - The Commercial Dispatch

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Nov 14, 2021

The number of new COVID-19 cases across the North Country has remained stubbornly high this fall. Public health officials fear the holidays will trigger another surge.

St. Lawrence County, like others in the region, has a dangerous combination a high positive test rate and a vaccination rate below the state average.

Dr. Andrew Williams is the president of the St. Lawrence County Board of Health. He told David Sommerstein public health leaders have spent a year and a half reinforcing the regions hospital system, but its showing strain.Their conversation has been lightly edited for clarity.

Dr. Andrew Williams on concerns over stubbornly high COVID-19 cases

DR. ANDREW WILLIAMS: We're talking about taking care of patients both with COVID, but also patients who have non-COVID-related reasons to be hospitalized. However, because the number of cases has stayed high for so long, it's really put a strain and stress on our local hospital systems.

DAVID SOMMERSTEIN: So are we seeing patients being turned away or ambulances having to drive longer distances to other hospitals?

WILLIAMS: At this point, we never turn away patients who arrive at the emergency room. But one of the challenges for us is to have a bed available for them within the hospital. For patients who require a higher level of care and a transfer to one of the larger regional hospitals, because those hospitals are so full, oftentimes there's a delay in the transfer, or difficulty getting them there. Partly also, our transportation system is also under significant stress because of the volumes.

SOMMERSTEIN: And worker shortages in all of those categories is exacerbating all of this.

WILLIAMS:I think, as with other industries, in the hospital systems, we're definitely noticing the impact of staffing shortages, on how we're able to take care of our patients and deliver care.

SOMMERSTEIN: What can the county do, to try to, as we said at the very beginning of the pandemic, flatten the curve, or bend the curve back down and lower cases?

WILLIAMS: It's interesting, even as the pandemic goes on, we still fall back on what we call the 'pillars of community response'. So it's really six things. It used to be five pillars, but now we've added vaccination.

The Six Pillars of community response to help flatten the curve are vaccination; wearing masks when people are indoors; physical distancing; handwashing; staying home when sick; and staying local. So, those strategies really haven't changed.

We do continue to work on isolation and quarantine on a county health department level so that we can identify cases and try and reduce the spread in the community by isolating people who have COVID, and then also quarantine people who have a high-risk exposure.

SOMMERSTEIN:And then there's that sixth one that you mentioned, which is getting more people vaccinated, which is still a really big issue. St. Lawrence County has a lower vaccination rate than other places.

WILLIAMS: If you look at St. Lawrence County, we, despite the efforts of the medical community and the public health community, right now, fully vaccinated residents of St. Lawrence County are at 55%. New York State has an overall average of 67% fully vaccinated. And there are a number of counties where there's more than 75% of the population that's vaccinated. So we're unfortunately a relatively low vaccination community.

What we find in particular is that the age demographic of our unvaccinated population tends to be our younger residents, and in particular tends to be people who are in the workforce, who might be parents of young children who are attending school or daycare.

SOMMERSTEIN: You come into contact with all kinds of people as your patients. How do you talk with people who may be wary of getting vaccinated? How do you approach them?

WILLIAMS:It's a great question. Anytime somebody is unvaccinated and is interested in discussing vaccination, I talk about the risks and benefits of vaccination, just like any other therapy or intervention I might be recommending.

I really point out that we've vaccinated millions of people in this country. There's lots of research that went into vaccine development. There's really now an excellent track record of safety for the vaccinations. And we also know that the vaccines remain very effective at keeping people from becoming severely ill requiring hospitalization or dying.

I also explained to them that even though they may have some concerns about vaccination, the greatest risk is getting the COVID-19 infection, and that if you compare the risk of the infection to the risk, or perceived risk, of vaccination, vaccination is a far better choice.

SOMMERSTEIN:What worries you most right now,

WILLIAMS: My concern is that we have this steady high rate of cases that we've seen now for several months and that we're about to go into the winter season. We're about to go into the holiday season where many of our families get together. And I just really worry that we're not going to see a decrease in cases, and that, in fact, we may end up seeing another surge on top of the current surge.

When I talk to patients about the importance of vaccination, I emphasize that it's important and safe and effective for them as an individual, but that the benefit of vaccination really does go beyond protecting them as an individual. It's the best way to protect our families and our community.

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St. Lawrence County doctor fears a new COVID-19 spike at the holidays - North Country Public Radio

For the censors out there, this is not an anti-vaccine piece. Just the opposite. I believe vaccines represent the best hope to billions of people around the world. This is simply about our rights as Americans, in the age of COVID-19, to ask certain questions. I say that because, although some will disagree, for many people life seemingly has become a dystopian science fiction movie of Do as we say edicts.

And quite sadly, an ugly and potentially harmful Us vs. Them mentality has taken hold with some on both sides of the COVID-19 treatment divide. Its a divide that has appeared because of the consequences of forced or controlled ignorance.

During the first few months of the pandemic, you could use Google or another search engine to look up questions such as What is the survival rate for COVID-19? or What is the average age of those getting the virus? or Does the virus hit the obese or those with chronic morbidities harder? or Where did the virus originate? or Has the virus gotten weaker as it has mutated? But just try to do that now. Youll find that many of the answers are buried, dating to early 2020, or simply impossible to find.

Why is that? Shouldnt we Americans be allowed to look up such information and then make judgments ourselves?

In the United States, it can seem as if They (typically the politicians or their proxies) have decided for our own good that certain questions should not be asked, certain answers should be buried, certain scientists and doctors should be criticized, certain people should be fired, and a certain class should do the thinking for the rest of us.

There is no sane person who does not hope or pray that medical science can at least weaken the threat from the SARS-CoV-2 virus so that we can resume life as it mostly was before COVID-19. That said, everyone including doctors and scientists in the field of infectious disease should be able to ask questions or express doubts about certain protocols without being castigated or fired from their jobs.

In this unhealthy Us vs. Them dynamic that has sprung up as a toxic byproduct of the pandemic, there are many Americans politicians, celebrities and Twitter trolls who are not only calling for the firing of doctors, nurses, firefighters, police officers, military personnel, teachers, pilots, air traffic controllers and U.S. intelligence officers but also taking joy in that possible outcome.

Fire them. Can we step back for a second and realize what that punishment truly would mean? Punishing these Americans potentially would deny them the ability to buy food for their children, pay their rent or mortgage, buy gasoline, pay for medicine or pay for the care of loved ones. This is what Us vs. Them can produce.

To this point, on a recent Real Time with Bill MaherWilliam (Bill) MaherWhat must never be asked about COVID-19 and vaccines nor ever revealed Juan Williams: Trump is killing American democracy Bill Maher pushes back on criticism of Chappelle: 'What the f--- was that reaction?' MORE, the liberal host said, The world recognizes natural immunity. We dont because everything in this country has to go through the pharmaceutical companies. Natural immunity is the best kind of immunity. We shouldnt fire people who have natural immunity because they dont get the vaccine. We should hire them. Yes? Many doctors have made the same point.

Others have argued that many Americans who have not yet received vaccines are not necessarily anti-vaxxers but simply adults who are waiting as long as possible to see how the effects of the vaccines play out. And our understanding of the COVID-19 vaccines, compared to natural immunity and other questions, remains a moving target.

As one recent story in The Hill reported, Vaccinated just as likely to spread delta variant within household as unvaccinated: study. Another story from last week reported, Immunity from both vaccines, COVID-19 infection lasts at least six months: CDC.

That is not a criticism or indictment of the vaccines. Everyone should hope for their complete success. The point is, as with all viruses, there is a learning curve. Shouldnt we want those in charge to know as much as possible, to give them the confidence needed to set policy for the rest of us?

Americans should be rooting for medical science to win the war against the virus. That said, we should still have the option to question any policies political, medical, or other that are handed down from those who hold dominion over us and the lives of our children.

The last time I checked, that is our right as American citizens. As President Biden saidin his inaugural address,Thats democracy. Thats America. The right to dissent peaceably within the guardrails of our republic is perhaps our nations greatest strength.

Douglas MacKinnon, a political and communications consultant, was a writer in the White House for Presidents Ronald Reagan and George H.W. Bush, and former special assistant for policy and communications at the Pentagon during the last three years of the Bush administration.

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What must never be asked about COVID-19 and vaccines nor ever revealed | TheHill - The Hill

Uncertain and disquieting times: Experts warn of potential swell in California COVID-19 cases  The Mercury News

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Uncertain and disquieting times: Experts warn of potential swell in California COVID-19 cases - The Mercury News

by: Nathaniel Hafer UMass Chan Medical School, AP The Conversation

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(THE CONVERSATION) At this point in the pandemic, you or someone you know has probably received at least one COVID-19 test. But do you know which kind of test you got and the strengths and weaknesses of these different tests?

Im a molecular biologist, and since April 2020 Ive been part of a teamworking on a National Institutes of Health-funded program called RADxthat is helping innovators develop rapid tests to detect when a person is infected with SARS-CoV-2, the virus that causes COVID-19.

Two major types of tests are used to diagnose infection with SARS-CoV-2: molecular tests better known asPCR tests andantigen tests. Each detects a different part of the virus, and how it works influences the tests speed and relative accuracy. So what are the differences between these types of tests?

Looking for genetic evidence

The first step for either kind of test is to get a sample from the patient. This can be a nasal swab or a bit of saliva.

For PCR tests, the next step is amplification of genetic material so that even a small amount of coronavirus genes in the patients sample can be detected. This is done using a technique called apolymerase chain reaction. A health care worker takes the sample and treats it with an enzyme that converts RNA into double-stranded DNA. Then, the DNA is mixed with a solution containing an enzyme called a polymerase and heated, causing the DNA to separate into two single-stranded DNA pieces. The temperature is lowered, and polymerase, with the help of a small piece of guide DNA called a primer, binds to the single-stranded DNA and copies it. The primers ensure that only coronavirus DNA is amplified. Youve now created two copies of coronavirus DNA from the original one piece of RNA.

Laboratory machinesrepeat these heating and cooling cycles 30 to 40 times, doubling the DNA until there are abillion copies of the original piece. The amplified sequence contains fluorescent dye that is read by a machine.

The amplifying property of PCR allows the test to successfully detect even the smallest amount of coronavirus genetic material in a sample. This makes it ahighly sensitive and accurate test. Withaccuracy that approaches 100%, it is the gold standard for diagnosing SARSCoV2.

However, PCR tests have some weaknesses too. They require a skilled laboratory technician and special equipment to run them, and the amplification process can takean hour or more from start to finish. Usually only large, centralized testing facilities like hospital labs can conduct many PCR tests at a time. Between sample collection, transportation, amplification, detection and reporting, it can takefrom 12 hours to five days for a person to get results back. And finally, they arent cheap at$100 or more per test.

Antigen tests

Rapid, accurate tests are essentialto contain a highly contagious virus like SARS-CoV-2. PCR tests are accurate but can take a long time to produce results. Antigen tests, the other major type of coronavirus test, while much faster, are less accurate.

Antigens are substances that cause the body to produce an immune response they trigger the generation of antibodies. These tests use lab-made antibodies to search for antigens from the SARS-CoV-2 virus.

To run an antigen test, you first treat a sample with a liquid containing salt and soap that breaks apart cells and other particles. Then you apply this liquid to a test strip thathas antibodies specific to SARS-CoV-2 painted on it in a thin line.

Just like antibodies in your body, the ones on the test strip willbind to any antigen in the sample. If the antibodies bind to coronavirus antigens, a colored line appears on the test strip indicating the presence of SARS-CoV-2.

Antigen tests have a number of strengths. First, they are so easy to use that people with no special training can perform them and interpret the results even at home. They also produce results quickly,typically in less than 15 minutes. Another benefit is that these tests can be relatively inexpensive ataround $10-$15 per test.

Antigen tests do have some drawbacks. Depending on the situation, they can beless accurate than PCR tests. When a person is symptomatic or has a lot of virus in their system,antigen tests are very accurate. However, unlike molecular PCR tests, antigen tests dont amplify the thing they are looking for. This means there needs to be enough viral antigen in the sample for the antibodies on the test strip to generate a signal. When a person is in the early stages of infection, not a lot of virus is in the nose and throat, from which the samples are taken. So, antigen tests canmiss early cases of COVID-19. Its alsoduring this stage that a person has no symptoms, so they are more likely to be unaware theyre infected.

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More tests, better knowledge

A few antigen tests are already available over the counter, and on Oct. 4, 2021, the Food and Drug Administrationgranted emergency use authorization to another at-home antigen test. The U.S. government is also pushing tomake these tests more available to the public.

At RADx, the project I am a part of, we arecurrently conducting clinical studiesto get a better understanding of how antigen tests perform at various stages of infection. The more data scientists have on how accuracy changes over time, the more effectively these tests can be used.

Understanding the strengths and limitations of both PCR and antigen tests, and when to use them, can help to bring the COVID-19 pandemic under control. So the next time you get a COVID-19 test, choose the one that is right for you.

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Whats the difference between a PCR and antigen COVID-19 test? A molecular biologist explains - KRQE News 13

Building off the success of the fall term, students, faculty and staff at the University of Michigan can expect many of the same COVID-19 protections and community expectations this winter to support another productive and healthy academic term.

Indoor masking, weekly testing for the small fraction of the community who have vaccine exemptions, and daily use of ResponsiBLUE are among the mitigation strategies that will continue.

Here are the top things to know for the winter 2022 term:

All students, faculty and staff are required to submit proof of their COVID-19 vaccination or request an exemption under the U-M COVID-19 Vaccination Policy. New federal COVID-19 vaccination mandates apply to bargained-for U-M employees on all three campuses who were not previously covered by the universitys vaccination policy.

Stricter accountability measures including dismissal have been established for employees who do not report their vaccination information or obtain an exemption as required under the universitys COVID-19 vaccination policy.

Vaccines are available through Michigan Medicine, University Health Service and Occupational Health Services as well as local pharmacies.

While breakthrough infections positive tests among those vaccinated occur with every vaccine, health officials say vaccines reduce the risk of infection and greatly reduce the likelihood of severe illness, even with the COVID-19 delta variant.

The university is providing limited exemptions to its COVID-19 vaccination policy for medical or religious reasons. Those who receive an exemption are required to undergo weekly COVID-19 testing.

Instruction in the winter will look much like the fall with more courses taught in-person, especially for graduate and professional students.

U-M officials report there has been no established association with COVID-19 transmission in classrooms due to the universitys high vaccination rate, indoor masking requirement and ventilation rates that exceed Centers for Disease Control and Prevention recommendations.

Under the U-M face-covering policy, all students, staff, faculty and visitors must wear a face covering that covers their mouth and nose while indoors and on U-M transportation, regardless of vaccination status.

The CDC recommends masking indoors in public in areas of substantial or high transmission to maximize protection from the delta variant and prevent possible spread. Based upon the current Campus Metrics and Mitigation Strategies guidance, local transmission levels would need to return to low or moderate levels for indoor masking to be reconsidered.

The university policy cites limited exceptions in which a person is not required to wear a face covering indoors, including while alone in a single, enclosed, private office with the door closed, while actively eating or drinking, while giving a speech and maintaining 6 feet distance from others, or while receiving a health care service that requires them to temporarily take off their face covering.

A key exception to the policy allows for vaccinated students living on campus to not wear a face covering while in their own residence hall, including common areas.

Testing for asymptomatic COVID-19 remains available through the Community Tracking and Sampling Program for those who want it or are required to test weekly.

Weekly testing is required for individuals who have received a medical or religious exemption under the vaccine policy, as well as for those who have started their vaccination series but are not yet considered fully vaccinated.

The weekly testing requirement will be waived for those individuals who received an exemption and are in fully remote situations, but it is expected that those individuals be tested within the previous week if they come to campus for any reason. ResponsiBLUE will track compliance with weekly testing for all students and employees granted vaccine exemptions, even those usually in a fully remote arrangement.

Individuals with symptoms of COVID-19 or a close-contact exposure should contact Occupational Health Services for faculty and staff, or University Health Service for students.

The policies in place now for U-M Housing will continue next term. Nearly 99 percent of students residing in U-M Housing are fully vaccinated. Those in the residence halls for winter 2022 with approved vaccine exemptions will continue to be required to participate in mandatory weekly testing. Face coverings are not required for students while in their assigned residence hall or apartment including common areas, however unvaccinated students should continue to mask in common areas.

Read more here:

University COVID-19 prevention measures remain for winter term | The University Record - The University Record

1. Is this the fifth COVID-19 wave? Experts fear we may simply come to call it 'winter'  USA TODAY
2. COVID-19 hot spots offer sign of what could be ahead for U.S.   The Atlanta Journal Constitution
3. States see surge in COVID-19 cases heading into winter  NewsNation Now
4. Doctors say there are signs a winter surge of COVID-19 has already started in Northeast Ohio  WJW FOX 8 News Cleveland
5. As Covid cases drop in Georgia and Florida, some states with colder weather see an increase  CNN
6. View Full Coverage on Google News

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Is this the fifth COVID-19 wave? Experts fear we may simply come to call it 'winter' - USA TODAY

Eugene Mymrin/Getty Images

Eugene Mymrin/Getty Images

Kelly LaDue thought she was done with COVID-19 in the fall of 2020 after being tormented by the virus for a miserable couple of weeks.

"And then I started with really bad heart-racing with any exertion. It was weird," says LaDue, 54, of Ontario, N.Y. "Walking up the stairs, I'd have to sit down and rest. And I was short of breath. I had to rest after everything I did."

A year later, LaDue still feels like a wreck. She gets bad headaches and wakes up with pain all over her body on more days than not. She also experiences a sudden high-pitched whistling in her ears, bizarre phantom smells and vibrations in her legs. Her brain is so foggy most of the time that she had to quit her job as a nurse and is afraid to drive.

"These symptoms, they come and go," she says. "You think: 'It's gone.' You think: 'This is it. I'm getting better.' And then it'll just rear back up again."

Kelly LaDue, of Ontario, N.Y., was working as a nurse when she got COVID-19 and recovered. But a year later, she's still grappling with a strange constellation of symptoms. Kelly LaDue hide caption

Kelly LaDue, of Ontario, N.Y., was working as a nurse when she got COVID-19 and recovered. But a year later, she's still grappling with a strange constellation of symptoms.

Patients like LaDue have researchers scrambling to figure out why some people experience persistent, often debilitating symptoms after catching SARS-CoV-2. It remains unclear how often it occurs. But if only a small fraction of the hundreds of millions of people who've had COVID-19 are left struggling with long-term health problems, it's a major public health problem.

"I think it's the post-pandemic pandemic," says Dr. Angela Cheung, who's studying long-COVID-19 at the University of Toronto. "If we are conservative and think that only 10% of patients who develop COVID-19 would get long COVID, that's a huge number."

So far there are more theories than clear answers for what's going on, and there is good reason to think the varied constellation of symptoms could have different causes in different people. Maybe, in some, the virus is still hiding in the body somewhere, directly damaging nerves or other parts of the body. Maybe the chronic presence of the virus, or remnants of the virus, keeps the immune system kind of simmering at a low boil, causing the symptoms. Maybe the virus is gone but left the immune system out of whack, so it's now attacking the body. Or maybe there's another cause.

"It's still early days. But we believe that long COVID is not caused by one thing. That there are multiple diseases that are happening," says Akiko Iwasaki, a professor of immunobiology at Yale University who is also studying long COVID-19.

But Iwasaki and others have started finding some tantalizing clues in the blood of some patients. Those include unusual levels of cytokines, which are chemical messengers that the immune system uses to communicate, as well as proteins produced by the immune system known as autoantibodies, which attack cells and tissues in the body instead of the virus.

"We are finding elevated cytokines in long-COVID patients and we're trying to decode what those cytokines mean. We're also seeing some distinct autoantibody reactivity and are trying to find out what those antibodies are doing and whether they are causing harm," Iwasaki says.

Other researchers have produced similar findings. Dr. Steven Deeks at the University of California, San Francisco, found long-COVID-19 patients appear to have elevated levels of a cytokine called interleukin-6, suggesting they may be suffering from a state of chronic inflammation.

"The first couple of weeks of the infection is associated with a massive amount of inflammation. The virus just blows up the immune system," Deeks says. "So it's reasonable to think that, in some people, the acute COVID results in an inflammatory state that can contribute to long-COVID over time."

Yet another clue found in one subgroup of patients is an unusual pattern of activity by key immune system cells, such as as T-cells, which may support the idea that the virus is hiding in the body.

"That's a signature or pattern which could be consistent with a low-level, but persistent, infection in the long-COVID syndrome patient," says Dr. Igor Koralnik at Northwestern Feinberg School of Medicine.

While much more research is needed, the researchers hope these findings could eventually lead to ways to help long-COVID patients. One possible therapy for some patients might turn out to be anti-viral drugs that target a virus hiding in the body. Another possibility might be clearing the virus with a vaccine, which does seem to help some long-COVID patients. Researchers think drugs that dampen down the immune system may also help.

"We need to understand what's going on in each patient because the treatment option will be very different depending on what they actually have," Iwasaki says.

But others are not so sure that any of the evidence produced so far linking subtle changes in lab tests to physical problems in long-COVID-19 patients is very convincing. That includes any signs that the immune system is the problem what's known as an autoimmune disease.

"The thing that has struck me most now in a year and a half of seeing these patients and extensively testing them is that we are finding little to no abnormalities," says Dr. Michael Sneller, who has been conducting a battery of detailed tests on hundreds of long-COVID-19 patients at the National Institutes of Health.

"Echocardiogram, pulmonary function tests, X-rays, brain MRIs. You name it. Laboratory markers of organ dysfunction. We're not seeing any of that," Sneller says of the patients in his study. "And precious little evidence of immune activation, looking just at the sort of standard markers of inflammation. I'm running out of tests to do basically."

But Sneller says his team hasn't ruled out anything and is continuing to analyze data about the immune system. His team is also conducting psychological testing on their study's subjects though not because he doubts their symptoms.

"It's 100% real. These people have these symptoms. Absolutely. The question is what's causing them," he says. "Anxiety can produce real symptoms."

For her part, LaDue hopes researchers eventually figure out what's going with her and other patients.

"I want to feel normal, and I hope to be back to normal again someday," she says. "The hardest part, definitely, is trying to look and be normal but not feeling normal."

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Clues to what causes long COVID are starting to emerge : Shots - Health News - NPR

An employee of Toyota company works on an assembly line on April 21, 2020 in Onnaing, northern France. FRANCOIS LO PRESTI/AFP via Getty Images hide caption

An employee of Toyota company works on an assembly line on April 21, 2020 in Onnaing, northern France.

Toyota, one of the world's largest vehicle manufacturers, said it will increase production in December as it recovers from parts shortages caused by the COVID-19 pandemic.

The Japanese automaker announced it expects to build 800,000 vehicles globally next month, up from the roughly 760,000 it made last December.

The company also said it was maintaining its forecast of producing 9 million vehicles in the current fiscal year, which ends March 31. Toyota produced about 7.6 million units in the previous fiscal year.

"We would like to express our gratitude to all parties concerned for their immense support in helping us maintain production," Toyota said in a statement.

Automakers have recently struggled to make enough vehicles in the face of a parts shortage, particularly semiconductors. Meanwhile, soaring demand has driven prices up at the dealership.

All of Toyota's 14 plants and 28 production lines in Japan will be operating normally for the first time since May, the company announced, further helping it rev up production.

Still, the company said it was responding to a continuing shortage of some parts by attempting to shore up its supply chain.

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Toyota to ramp up production after cutbacks driven by the COVID-19 pandemic - NPR

Patients gasping for air in hospital hallways, trailers serving as makeshift morgues, emergency medical tents erected in New Yorks Central Park: In March 2020, what we watched happening in high-income settings in the U.S. and elsewhere around the world seemed to us in Uganda like scenes from a science fiction movie.

As physician-researchers who are acutely aware of our countrys deficits of Covid-19 diagnostics, personal protective equipment, and intensive care beds with medical oxygen, we grew increasingly worried about the devastation this new virus could bring to Uganda and our medical practices.

With no Covid-19 cases yet reported locally, there was still time to make potentially life-saving preparations, from providing infection-control training for hospital staff to educating the public about prevention and symptoms. Another positive was that, as a result of Ugandan universities longstanding global health partnerships, health experts from U.S. and European academic medical centers and humanitarian organizations were already stationed in health facilities around the country.

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With their extensive experience treating patients with infectious diseases and researching infectious pathogens in low-income countries, along with their stated goals of serving the global poor, these skilled workers were well-positioned to support Uganda as it faced the worlds biggest public health challenge in decades.

Like soldiers on a battlefield confronting a foe that threatened populations everywhere, we assumed that combatants and commanders alike would not retreat or surrender in the face of danger. But despite years of consensus around the need to stand with populations in materially impoverished settings, the known consequences of Ugandas health worker shortages, and the urgency of preparing for the pandemic, our international collaborators were suddenly acting like the idea that their staff would stay in Uganda was absurd.

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In the days following the initial chaotic reports from Italy, New York, and elsewhere, we watched our non-Ugandan colleagues receive a wave of evacuation orders from their respective home organizations and countries. By the end of that March 2020, we found ourselves fighting Covid-19 essentially alone.

Ugandan policymakers did everything they could to keep cases to a minimum implementing strong social distancing policies and contact tracing programs but within months the horror scenes we had previously watched on the news were playing out in Ugandas underfunded and understaffed hospitals. From a safe distance, many partners from the Global North sent messages asking how they could be of help, a sentiment that was appreciated yet did not address the void left by their abrupt disappearance.

From our experiences during Ebola epidemics, we fully understand the fear of working during a disease outbreak, including how challenging it can be to be separated from loved ones in such moments. At the same time, the isolation through which weve endured Covid-19 underscores a reality that Uganda and other countries in Africa have known for a long time: Equity in global health partnerships almost always feels like a moving target.

Although collaborations between scientists from high-income and low-income settings have yielded tremendous public health achievements, partnership priorities are too often dictated by the perspectives of those who control project funding, not necessarily by the individuals living in the communities where these programs take place.

Sometimes, as was the case for Covid-19 staff withdrawals, choices affecting both parties are made without the collaborating local scientists and clinicians being asked for their opinions at all.

Medical and public health workers in Uganda are well acquainted with the consequences of this power imbalance, from the many studies conducted here that fail to include local authors to the large pay differentials between collaborating investigators of different nationalities employed by the same programs. Local health specialists rarely openly highlight these inequitable practices, fearing that speaking up could cause them or their beneficiary communities to lose access to much-needed funds and resources. Even facing a threat as existential as Covid-19, many Ugandan experts have not felt empowered to protest the ways in which they have felt abandoned and instead have remained silent as international partners try to fix our public health systems over email.

We hope that as American and European organizations become more aware of these challenges, the response is not to draw back even further from places like Uganda but rather to take action so essential global health programs can be delivered in fairer ways. With no end to the pandemic yet in sight and the indisputable threat of future disease outbreaks, we especially hope that international collaborators will work to create more equitable contingency plans for continuing operations in the face of public health threats.

Although evacuations can be justifiable in situations of targeted risk, such as instances of rebel insurgency or abductions of foreign workers, pathogens like Covid-19 affect all susceptible hosts regardless of nationality visitor or local and can spread to populations everywhere if not quickly addressed. We call on global health practitioners to more clearly identify opportunities to respond to such situations in partnership and to be transparent about conditions that would render impossible in-person support from visiting staff.

Clinicians and public health experts from the Global North have remarkable expertise in responding to infectious diseases, but outbreak response teams in the Global South need to know whether they can rely on them in their moments of greatest need.

There has been talk for decades about how the most challenging global health problems must be tackled together as a global community. As health workers in Uganda mark almost two years of fighting Covid-19 largely on their own, we wonder whether solidarity will indeed be the new norm, or whether withdrawals will be once again be repeated when another pandemic hits.

Stephen Asiimwe is an epidemiologist and program director of the Global Health Collaborative at Mbarara University of Science and Technology as well as principal investigator at the Kabwohe Clinical Research Center. Edith Nakku-Joloba is a senior lecturer in epidemiology at Makerere University School of Public Health, a sexually transmitted infections specialist, and a consultant with the Uganda Ministry of Health. Aggrey Semeere is a senior physician at the Infectious Diseases Institute at Makerere University and principal investigator for the East African International Databases to Evaluate AIDS.

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Covid-19 highlights the unfairness of global health partnerships - STAT