Tag: COVID

Banking risks amid challenges: How economic turbulences are spilling over into the banking sector – Banking blog

The COVID pandemic, the war in Ukraine and the merger of UBS and CS represent the three most prominent in a series of events that have affected the Swiss economy. While pandemic-related aid given by the Swiss government was covering up parts of it, the consequences of higher corporate debt are manifesting now. In this blog we investigate the effects of these developments on corporate loans and on how financial services providers are and will be affected.

Over the past few years, the financial markets have experienced several shocks, most recently the announcement of the merger of Switzerland’s two largest banks, Credit Suisse, and UBS. Before that, the armed conflict between Russia and Ukraine and the COVID-19 pandemic had already weighed on the economic outlook. The accumulation of these events in a short period of time resulted in severe economic consequences, which we explore in this blog.

To begin with, the measures taken by the Swiss government in March 2020 to counter the impact of COVID-19 negatively affected the local economy. The restrictions on personal mobility led to a sharp reduction in household consumption. Consequently, many firms faced a large drop in revenue. Liquidity shortages and a wave of company bankruptcies were expected, and a spillover into the banking sector, with defaults and, ultimately, loan losses was widely anticipated.

Such scenarios were not just predicted by analysts and the media – banks themselves were anticipating an increase in defaults in their loan books. This expectation manifested itself mainly through large increases in banks’ loan loss provisions in the first quarter of 2020. Banks in both Europe and the US reported much higher loan loss provisions compared to the same reporting period in the previous year (Deloitte 2020). A similar pattern was observed for Swiss banks. Graph 1 shows the changes in Swiss banks’ loan loss provisions over time. The large Swiss banks increased their loan loss provisions by over 100 bps in the first half of 2020, whereas the retail and cantonal banks increased their provisions more moderately.

Graph 1: Development of provisions by banks (loan loss provisions as a share of total loan book)

Nevertheless, as shown in Graph 2, a wave of corporate defaults did not occur in 2020. On the contrary, a significant reduction in the number of defaults was observed throughout 2020-2021, compared to the pre-pandemic years. This was likely a consequence of the legal and fiscal measures implemented by the Swiss government.

The legal measures, which included an extended debt collection holiday and no obligation to report over-indebtedness, gave firms additional time to adapt to the changed circumstances. The financial aid directly supported firms through two different measures: first through the COVID-19 credit programme which from the end of March 2020 onwards enabled companies to obtain state-backed loans on favourable conditions, and second, the government allowed firms to introduce short-time working, thereby reducing their fixed personnel costs.

Graph 2: Cumulative number of Swiss corporate defaults on a monthly basis

These government measures were successful in preventing the anticipated wave of bankruptcies. However, COVID-19 was only the first in a series of hits to the economy.

Interplay of negative factors

While the pandemic did not cause an immediate wave of bankruptcies, it had several secondary effects. In order to remain liquid, many Swiss firms made use of additional credit lines and corporate loan volumes in Switzerland increased substantially, both during and after the pandemic, by a total of CHF 53 billion. Of this total, only CHF 13 billion in loans were granted as part of the federal COVID-19 credit programme. The remaining credit of over CHF 40 billion since then has consisted of standard bank loans.

In addition, the global economy experienced complications due to the mobility restrictions imposed around the world. This resulted in a first wave of upward price pressure, but central banks did not respond to the signs of inflation because they considered it transitory. Subsequent the easing of pandemic measures by governments, the macroeconomic outlook worsened following the attack by Russia on Ukraine in February 2022, which led many European countries to impose sanctions on Russian fossil fuel exports. The resulting energy scarcity and rising energy costs led to increased production costs in many industries, and higher consumer goods prices. The price pressures in Switzerland were lower than in many other European countries. This can be attributed to the favourable energy mix in Switzerland and the comparatively low energy intensity of the Swiss economy. Nonetheless, as shown in Graph 3, year on year price inflation in Switzerland reached more than 3 per cent in June 2022, a 25-year-high. In response, the Swiss National Bank raised its key interest rate by 225 bps in a period of less than a year.

Graph 3: Development of the inflation rate in Switzerland and the SNB key interest rate over time

The rising cost of capital might already have worried over-leveraged Swiss firms, but the overall lending outlook for the Swiss market worsened further with the announcement of the merger between Credit Suisse and UBS. Given that the share of the enlarged UBS in trade finance, bank guarantees and unsecured corporate loans might be as high as 70 per cent, costs for corporate clients are expected to increase. Corporate clients from Credit Suisse are in a particularly difficult situation. In the best-case scenario, UBS will take over the existing loans from Credit Suisse – 15 per cent of total corporate loan volume in Switzerland – and refinance firms at similar risk assessments. In the worst-case scenario, the newly established bank would introduce stricter risk assessment and therefore deny refinancing of some corporate loans. Given that clients may be unknown to the bank, this second scenario is not unlikely. If it turns out to be the case, further corporate liquidity shortages would occur – assuming that no smaller lender would be willing or able to take over the credit risks instead.

Spill-over to banks

While the effects of lower corporate revenues caused by the pandemic were partially offset by state intervention, the effects of events following the pandemic could not be dealt with as effectively by the Swiss government. Even though the state interventions during the pandemic could mitigate the problems temporarily, due to the subsequent external shocks they failed to prevent corporate defaults in the long run. In the current situation, Swiss firms not only pay significantly higher interest for the debts they accumulated in the past, they also face challenges in refinancing their debt.

Mortgage rates in Switzerland are an illustrative example. These rates hit a low of below 1 per cent in 2020 but in less than 3 years, correcting slightly to levels that still constitute an increase by a factor of 2.5. The increases in loan rates, combined with historically high loan volumes, negatively affect companies with tight budgets. This is also reflected in the analysis of corporate defaults, shown in Graph 2, which shows a 14 per cent year on year increase in the first months of 2023. It is expected that this rising trend will continue further throughout the year. The sharp increase in corporate defaults is worrying not only for the indebted firms themselves, but it also directly affects banks. Lenders are expected to incur significant losses on defaulted corporate loans as a consequence of these developments. In addition, losses due to greater market volatility and the resulting need to reshuffle loans will weigh on banks’ operations and results. Similar trends are visible in wealth management, securities-backed Lombard loans as well as retail, private, and leasing credits. Graph 1 shows that the large Swiss banks began to readjust their loan loss provisions in Q4 2022 in response to recent developments.

In addition to being concerned about loan defaults, lenders should also be aware of the fair value of their loan books in relation to their liquidity reserves. The recent outflows of upwards of USD100 billion in deposits at First Republic Bank can be taken as a warning sign of what can happen when lenders neglect this ratio. As a result, the lender was first seized by the Federal Deposit Insurance Corporation and later sold to JP Morgan.

Rising key interest rates will in general cause a fall in the fair value of loans: the fall is greater the longer the maturity and the lower the interest rate on the loan. In the current situation, in which central banks are trying to counter inflation and are therefore raising interest rates at a faster than usual pace, it is more important than ever to stay alert to changes in the fair value of loan books.

In order to minimise their losses, lenders need to act fast to mitigate rising non-performing loan ratios and perform quality reviews on their loan books and assets. Measures such as stress testing uncover potential problems in time to allow banks to adjust their asset and loan books to fit their risk appetite. Additionally, lenders should monitor closely the fair value of their loans and ensure that they have sufficient liquidity reserves to meet a potential outflow of assets.

This is the third blog in our series on the impact of the COVID-19 crisis on Swiss banks and the increased risk of loan defaults. Read the previous parts here.

Key contacts

Dr. Marc D. Grüter – Partner – Risk Advisory

Marc leads the FS Regulatory, Risk and Compliance practice of Deloitte in Switzerland and is part of the leadership team for FS Regulatory within Deloitte North West Europe (NWE). In addition to this he is a senior financial services Partner and lead client Partner for leading Financial Institutions in Switzerland. With nearly 20 years of experience in financial services and Consulting (leading global Strategy Consulting firms, Big4) he has built deep expertise in this context with large financial services organisations in Switzerland, Germany, UK, USA, Middle East and Asia.

Email | LinkedIn

Eric Gutzwiller – Director – Risk Advisory

Eric is a Director at Deloitte specialising in the Financial Services industry, with a particular focus on process optimisation and digitalisation as well as TOM design projects. He brings over 10 years of strategy consulting experience in financial services, for both, leading global institutions and developing players, as well as central banks and regulators, in various established markets (Switzerland, UK, US, HK, Germany, Canada) and also in emerging markets (CEE, Middle East).

Email | LinkedIn

Marco Käser – Assistant Manager – Risk Advisory

Marco is an Assistant Manager with the Financial Services Transformation team of Deloitte’s Risk Advisory practice in Zurich. Besides his core focus on front-to-back process optimization, Marco worked on projects around stress testing, scenario modelling as well as operational risks for Swiss and international banks. The first-hand client expertise coupled with his quantitative background contribute to his interest in macroeconomic developments and their manifestation within the banking sector.

Email | LinkedIn

Lena Woodward

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June 8, 2023
The Braless Years: How the Pandemic Changed How We Wear Underwear for Good

“Am I showing off my boobs? Or do I just have boobs…and exist?” asks TikTok creator Rachel Levin in a viral video from November 2021. Even though the clip is nearly two years old, the audio has continued to resonate among the platform’s users—nearly 11,000 posts using the sound bite exist, many of which feature women in tops of varying necklines, pondering the exact same question.

This content is imported from Tiktok. You may be able to find the same content in another format, or you may be able to find more information, at their web site.

Questioning how we view breasts—and exactly how visible they can be to remain “appropriate”—is nothing new. The “Free the Nipple” campaign began in 2012, and a film of the same name was released in 2014. The image of the “bra-burning feminist” is synonymous with the Women’s Liberation Movement of the 1960s and 1970s, although the actual burning of bras has since been proven to be a myth. But perhaps the most significant event regarding how society views wearing bras in recent history has been the COVID-19 pandemic. Beginning in March 2020, when offices shut down worldwide and remote work protocols were put into place, working in sweatpants, and often, braless, from one’s living room (or bed) became the new normal for many. In the years since the pandemic began, a shift away from traditional bras is tangible: remote work is still common, fashion trends like backless tops and sheer dresses are gracing red carpets, the body positivity movement is continuing to evolve, and bodily autonomy, in the wake of the overturn of Roe v. Wade, is at the forefront of our minds.

Julia Fox in L.A. on May 11, 2023.
Rachpoot/Bauer-Griffin

For some, the onset of the pandemic was, in fact, the catalyst for saying goodbye to bras, and the practice has stuck. “I’m a 42H and I haven’t worn a bra since June 2020,” reveals Agnes Bebon, a marketing manager based in Montreal, who added that she overhauled her wardrobe when she made the decision to go braless because she “was finally dressing for myself and not hiding my body.” (Though she also notes that she does wear sports bra-like tops now, following back-to-office mandates.) “Bras were always uncomfortable, never fit right, and left marks on me. I stopped wearing them around the same time that I started making real efforts to like my body, and part of that was me accepting that, yeah, my boobs are big and they sag a bit, but that’s fine and I’m hot.”

For Suze Heller, a writer and baker based in Asheville, North Carolina, letting go of bras during the early days of lockdown was for more than comfort. “Part of it was figuring out what was gender-affirming as my body changed in the last few years,” they said, noting that they went from wearing bralettes before the pandemic began to “no bra for a while and then binders and now sports bras.” The singularity of what is considered office appropriate has changed now that hybrid work is common, in that multiple people I interviewed mentioned wearing bralette-type undergarments to the office—something they never would have thought to do before COVID-19.

The reasons for reevaluating one’s relationship with bras are plentiful, but a common thread appears to be a journey toward body neutrality. Victoria Paris, an influencer based in Los Angeles, also said she started wearing bras less frequently in 2020. “I think I just stopped caring as much about the way I looked because…I wasn’t going into an office, I wasn’t going to school. I wasn’t worried about how people saw me,” she says of her early COVID uniform, which consisted of oversized shirts and tank tops with no bra. Paris, who is known largely for her fashion, travel, and home decorating content and has had partnerships with brands like Urban Outfitters and Anthropologie, frequently posts photos of her outfits, many of them braless.

And as confident as she may appear, the creator also admits that it wasn’t easy to start. As a teen and into her early twenties, “I was extremely insecure about not wearing a bra and the way that looked…even my breast shape,” Paris says. However, since she started going braless more frequently over the past three years, she’s felt empowered to start embracing the way her breasts look naturally. “For the longest time, I was so caught up over, ‘I don’t want saggy boobs,’ even though there’s nothing wrong with having saggy boobs. It’s natural, it’s beautiful, it’s womanly.” And when she posts a photo in which her nipples show or it’s clear she’s not wearing a bra? “Honestly, I feel like [my followers] never see me in a bra, so they wouldn’t even clock it. That’s just how they see me.”

Unsurprisingly, the fashion world is catching on. Stacey Chia, a New York City-based communications manager at the fashion label Tanya Taylor says she’s noticed trends like “thicker fabrics on tops, backless dresses, [and] deep V-necklines that really mean you can’t wear a bra, and if you wanted some sort of coverage, you’d have to use nipple covers,” over the past few years that signify a cultural shift away from bras. As far as her own preferences go, she says she often opted for bralettes before the pandemic, but once it began, “I even found myself even ditching the bralettes, since I had a uniform of loose button-downs” throughout COVID, adding, “I think the pandemic opened us up to a new level of comfort with our bodies and other aspects of our lives as well.”

A vintage brasserie ad.
CSA Images

Aja Barber, a London-based stylist and author of Consumed: The Need for Collective Change: Colonialism, Climate Change, and Consumerism, on the other hand, let go of bras years before the pandemic began, although lockdown did solidify her shift away from them for the long term. By her late twenties, in fact, Barber had become fed up with uncomfortable clothing, including tight-fitting trousers, heeled shoes, and, of course, bras. “I’ve never been a super keen bra wearer,” she says. “I’ve never been that excited about it. I’ve always thought that bra shopping was burdensome and annoying and money that I really didn’t want to spend in that direction.”

As a way to still feel fashionable and put-together, “I would buy summer dresses that normally have some sort of tightness in the chest area to push things together and keep [my breasts] up. That’s how you get away with not wearing a bra,” she says of how her habit of going braless began. “But I fully expect that in my later years I will become that braless old woman, and I do not care at all.”

Since Barber primarily works from home, her bralessness doesn’t pose any issues to her level of professionalism. Though she raises the point that there’s a great degree of privilege when it comes to who can go braless in professional or formal settings and still be taken seriously, reflecting on a former co-worker who was an “older white woman who would wear sweatpants and an old sweater and never a bra.” Barber notes, “I do think that there’s a bit of white privilege wrapped up in the ability to come to work looking that way. As a Black person, I don’t think I have that privilege ever.”

Similarly, there’s a great deal of privilege when it comes to size, given that fatphobia remains present both in the workplace and the fashion industry. “I think it’s more acceptable for smaller breasted people to go braless, but I feel like if I [a D/DD] went braless, it would be very frowned upon,” says Megan Watson, a Chicago-based environmental consultant. “And especially for fat and plus size people—I feel like it adds to the anti-fat rhetoric if we don’t wear bras, i.e., we don’t care about our appearances, we don’t put in the effort, etc…,” she adds.

Conversely, the early days of quarantine have pushed some to discover a new appreciation for the pulled-together feeling that wearing a bra can provide. “At the beginning of quarantine, I relished in the ability to wear leggings and a sweater and call it a day,” says Caldwell Harden, a client services manager based in New York City. “But as quarantine lagged on, I just grew tired of not making an effort with my outfits and I started really thinking about how I got dressed every day. Soon, I started seeing a correlation in the effort I put into my outfit and my outlook towards the day.” Eventually, Harden returned to wearing a bra on a daily basis.

“I find when I don’t wear a bra, I usually am putting less effort into my appearance generally, and I just feel less prepared to take on the day,” Harden says. “My clothes and style are a type of armor for me to face the world, and my bras and undergarments are the chainmail.”

Rihanna attends Jean Paul Gaultier’s fall/winter 2014/2015 show during Paris Fashion Week.
Michel Dufour

Wearing (or not wearing) a bra is a personal choice, of course, though it’s also worth considering what its fundamental purpose is. “Bras can be helpful for women who have breast pain, which is very common, because, if properly fitted, the bra can provide support to the breast and can help reduce discomfort,” says Dr. Deanna J. Attai, MD, FACS, an associate clinical professor in the Department of Surgery at UCLA’s David Geffen School of Medicine and the UCLA Health Burbank Breast Care. She also mentioned that a supportive bra is usually recommended for “at least during the immediate postoperative period” for people who have undergone surgery. Otherwise, Dr. Attai says, “There are no good medical reasons for or against wearing a bra.”

If there are no serious health risks to going braless, and if not wearing a bra is now considered acceptable, and even stylish in many circumstances given the cultural shift of the past three years, it might be time to rethink what we believe is palatable when it comes to breasts, what feels comfortable, sexy, and gender-affirming, and, most importantly, who really gets to decide what we do with our breasts.

Madeline Diamond a writer and editor with bylines in Buy Side from WSJ, New York magazine, Travel + Leisure, and more. Originally from Southern California, she now lives in Brooklyn and can often be found in her favorite park, cappuccino in hand.

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June 1, 2023
Lessons as a lender: How FlexiLoans was conceived and grew in scale
Enthused by a strong wave of India’s march in the areas of Jan-Dhan (Banking accounts), Aadhar (KYC solutions) and Mobile (contactability/ alternate data), Ritesh, Deepak and I (classmates from Indian School of Business 2009) started FlexiLoans.com in 2016 to serve the deserving yet unserved micro and small businesses across India using data-backed credit underwriting and technology infrastructure for superior customer journeys.

When we met our first set of e-commerce and merchant platforms for distributing business loans digitally using surrogate data within 48 hours, we were welcomed with a red carpet. Our prospective investors/ lenders, however, wanted to see the traction and credit behaviour giving us the first lesson that in lending risk is rewarded more than book growth and potential.

Soon, FlexiLoans became one of the leading lenders for e-commerce sellers selling on platforms such as Shopclues, Snapdeal, Flipkart, Amazon, Paytm, and many more. During 2016-17, Indian MSMEs witnessed 2 big macro changes: a) demonetisation; and (b) Introduction of GST regime — pivotal changes for the Indian small businesses.

We developed surrogate underwriting models based on POS pay-outs, e-commerce sales that ensure seamless delivery of credit and data-backed eligibility computation for loans, which was unheard of till then. Covid period from year 2020-22 further spiralled the digital adoption of the Indian businesses, and today we receive over 3.5 lakh monthly applications and over 10 lakh monthly visits to our digital platforms. The lesson learnt here is that India is a very large underserved and high potential market, waiting for disruption in lending by category defining lending companies like FlexiLoans.com that leverages data and technology to service the loans viable

During 2019, Indian NFBCs suffered a huge setback post PNB and ILFS crisis where the funding literally dried up and sanctions which would take a few weeks to get disbursed started taking months. We learnt a tough lesson then that liability and liquidity management is one of the trickiest and a core task at Lending and if not set as a disciplined process, can hamper growth. We developed co-lending solutions for our customers along with a few prominent banks and NBFCs and these came very handy in 2021-22 when funding scenario for lending was again tight owing to covid but 70% of our AUM growth was catered seamlessly by our partner lenders via our co-lending platform. Our liability franchisee is today diversified with over 25+ Banks and FIs lending to us directly and multiple co-lending partners.

Lastly, the COVID period was a true test for any lender and we learnt the virtues of empathy, communication and technology in our Collection efforts. We kept in constant touch with our customers, expanded our reachability to the customers, restructured their loans at a customer level understanding and landed at credit costs of <5% even during the Covid years and least customer escalations. We used technology tools to remind customers, get payments and update them on their track records.

In summary, the last 6+ years have seen one of the toughest macro economic environments for Indian MSMEs but at the same time, saw the Indian Digital Stack gaining enormous strength aided by regulatory support. We are now amongst the leading Fintech Lenders in the country with over ₹1,000 crore of AUM, over ₹4,000 crore of annual disbursement run rate and amongst the few profitable fintechs supported by the trust and support of our valued customers and stakeholders. In lending, one is judged by the ability to grow risk sensitivity than loan book.

Manish Lunia is the co-founder of FlexiLoans.com
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Published on May 7, 2023
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May 7, 2023
WHO experts to weigh whether world ready to end COVID emergency

LONDON, May 4 (Reuters) – A panel of global health experts will meet on Thursday to decide if COVID-19 is still an emergency under the World Health Organization’s rules, a status that helps maintain international focus on the pandemic.

The WHO first gave COVID its highest level of alert on Jan. 30, 2020, and the panel has continued to apply the label ever since, at meetings held every three months.

However, a number of countries, such as the United States, have recently begun lifting their domestic states of emergency. WHO Director-General Dr Tedros Adhanom Ghebreyesus has said he hopes to end the international emergency this year.

A final decision by Tedros based on the panel’s advice is expected in the coming days. There is no consensus yet on which way the panel may rule, advisors to the WHO and external experts told Reuters.

“It is possible that the emergency may end, but it is critical to communicate that COVID remains a complex public health challenge,” said Professor Marion Koopmans, a Dutch virologist who is on the WHO panel. She declined to speculate further ahead of the discussions, which are confidential.

One source close to negotiations said lifting the “public health emergency of international concern,” or PHEIC, label could impact global funding or collaboration efforts. Another said that the unpredictability of the virus made it hard to call at this stage. Others said it was time to move to living with COVID as an ongoing health threat, like HIV or tuberculosis.

“All emergencies must come to an end,” said Lawrence Gostin, a law professor at Georgetown University in the United States who follows the WHO.

“I expect WHO to end the public health emergency of international concern. If WHO does not end it… [this time], then certainly the next time the emergency committee meets.”

Dr. Jarbas Barbosa, director of the Pan American Health Organization (PAHO), said he was concerned that a change in status would lead to complacency, with weaker surveillance and falling vaccination levels.

“(The PHEIC) does not bring any kind any harm for countries but at the same time it keeps their attention,” he told journalists.

Reporting by Jennifer Rigby in London and Emma Farge in Geneva; Editing by Alexandra Hudson

Our Standards: The Thomson Reuters Trust Principles.

Jennifer Rigby

Thomson Reuters

Jen reports on health issues affecting people around the world, from malaria to malnutrition. Part of the Health & Pharma team, recent notable pieces include an investigation into healthcare for young transgender people in the UK as well as stories on the rise in measles after COVID hit routine vaccination, as well as efforts to prevent the next pandemic. She previously worked at the Telegraph newspaper and Channel 4 News in the UK, as well as freelance in Myanmar and the Czech Republic.

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May 4, 2023
Hotel housekeeping jobs have fallen by 102,000 during the pandemic. What happened?

As some U.S. hotels hung on to practices they adopted during the early stages of the coronavirus pandemic — such as eliminating daily room cleanings — the number of hotel housekeepers fell by more than 102,000 last year from prepandemic levels, new data show.

The total number of hotel housekeeping jobs as of May 2022 was 364,990, a 22% decline from the total of 467,270 such positions during the same period in 2019, according to numbers released last week by the Bureau of Labor Statistics.

Unions…

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May 2, 2023
Long-Haulers Are Trying to Define Themselves

Imagine you need to send a letter. The mailbox is only two blocks away, but the task feels insurmountable. Air hunger seizes you whenever you walk, you’re plagued by dizziness and headaches, and anyway, you keep blanking on your zip code for the return address. So you sit in the kitchen, disheartened by the letter you can’t send, the deadlines you’ve missed, the commitments you’ve canceled. Months have passed since you got COVID. Weren’t you supposed to feel better by now?

Long COVID is a diverse and confusing condition, a new disease with an unclear prognosis, often-fluctuating symptoms, and a definition people still can’t agree on. And in many cases, it is disabling. In a recent survey, 1.6 percent of American adults said post-COVID symptoms limit their daily activities “a lot.” That degree of upheaval aligns with the Americans With Disabilities Act’s definition of disability: “a physical or mental impairment that substantially limits one or more major life activities.”

But for many people experiencing long COVID who were able-bodied before, describing themselves as “disabled” is proving to be a complicated decision. This country is not kind to disabled people: American culture and institutions tend to operate on the belief that a person’s worth derives from their productivity and physical or cognitive abilities. That ableism was particularly stark in the early months of the pandemic, when some states explicitly de-prioritized certain groups of disabled people for ventilators. Despite the passage of the ADA in 1990, disabled people still confront barriers accessing things such as jobs and health care, and even a meal with friends at a restaurant. Most of our cultural narratives cast disability as either a tribulation to overcome or a tragedy.

Consequently, incorporating disability into your identity can require a lot of reflection. Lizzie Jones, who finished her doctoral research in disability studies last year and now works for an educational consultancy, suffered a 30-foot fall that shattered half of her body a week before her college graduation. She told me that her accident prompted “radical identity shifts” as she transitioned from trying to get the life she’d imagined back on track to envisioning a new one.

These are the sorts of mindset changes that Ibrahim Rashid struggled with after contracting COVID in November 2020, when he was a graduate student. He dealt with debilitating symptoms for months, but even after applying for disability accommodations to finish his degree, he “was so scared of that word,” he told me. Rashid was afraid of people treating him differently and of losing his internship offer. Most terrifying, calling himself disabled felt like an admission that his long COVID wasn’t going to suddenly resolve.

Jennifer Senior: What not to ask me about my long COVID

Aaron Teasdale, an outdoors and travel writer and a mountaineer, has also been wrestling with identity questions since he got COVID in January 2022. For months, he spent most of his time in a remote-controlled bed, gazing out the window at the Montana forests he once skied. Although his fatigue is now slowly improving, he had to take Ritalin to speak with me. He was still figuring out what being disabled meant to him, whether it simply described his current condition or reflected some new, deeper part of himself—a reckoning made more difficult by the unknowability of his prognosis. “Maybe I just need more time before I say I’m a disabled person,“ he said. “When you have your greatest passions completely taken away from you, it does leave you questioning, Well, who am I?”

Long COVID can wax and wane, leaving people scrambling to adapt. It doesn’t mesh with the stereotype of disability as static, visible, and binary—the wheelchair user cast in opposition to the pedestrian. Nor does the fact that long COVID is often imperceptible in casual interactions, which forces long-haulers to contend with disclosure and the possibility of passing as able-bodied. One such long-hauler is Julia Moore Vogel, a program director at Scripps Research, who initially hesitated at the idea of getting a disabled-parking permit. “My first thought was, I’m not disabled, because I can walk,” she told me. But if she did walk, she’d be drained for days. Taking her daughter to the zoo or the beach was out of the question.

Once she got over her apprehension, identifying as disabled ended up feeling empowering. Getting that permit was “one of the best things I’ve done for myself,” Vogel told me. She could drive her kid to the playground, park nearby, and then sit and watch her play. After plenty of therapy and conversations with other disabled people, Rashid, too, came to embrace disability as part of his identity, so much so that he now speaks and writes about chronic illness.

Read: The future of long COVID

Usually, the community around a disease—including advocacy among those it disables—arises after scientists name it. Long COVID upended that order, because the term first spread through hashtags and support groups in 2020. Instead of doctors informing patients of whether their symptoms fit a certain illness, patients were telling doctors what symptoms their illness entailed. And there were a lot of symptoms: everything from life-altering neurocognitive problems and dizziness to a mild, persistent cough.

As long-COVID networks blossomed online, members began seeking support from wider disability-rights communities, and contributing fresh energy and resources to those groups. People who’d fought similar battles for decades sometimes bristled at the greater political capital afforded to long-haulers, whose advocacy didn’t universally extend to other disabled people; for the most part, though, long-haulers were welcomed.

Tapping into conversations among disabled people “has shown me that I’m simply not alone,” Eris Eady, a writer and an artist who works for Planned Parenthood, told me. Eady, who is queer and Black, found that long COVID interplayed with struggles they already faced on account of their identity. So they sought advice from disabled Black women about interdependence, mutual aid, and accessibility, as well as about being dismissed by doctors, an experience more prevalent among women and people of color.

Disabled communities have years of experience supporting people through identity changes. The writer and disability-justice organizer Leah Lakshmi Piepzna-Samarasinha told me that when she was newly disabled, she was dogged with heavy questions: Am I going to be able to make a living? Am I datable? Her isolation and fear dissipated only when she met other young disabled people, who taught her how to be creative in “hacking the world.”

For long-haulers navigating these transitions for the first time, the process can be rocky. Rachel Robles, a contributor to The Long COVID Survival Guide, told me she spent her early months with long COVID “waking up every day and thinking, Okay, is this the day it’s left my body?” Conceiving of herself as disabled didn’t take away her long COVID. She didn’t stop seeing doctors and trying treatments. But thinking about accessibility did inspire her to return to gymnastics, which she’d quit decades earlier because of a heart condition. If she couldn’t lift her hands over her head sometimes, and if a dive roll would never be in her future, then so be it: Gymnastics could be about enjoying what her body could do, not yearning for what it couldn’t. Before she identified as disabled, returning to gymnastics “was something I would have never, ever imagined,” Robles said. And she never would have done it had she remained focused only on when she might recover.

Read: Long COVID is being erased—again

Hoping for improvement is a natural response to illness, especially one with a trajectory as uncertain as long COVID’s. But focusing exclusively on relinquished past identities or unrealized future ones can dampen our curiosity about the present. A better way to think about it is “What are the things you can do with the body that you have, and what are the things you might not know you can do yet?” Piepzna-Samarasinha said. “Who am I right now?”

Lindsay Ryan

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April 28, 2023
New Survey Reveals That Covid Has Turned Many Homeowners Into Homebodies

Homeowners are cooking more at home and happily spending more time there post-pandemic, according to … [+] recent survey.

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Covid turned many Americans into homebodies, according to the Research Institute for Cooking and Kitchen Intelligence. In its recently released “RICKI 2022 Changes Driven by the Pandemic” survey sent to more than 1,000 homeowners, the research consultancy sought to learn how respondents’ pandemic experiences impacted their relationships with their homes, especially in the kitchen, what changes they’ve made, and how their attitudes have shifted as a result of this massive disruption.

Greater Desire to Be Home

One response that leaped from the RICKI survey was 64% of surveyed homeowners strongly agreeing that “I have a greater desire to be home now than I did before the pandemic.” How might this be showing up in home remodeling plans?

One trend is increased requests for wine and coffee centers by kitchen project clients, facilitating the kind of socializing that was next to impossible during the first months of the pandemic. This has spurred more product releases that help store wine, serve beer and brew coffee at home.

Steve Smith, CEO of high end Southern California retail chain Pirch shared in trade magazine Kitchen & Bath Design News’ annual Trend Spotting wrap-up last November, “We used to sell built-in coffee machines in one out of 10 kitchens, and now it’s more like three or four out of 10. Customers want to put in their own version of either a bar or a soft drink center, so their homes are better equipped for entertaining. Anything that allows people to entertain in their home has become a must-have.”

Another area where the pandemic’s influence has shown up is the continued popularity of outdoor living spaces for socializing and relaxation, which are larger, more luxurious and better equipped than ever before. Climate control features extending their use into the hotter and colder months include fans and misters for the hotter months and fire features for the colder ones. Materials like porcelain slab countertops and decking also make these spaces heat and frost resistant.

Home fitness continues to be popular – even though, as noted here recently, those spaces may be smaller and multi-use in some regions – so that time-pressed, health-conscious homeowners can get a workout in without driving to a gym or sharing showers.

My Home Makes Me Happier Now

Covid showed homeowners where their homes were serving them poorly, and a burst of remodeling activity followed to redress some of those issues. For example, the National Kitchen & Bath Association’s 2022 Trends Summary of industry professionals noted that clients have been choosing easy to clean, sanitary surfaces; hands-free faucets; paints that don’t off-gas, and universal design features that accommodate aging in place, all of which contribute to peace of mind. They’re also adding comfort features like radiant flooring, bathroom storage with outlets for beauty tools, and large islands for entertaining.

Mental well-being showed up as the top priority for 60% of surveyed homeowners in the John Burns Research & Consulting’s January 2023 Healthy Homes survey, described in this April 11 Forbes.com article. Features that enhance peace of mind definitely support that priority!

I Am Spending More Time in My Kitchen Now

There are several factors that likely have 50% of the RICKI survey respondents strongly agreeing that they’re spending more time in the kitchen now than they did pre-pandemic. These include early restaurant shutdowns, the drive to use time at home in creative new ways during COVID, the links between healthy eating and reducing COVID co-morbidities, and inflation creating the need to get smarter about shopping and meal preparation.

The NKBA survey points out that homeowners are planning their kitchen redesigns for more than just cooking though. Islands are getting larger, the report notes, with 62% wanting eating areas and 59% wanting areas for their kids to complete their homework and school assignments. Also high on 64% of homeowners’ kitchen wish lists in the NKBA study is space to charge and view their phones, tablets and laptops.

I’m Much More Knowledgeable About Cooking

That extra time in the kitchen has led 43% of RICKI respondents to agree strongly that they feel better prepared to create meals for themselves and their households than they did pre-pandemic. Appliance manufacturers are helping in this regard, with built-in recipe helpers, cooking app tie-ins and remote operation, letting you check on your oven’s progress from your home office to avoid burning your food. Half of the NKBA respondents (50%) say clients want mobile apps to control their appliances.

It’s also driving interest in newer, more advanced appliances like ovens with steam or air frying capabilities (63% of NKBA respondents), induction cooktops with smart ventilation and enhanced refrigeration with flex drawers that switch from fridge to freezer to wine cooling.

While pro-style gas ranges and cooktops have been popular for decades now, the NKBA Report shows “induction popularity expected to climb into mainstream” in the next three years. The 2022 report had induction popularity at 42% versus gas at 46%. Recent studies on the health risks associated with gas cooking and regional bans on gas lines to homes will likely drive those numbers much higher.

The home cooking trend is also spurring remodels with better pantry storage. The NKBA survey reported a 60% interest in these spaces. Not only do they accommodate food storage, they also often include countertop appliances to help in meal prep, storage for serving pieces and pro-style sinks for prep and cleanup.

Jamie Gold, Contributor

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April 25, 2023
It’s not 2020 anymore. Biden’s re-election campaign faces new challenges

WASHINGTON, April 23 (Reuters) – It won’t be a campaign from the basement this time.

As U.S. President Joe Biden gears up for a bruising re-election battle, the realities of the 2024 race and differences with 2020 at the height of the coronavirus pandemic create new challenges for him.

Biden, a Democrat, says he is running again and is considering a formal announcement via video as soon as Tuesday.

In 2020, Biden kept a low profile as the spread of COVID-19 caused havoc to most aspects of American life, including the election campaign that pitted him against then-President Donald Trump, a Republican.

Trump still spoke at big rallies, but Biden did much of his campaigning virtually from the basement of his home in Wilmington, Delaware, largely avoiding crowds to prevent the spread of disease and reduce his own risk of catching the virus.

That will change this time around. Gone will be the aversion to public events, large and small, likely replaced by traditional campaign stops at diners, factories and union halls with handshakes, selfies, and crowds of people.

The Democratic convention in Chicago will be in-person rather than online. And Biden, who at 80 is already the oldest president in U.S. history, will have his day job to do while he makes the case for four more years in office.

Biden beat Trump in 2020 by winning the Electoral College 306 to 232, winning the close swing states of Pennsylvania and Georgia, and he bested Trump by more than 7 million votes nationally, capturing 51.3 percent of the popular vote to the Republican’s 46.8 percent.

AGE FACTOR

Republicans will watch closely for signs of a diminished schedule to suggest that age has made Biden less fit for the campaign trail, and for the White House.

“It’s quite shocking that Biden thinks he would be able to fill a second term, let alone the rest of this term,” said Republican strategist Scott Reed.

Trump, the early front-runner for the Republican nomination, is himself 76 years old.

Biden’s reply to concerns about his age and running for re-election has been to say “watch me,” and the White House points to his record of legislative accomplishments as a sign of his effectiveness.

“An extensive travel schedule is not the measure of a candidate’s ability to do the job,” said Democratic strategist Karen Finney. “There’s no scenario where the Republicans don’t try to make his age an issue. We know that. And so the focus has to be on … what is the most effective way to reach the American people. Some of that, yes, is going to be in-person events and travel, but there may be other innovations.”

CAMPAIGN REINVENTED

Biden campaign aides reinvented his 2020 campaign as COVID-19 spread across the country.

Some of the innovations were regarded as a success, including star-studded virtual fundraisers done without the need for expensive travel.

But other changes were more controversial, including a months-long prohibition on the use of door-knocking by campaign volunteers and the regular appearances by Biden in his home’s basement, which became a meme panned by right-wing voters.

Having to get out more than in 2020 could help Biden, said Meg Bostrom, co-founder of Topos Partnership, a strategic communications firm.

“Just look at the State of the Union (address.) That was the best I’ve ever seen. When Republicans started heckling him, he just lit up,” she said. Biden sparred ably with Republicans during his speech to Congress in February.

But other issues may trip up the incumbent president on the campaign trail, including his handling of the economy.

“The allure for voting for Biden in 2020 was sort of the quaint notion of getting back to normal,” said Republican strategist Ford O’Connell, referring to the chaos of Trump’s time in office.

“The problem for Biden is that he’s been in power … and things are anything but normal, especially when it comes to the economy and inflation.”

Reuters Graphics Reuters Graphics

RECESSION CONCERNS

Biden took office in January 2021 just as COVID vaccines were rolling out, and economic conditions gradually normalized during his early tenure after the shock of nationwide shutdowns. The United States now boasts 3.2 million jobs over the pre-pandemic peak.

But Americans are concerned about a potential recession, and Biden may suffer from being on the wrong side of an economic cycle heading into 2024, with unemployment likely to rise as growth slows, interest rates remaining high and inflation potentially hovering above pre-pandemic levels.

Reuters Graphics Reuters Graphics

Trump, who has announced his re-election bid already and could be Biden’s opponent again, is expected to follow the strategy that he employed in 2016 and 2020 with multiple large rallies to energize his base.

But he will first have to win what could be a grueling Republican nomination contest – something that Biden, as an incumbent without major opposition inside his party, will not face.

“We don’t need fire and brimstone. We don’t need rah rah rallies,” said Democratic strategist Joe Lestingi. “We need the strength and conviction of our values and a steadiness not to move on them.”

Biden, he said, would provide that steadiness.

“I think he’ll get out more,” Lestingi said, praising Biden’s skill at traditional “retail” politics. “If you get an opportunity to be with him in a small intimate setting, he can make a real big difference.”

Reuters Graphics Reuters Graphics

Reporting by Jeff Mason; additional reporting by Trevor Hunnicutt, Steve Holland, Howard Schneider and Andrea Shalal; editing by Grant McCool

Our Standards: The Thomson Reuters Trust Principles.

Jeff Mason

Thomson Reuters

Jeff Mason is a White House Correspondent for Reuters. He has covered the presidencies of Barack Obama, Donald Trump and Joe Biden and the presidential campaigns of Biden, Trump, Obama, Hillary Clinton and John McCain.

He served as president of the White House Correspondents’ Association in 2016-2017, leading the press corps in advocating for press freedom in the early days of the Trump administration. His and the WHCA’s work was recognized with Deutsche Welle’s “Freedom of Speech Award.”

Jeff has asked pointed questions of domestic and foreign leaders, including Russian President Vladimir Putin and North Korea’s Kim Jong Un. He is a winner of the WHCA’s “Excellence in Presidential News Coverage Under Deadline Pressure” award and co-winner of the Association for Business Journalists’ “Breaking News” award.

Jeff began his career in Frankfurt, Germany as a business reporter before being posted to Brussels, Belgium, where he covered the European Union.

Jeff appears regularly on television and radio and teaches political journalism at Georgetown University. He is a graduate of Northwestern University’s Medill School of Journalism and a former Fulbright scholar.

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April 24, 2023
China says it respects sovereignty of ex-Soviet states after EU uproar
Chinese ambassador to Paris caused uproar in EU

Comments focused on Ukraine, ex-Soviet states

Beijing says he was expressing personal views

EU welcomes ‘clarification’
LUXEMBOURG, April 24 (Reuters) – China respects the status of former Soviet member states as sovereign nations, its foreign ministry said on Monday, distancing itself from comments by its envoy to Paris that triggered an uproar among European capitals.

Several European Union foreign ministers had said comments by ambassador Lu Shaye – in which he questioned the sovereignty of Ukraine and other former Soviet states – were unacceptable and had asked Beijing to clarify its stance.

Asked if Lu’s comments represented China’s official position, foreign ministry spokesperson Mao Ning said that Beijing respected the status of the former Soviet member states as sovereign nations following the collapse of the Soviet Union.

Mao told a regular news briefing that it was her remarks on sovereignty that represented China’s official government stance.

The Chinese embassy in Paris issued a statement later on Monday to say that Lu’s comments on Ukraine “were not a political declaration but an expression of his personal views”.

Both statements, following the backlash, appeared to be an effort to ease the tension with the EU while Washington also cited growing closeness between Beijing and Moscow.

“Beijing has distanced itself from the unacceptable remarks by its ambassador,” Josep Borrell told a news conference, saying it was “good news”.

The French foreign ministry said it was “taking note” of Beijing’s “clarifications” and that the minister’s chief of staff had met with Lu on Monday, told him his comments were unacceptable and urged him to speak in a way “that is in line with his country’s official stance.”

Lu has earned himself a reputation as one of China’s “wolf warrior” diplomats, so-called for their hawkish and abrasive style.

Asked about his position on whether Crimea was part of Ukraine or not, Lu had said in an interview aired on French TV on Friday that historically it was part of Russia and had been offered to Ukraine by former Soviet leader Nikita Khrushchev.

“These ex-USSR countries don’t have actual status in international law because there is no international agreement to materialize their sovereign status,” Lu added.

Czech Foreign Minister Jan Lipavsky speaks during a news conference, in Riga, Latvia April 21, 2023. REUTERS/Ints Kalnins

‘TOTALLY UNACCEPTABLE’

Monday’s statements from the Chinese foreign ministry and embassy in Paris came after criticism from across the EU.

Speaking ahead of a Luxembourg meeting of EU foreign ministers earlier in the day, Czech Foreign Minister Jan Lipavsky said Lu’s comments were “totally unacceptable”.

“I hope the bosses of this ambassador will make these things straight,” he told reporters.

A spokesperson for Germany’s foreign ministry said it had taken note of Lu’s comments “with great astonishment, especially as the statements are not in line with the Chinese position we have known so far.”

Lithuanian Foreign Minister Gabrielius Landsbergis said the three Baltic countries would summon Chinese representatives to officially ask for clarification.

He said Beijing was “sending the same message” as Moscow on questioning the sovereignty of former Soviet countries, which he described as “dangerous”.

Lithuania and its Baltic neighbours Latvia and Estonia were incorporated into the Soviet Union in 1940, but regained independence after its break-up in 1991.

EU leaders would discuss the bloc’s stance towards China and its future relations with Beijing during their next summit in June, EU Council President Charles Michel said.

Lu has been summoned to France’s foreign ministry several times in the past, including for suggesting France was abandoning old people in nursing homes during the COVID-19 pandemic and for calling a respected China scholar at a French think-tank a “mad hyena”.

Asked about Chinese officials’ comments, White House spokesperson John Kirby told MSNBC broadcaster that China and Russia are clearly aligning, adding: “These are two countries that want to challenge outright the international rules-based order … that respects sovereignty around the world.”

“They want to undermine it. They want to reduce and diminish not only the United States and our influence around the world but also our allies and partners.”

Reporting by Bart Meijer

Our Standards: The Thomson Reuters Trust Principles.
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April 24, 2023
Europe presses tough Taiwan stance after backlash against Macron comments

April 14 (Reuters) – European foreign policy officials on Friday urged China not to use force over Taiwan, taking a tough stance against Beijing’s threats over the democratically governed island, after comments by French President Emmanuel Macron were perceived as weak.

China in recent days has held intense military drills around Taiwan, which it claims as its own, and has never renounced the use of force to bring the island under its control.

German Foreign Minister Annalena Baerbock, addressing the issue at a press conference in Beijing alongside her Chinese counterpart Qin Gang, said any attempt by China to control Taiwan would be unacceptable and would have serious repercussions for Europe.

EU foreign policy chief Joseph Borrell echoed her remarks in a statement prepared for a speech due to be delivered in Beijing at the Center for China and Globalization think tank on Friday that had to be cancelled after he caught COVID-19.

“A military escalation in the Taiwan Strait, through which … 50% of world trade goes every day, would be a horror scenario for the entire world,” said Baerbock, adding it would have “inevitable repercussions” for European interests.

In interviews published after his trip to China last week, which was meant to showcase European unity on China policy, Macron cautioned against being drawn into a crisis over Taiwan driven by an “American rhythm and a Chinese overreaction”.

While many of the remarks were not new, the timing of their publication, and their bluntness, annoyed many Western officials.

“The European Union’s position (on Taiwan) is consistent and clear,” Borrell said in his remarks. “Any attempt to change the status quo by force would be unacceptable.”

UKRAINE ISSUE

Borrell also said Europe’s future relationship with China depended on it trying to use its influence to find a political solution to the Ukraine crisis.

“It will be extremely difficult, if not impossible, for the European Union to maintain a relationship of trust with China, which I would like to see, if China does not contribute to the search for a political solution based on Russia’s withdrawal from the Ukrainian territory,” Borrell said.

“Neutrality in the face of the violation of international law is not credible,” Borrell said, adding an appeal for Chinese President Xi Jinping to speak to Ukrainian President Volodymyr Zelenskiy and for China to provide more humanitarian aid to Ukraine.

Xi has met Russian President Vladimir Putin twice but not spoken with Zelenskiy since Russia invaded Ukraine in what Moscow calls a “special military operation” in February 2022.

China stated its opposition to attacks on civilians and on nuclear facilities in a position paper on Ukraine published in February, but it has refrained from openly criticising Russia.

“President Xi’s visit to Moscow has demonstrated that no other country has a bigger influence on Russia than China,” said Baerbock.

“It is good that China has signalled to get engaged in finding a solution. But I have to say clearly that I wonder why China so far has not asked the aggressor Russia to stop the war. We all know President Putin has the opportunity to do so any time he wants to.”

Poland’s prime minister warned earlier this week that Ukraine’s defeat may embolden China to invade Taiwan.

Baerbock and Borrell also spoke about the risks of being too dependent economically on China, in line with comments made by European Commission President Ursula von der Leyen in a speech last month on the eve of her China visit.

“We just paid a high price for our energy dependency on Russia, and it is well-known that one should not make the same mistake twice,” said Baerbock, adding that economic security is core to Germany’s strategy for China.

Borrell said that the EU needs to diversify its value chains to reduce its dependency on China for raw materials.

He also said that the increasing trade imbalances between the EU and China are “unsustainable” and called on China to remove market access barriers.

Reporting by Yew Lun Tian in Beijing; Editing by Clarence Fernandez

Our Standards: The Thomson Reuters Trust Principles.

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April 14, 2023
Free COVID testing will fade with US health emergency in May | Long Island Business News

When the COVID-19 public health emergency ends in the U.S. next month, you’ll still have access to a multitude of tests but with one big difference: Who pays for them.

For the first time, you may have to pick up some or all of the costs, depending on insurance coverage and whether the tests are done at home or in a doctor’s office.

But there’s still time to get some free tests before the May 11 change, and there could still be free ones available afterward. Some state and local governments may continue to distribute free home tests through clinics, libraries and community centers. And the federal government, for now, is still sending free tests through the U.S. Postal Service to households that haven’t already received two shipments.

And don’t discount those old tests you haven’t used. The expiration date on the package may have been extended. The Food and Drug Administration’s website provides a list to check and see which tests are still good.

Here’s a look at what the end of the government’s emergency declaration on May 11 means for testing:

AT-HOME TESTS

The biggest changes will be for over-the-counter tests, which account for the vast majority of screening in the U.S. today.

Since early 2021, the federal government has required all private insurers to cover up to eight COVID-19 tests per month. That requirement will soon go away. Coverage is also scheduled to lapse for tens of millions of seniors in the federal government’s Medicare program, though some members of Congress are pushing to extend the benefit.

While some private insurers may continue to cover all or some home tests, there will be no longer be a nationwide rule. A two-pack of tests typically costs between $20 and $24.

“What we will see is a hodgepodge of approaches by different insurance companies, which is going to make it difficult for individuals to know what they’re going to be paying,” said Christina Silcox, of the Duke Margolis Center for Health Policy, which recently issued a report on the outlook for testing.

One exception will be for those enrolled in the government Medicaid program for low-income individuals and families, who will continue to receive free tests until September 2024.

IN-OFFICE TESTS

Americans can also expect to pay more for any COVID-19 tests performed at a hospital, clinic or doctor’s office.

Insurers have been barred from charging copays, or any other cost-sharing fees related to COVID-19 testing. That requirement also ends next month.

While insurers will still cover basic testing costs, some people could face new fees for a portion of the test’s price or for the services of the health professional performing it. Lab tests have typically ranged between $70 and $100 and some of that could be passed along to patients.

COVID-19 vaccines and drugs will remain free because they are not paid for through insurance, but by the federal government. One concern is that uncertainty around testing costs could lead to delays in treatment. Current treatments for high-risk patients, like Paxlovid, generally need to be taken within the first few days of symptoms to be effective.

If people are worried about testing costs, “they may wait a couple days to see if things clear up and miss that five-day treatment window,” Silcox said.

TESTING CAPACITY

The U.S. struggled to build up its test manufacturing capacity during the first two years of the pandemic, with demand waning after each surge. Experts worry that the country could again be caught flat-footed after the federal government stops purchasing tests in bulk.

Only after the U.S. government said it would buy 1 billion tests did production stabilize, reaching a peak of 900 million monthly tests in February 2022.

“Those bulk purchases basically guaranteed the market for test manufacturers,” said Jennifer Kates, a senior vice president with the nonprofit Kaiser Family Foundation.

As of September, manufacturers were still producing over 400 million tests per month, far exceeding U.S. testing levels, according to Duke researchers.

Companies including Abbott Labs say they will be able to ramp up test production as needed. But the company declined to discuss specific production targets or how they will be impacted by the end of the health emergency.

Congress has shown little willingness to buy more tests and the Biden administration did not propose new spending in its latest budget.

“That upfront guarantee by the federal government that takes care of testing volatility won’t be there anymore,” Kates said.

TESTING TECHNOLOGY

The hundreds of different COVID-19 tests authorized by the Food and Drug Administration over the last three years will remain available after May 11. That’s because the FDA OK’d those products under a separate emergency measure that isn’t affected by the end of the national declaration.

Still, FDA officials have been encouraging test makers to apply for full regulatory approval, which will allow their products to stay on the market indefinitely. Last month, the FDA formally approved the first rapid COVID test.

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The Associated Press

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April 11, 2023
Home-based workers became younger, more diverse in pandemic | Long Island Business News

People working from home became younger, more diverse, better educated and more likely to move during the worst part of the COVID-19 pandemic, according to survey data from the U.S. Census Bureau.

In many respects, the demographic makeup of people working from home from 2019 to 2021 became more like workers who were commuting, while the share of the U.S. labor force working from home went from 5.7% in 2019 to 17.9% in 2021, as restrictions were implemented to help slow the spread of the virus, according to a report released last week based on American Community Survey data.

“The increase in homebased workers corresponded with a decline in drivers, carpoolers, transit riders, and most other types of commuters,” the report said.

The share of people working from home between ages 25 and 34 jumped from 16% to 23% from 2019 to 2021. The share of home-based workers who are Black went from 7.8% to 9.5%, and it went from 5.7% to 9.6% for Asian workers. It remained flat for Hispanic workers, the report said.

The share of home-based workers with a college degree also jumped from just over half to more than two-thirds, and people working from home were more likely to have moved in the past year than commuters.

The two industry groups that saw the greatest jumps in people working from home were in information, where it went from 10.4% to 42%, and finance, insurance and real estate, going from 10.8% to 38.4%. Professional and administrative services, also went from 12.6% to 36.5%.

The smallest gains were in agriculture and mining; entertainment and food services; and armed forces.

While every income level saw jumps in people working from home, those in the highest income bracket were most likely to work from home. While it doubled from 2019 to 2021 for workers in the lowest income bracket, it tripled for those in the highest, the report said.

Home-based work also varied by region. By 2021, it was more prevalent in the West and Northeast, making up about a fifth of the workforce, compared to 16.2% in the South and 15.8% in the Midwest. The variation may have been caused by the availability of Internet access, the cluster of information technology jobs on the coasts and the way people commute, whether by car or public transportation, the report said.

The tech-heavy San Francisco and San Jose metro areas had more than a third of their labor force working from home in 2021 — the largest share among metros with more than 1 million residents.

Since most pandemic restrictions have been lifted since the 2021 survey was taken, it is unknown at this point if the growth in work-from-home is permanent.

“If only temporarily, the COVID-19 pandemic generated a massive shift in the way people in the United States related to their workplace location,” the report said. “With the centrality of work and commuting in American life, the widespread adoption of home-based work was a defining feature of the pandemic era.”

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The Associated Press

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April 10, 2023
Long COVID Hitting Some States, Minorities, Women Harder

April 7, 2023 – More than 3 years into the COVID-19 pandemic, lasting symptoms are becoming quite common, with residents of certain states, women, Hispanic people, and transgender people more at risk, a new report shows.

More than one in four adults sickened by the virus go on to have long COVID, according to a new

report

from the U.S. Census Bureau. Overall, nearly 15% of

all American adults

– more than 38 million people nationwide – have had long COVID at some point since the start of the pandemic, according to the report.

The report, based on survey data collected between March 1 and 13, defines long COVID as symptoms lasting at least 3 months that people didn’t have before getting infected with the virus.

It is the second recent look at who is most likely to face long COVID.

A similar study

, published last month, found that women, smokers, and those who had severe COVID-19 infections are most likely to have the disorder

The Census Bureau report found that while 27% of adults nationwide have had long COVID after getting infected with the virus, the condition has impacted some states more than others. The proportion of residents hit with long COVID ranged from a low of 18.8% in New Jersey to a high of 40.7% in West Virginia.

Other states with long COVID rates well below the national average include Alaska, Maryland, New York, and Wisconsin. At the other end of the spectrum, the states with rates well above the national average include Kentucky, Mississippi, New Mexico, Nevada, South Carolina, South Dakota, and Wyoming.

Long COVID rates also varied by age, gender, and race. People in their 50s were most at risk, with about 31% of those infected by the virus going on to have long COVID, followed by those in their 40s, at more than 29%.

Far more women (almost 33%) than men (21%) with COVID infections got long COVID. And when researchers looked at long COVID rates based on gender identity, they found that transgender adults were more than twice as likely to have long COVID than cisgender males. Bisexual adults also had much higher long COVID rates than straight, gay, or lesbian people.

Long COVID was also much more common among Hispanic adults, affecting almost 29% of those infected with the virus, than among White or Black people, who had long COVID rates similar to the national average of 27%. Asian adults had lower long COVID rates than the national average, at less than 20%.

People with disabilities were also at higher risk, with long COVID rates of almost 47%, compared with 24% among adults without disabilities.

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April 7, 2023
China is not only asserting itself geopolitically but openly questioning the U.S.’s central role on the world stage

It’s been a busy few months for China — and sobering ones for the United States.

Days later, Beijing announced it had brokered a deal that will see Persian Gulf rivals Saudi Arabia and Iran normalize relations, a shocking diplomatic coup in an area long dominated by the United States. Xi was reportedly personally involved in the negotiations.

“This landmark agreement has the potential to transform the Middle East by realigning its major powers,” the journal Foreign Affairs declared, adding that the gambit is “weaving the region into China’s global ambitions. For Beijing, the announcement was a great leap forward in its rivalry with Washington.”

But the biggest news came two weeks ago, when Xi flew to Moscow and met with Vladimir Putin, just days after the International Criminal Court in the Hague issued an arrest warrant for the Russian president on charges of war crimes in Russia’s year-old invasion of Ukraine.

“ ‘China has seen a space where it is hard for the West to really block off — heading into issues [that the Western powers] feel are too intractable or too toxic to touch and trying to demonstrate that there might be a different way to mediate or involve yourself in these problems.’ ”

— Kerry Brown, King’s College London

“There are changes coming that haven’t happened in 100 years,” Xi told Putin as the self-described “dear friends” concluded their talks. “When we are together, we are driving these changes.”

China’s assertiveness comes after three years of COVID restrictions that saw the country close off from the world in an attempt to tame the virus, a policy that was suddenly scrapped in December.

“It has sunk in that China needs friends. It has ended up too isolated, and that has cut across the narrative of the Xi third term, which was due to be somewhat more sunny,” Kerry Brown, director of the Lau China Institute at King’s College London, told MarketWatch.

Others agreed. “China certainly is exiting a period of diplomatic isolation during the height of COVID,” said Victor Shih, the Ho Miu Lam chair in China and Pacific relations at the University of California, San Diego, and an expert on Chinese elite politics.

That exit has been swift, with Beijing taking concrete steps toward a belief that previously had been mostly rhetoric — that the U.S.-led global system is not the only path.

“China has seen a space where it is hard for the West to really block off — heading into issues [that the Western powers] feel are too intractable or too toxic to touch and trying to demonstrate that there might be a different way to mediate or involve yourself in these problems,” Brown said.

Those sentiments are increasingly pervasive across China, particularly in government, academia and media.

“The U.S., which is accustomed to enjoying the spotlight, is now puzzled for it never thought that one day China would be more popular than it,” state tabloid Global Times said in a front-page story last Thursday.

Wang Yong, director of the Center for International Political Economy and the Center for American Studies at Peking University, told MarketWatch, “The rise of China as a great power is facing an increasingly complicated situation, mainly because U.S. elites judge China as the foremost strategic and systemic threat, and attack China’s development.”

Wang highlighted concerns over Washington’s policy toward self-ruled Taiwan, which Beijing claims as a renegade province.

In fact, Taiwanese President Tsai Ing-wen is stopping over in the U.S. this week after visits to the island’s few remaining allies in Central America. Beijing has threatened for weeks against her being welcomed by any high-level American officials.

Those threats turned to ire on Monday, when Republican House Speaker Kevin McCarthy said he would meet with Tsai on Wednesday in California. China said this could lead to “serious confrontation” and that Beijing would “resolutely fight back” — without giving specifics.

“ ‘Why is it assumed we live in a U.S. world?’ ”

— Alan Ma, graduate student, Tsinghua University.

“Gradually deviating from the past promise of ‘one China,’ promoting Taiwan independence and using Taiwan to contain China’s development — these could trigger a China-U.S. war,” Peking University’s Wang said from Beijing.

See: U.S. tells China not to ‘overreact’ to Taiwan leader’s stopover

Average citizens including younger people expressed frustration with U.S. policy.

Taiwan’s president, Tsai Ing-wen, arrives on Thursday at her hotel in New York.

AP/John Minchillo

“Why isn’t it China’s time to lead? Why is it assumed we live in a U.S. world?” asked 27-year-old Alan Ma, a graduate student in politics at Beijing’s Tsinghua University.

Other areas are reaching heightened levels of tension. China’s military said last month it drove out an American destroyer ship that had “illegally” entered the South China Sea. And the CEO of Chinese-owned video sensation TikTok appeared before U.S. lawmakers in hopes of preventing an American ban on the app over national-security concerns.

Context: Biden White House and bipartisan group of 12 senators back TikTok ban

Also: TikTok is the next Chinese product the U.S. could shoot down

But China’s rise, however rapid, must be put in a realistic context, experts said.

“I don’t think that we can say China has entered a new period as a global power until it has deployed large troop contingents overseas on its own,” said UC San Diego’s Shih.

Tanner Brown covers China for MarketWatch and Barron’s.

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April 4, 2023
‘We’re Struggling’: Long COVID Mystery Has Doctors in the Dark

March 23, 2023 — This month, I took care of a patient who recently contracted COVID-19 and was complaining of chest pain. After ruling out the possibility of a heart attack, pulmonary embolism, or pneumonia, I concluded that this was a residual symptom of COVID.

Chest pain is a common lingering symptom of COVID. However, because of the scarcity of knowledge regarding these post-acute symptoms, I was unable to counsel my patient on how long this symptom would last, why he was experiencing it, or what its actual cause was.

Such is the state of knowledge on long COVID. That informational vacuum is why we’re struggling and doctors are in a tough spot when it comes to diagnosing and treating patients with the condition.

Almost daily, new studies are published about long COVID (technically known as post-acute sequelae of COVID-19 [PASC]) and its societal impacts. These studies often calculate various statistics regarding the prevalence of this condition, its duration, and its scope.

However, many of these studies do not provide the complete picture — and they certainly do not when they are interpreted by t

he lay press and turned into clickbait.

Long COVID is real, but there is a lot of context that is omitted in many of the discussions that surround it. Unpacking this condition and situating it in the larger context is an important means of gaining traction on this condition.

And that’s critical for doctors who are seeing patients with symptoms.

Long COVID: What Is It?

The CDC considers long COVID to be an umbrella term for “health consequences” that are present at least 4 weeks after an acute infection. This condition can be considered “a lack of return to the usual state of health following COVID,” according to the CDC.

Common symptoms include fatigue, shortness of breath, exercise intolerance, “brain fog,” chest pain, cough, and loss of taste/smell. Note that it’s not a requirement that that symptoms be severe enough that they interfere with activities of daily living, just that they are present.

There is no diagnostic test or criteria that confirms this diagnosis. Therefore, the symptoms and definitions above are vague and make it difficult to gauge prevalence of the disease. Hence, the varying estimates that range from 5% to 30%, depending on the study.

Indeed, when one does routine blood work or imaging on these patients, it is unlikely that any abnormality is found. Some individuals, however, have met diagnostic criteria and have been diagnosed with postural orthostatic tachycardia syndrome (POTS). POTS is a disorder commonly found in long COVID patients that causes problems in how the autonomic nervous system regulates heart rate when moving from sitting to standing, during which blood pressure changes occur.

How to Distinguish Long COVID From Other Conditions

There are important conditions that should be ruled out in the evaluation of someone with long COVID. First, any undiagnosed condition or change in an underlying condition that could explain the symptoms should be considered and ruled out.

Secondly, it is critical to recognize that those who were in the intensive care unit or even hospitalized with COVID should not really be grouped together with those who had uncomplicated COVID that did not require medical attention.

One reason for this is a condition known as post-ICU syndrome or PICS. PICS can occur in anyone who is admitted to the ICU for any reason and is likely the result of many factors common to ICU patients. They include immobility, severe disruption of sleep/wake cycles, exposure to sedatives and paralytics, and critical illness.

Those individuals are not expected to recover quickly and may have residual health problems that persist for years, depending on the nature of their illness. They even have heightened mortality.

The same is true, to a lesser extent, to those hospitalized whose “post-hospital” syndrome places them at higher risk for experiencing ongoing symptoms.

To be clear, this is not to say that long COVID does not occur in the more severely ill patients, just that it must be distinguished from these conditions. In the early stages of trying to define the condition, it is more difficult if these categories are all grouped together. The CDC definition and many studies do not draw this important distinction and may confuse long COVID with PICS and post-hospital syndrome.

Control Groups in Studies Are Key

Another important means to understand this condition is to conduct studies with control groups, directly comparing those who had COVID with those that did not.

Such a study design allows researchers to isolate the impact of COVID and separate it from other factors that could be playing a role in the symptoms. When researchers conduct studies with control arms, the prevalence of the condition is always lower than without.

In fact, one notable study demonstrated comparable prevalence of long COVID symptoms in those who had COVID versus those that believe they had COVID.

Identifying Risk Factors

Several studies have suggested certain individuals may be overrepresented among long COVID patients. These risk factors for long COVID include women, those who are older, those with preexisting psychiatric illness (depression/anxiety), and those who are obese.

Additionally, other factors associated with long COVID include reactivation of Epstein-Barr virus (EBV), abnormal cortisol levels, and high viral loads of the coronavirus during acute infection.

None of these factors has been shown to play a causal role, but they are clues for an underlying cause. However, it is not clear that long COVID is monolithic — there may be subtypes or more than one condition underlying the symptoms.

Lastly, long COVID also appears to be only associated with infection by the non-Omicron variants of COVID.

Role of Antivirals and Vaccines

The use of vaccines has been shown to lower, but not entirely eliminate, the risk of long COVID. This is a reason why low-risk individuals benefit from COVID vaccination. Some have also reported a therapeutic benefit of vaccination on long COVID patients.

Similarly, there are indications that antivirals may also diminish the risk for long COVID, presumably by influencing viral load kinetics. It will be important, as newer antivirals are developed, to think about the role of antivirals not just in the prevention of severe disease but also as a mechanism to lower the risk of developing persistent symptoms.

There may also be a role for other anti-inflammatory medications and other drugs such as metformin.

Long COVID and Other Infectious Diseases

The recognition of long COVID has prompted many to wonder if it occurs with other infectious diseases. Those in my field of infectious disease have routinely been referred patients with persistent symptoms after treatment for Lyme disease or after recovery from the infectious mononucleosis.

Individuals with influenza may cough for weeks post-recovery, and even patients with Ebola may have persistent symptoms (though the severity of most Ebola causes makes it difficult to include).

Some experts suspect an individual human’s immune response may influence the development of post-acute symptoms. The fact that so many people were sickened with COVID at once allowed a rare phenomenon that always existed with many types of infections to become more visible.

Where to Go From Here: A Research Agenda

Before anything can be definitely said about long COVID, fundamental scientific questions must be answered.

Without an understanding of the biological basis of this condition, it becomes impossible to diagnose patients, development treatment regimens, or to prognosticate (though symptoms seem to dissipate over time).

It was recently said that unraveling the intricacies of this condition will lead to many new insights about how the immune system works — an exciting prospect in and of itself that will advance science and human health.

Armed with that information, the next time clinicians see a patient such as the one I did, we will be in a much better position to explain to a patient why they are experiencing such symptoms, provide treatment recommendations, and offer prognosis.

Amesh A. Adalja, MD, is an infectious disease, critical care, and emergency medicine specialist in Pittsburgh, and senior scholar with the Johns Hopkins Center for Health Security.

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March 23, 2023
WebMD Poll: Another Year of Tough COVID Questions

March 15, 2023 — Last year, on the second anniversary of the COVID-19 pandemic, we asked our audience questions about their pandemic experiences. A year later – and 3 years into living with COVID – we followed up with some more.

In total, our poll received 696 responses. Nearly 66% of those who answered identified as female, and 76% reported that they are older than 45. The confidence level used for editorial polls is 95%.

The fall of 2022 started out with President Joe Biden claiming that “the pandemic is over” on CBS’s 60 Minutes. Since then, he has ordered an end to the COVID-19 emergency orders issued in 2020, causing people to wonder if this really might be the beginning of the end of the pandemic.

In 2022, WebMD readers, for the most part (84%) did not see an end in sight. But a year later, attitudes seem to be shifting. Our current poll found that nearly a third – 30% – of our audience thinks the pandemic has come to an end. However, 42% of men said the pandemic is over, compared to just 25% of women.

The data, however, says differently. While daily life may have returned to its normal pace and we’re no longer in the midst of a state of emergency, many experts agree that we shouldn’t let our guard down. New cases and the number of deaths per week have indeed leveled off since January 2022, but data shows that there are still thousands of new cases reported daily. And given the evolution of the virus’s many variants, doctors and public health officials continue to urge caution.

The availability of vaccines and boosters is a big part of why we all feel more comfortable doing the everyday tasks that we may have taken for granted during the pandemic’s first couple of years. How many people, though, are actually protected against the virus? According to our poll, 7 in 10 respondents have been fully vaccinated against COVID-19; nearly 6 in 10 of those fully vaccinated have received at least two boosters (57%).

However, these numbers don’t totally reflect the reality of vaccine and booster uptake in the U.S. According to CDC data, Americans on the whole – quite similar to our findings – have completed their initial vaccination series at a rate of nearly 70%. But of those who have gotten fully vaccinated, only a little more than 23% have gotten at least one dose of the bivalent booster.

Sixty percent of respondents to our poll said that they have had COVID-19 at least once, which is notable when compared to an exhaustive nationwide survey that found that about half of Americans have had COVID. Within that study, however, researchers said there is a large chunk of positive at-home tests that have gone unreported.

Whether you had COVID-19 or not, the pandemic has undoubtedly changed the way we see and interact with the world around us. Last year, an overwhelming 88% of respondents agreed on this; this year, about half of our readers agreed with this statement – possibly indicating a growing acceptance of the changes happening around us.

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March 15, 2023
3 Years On, Why Don’t We Know the Extent of Long COVID?

SOURCES:

Amesh Adalja, MD, senior scholar, Johns Hopkins University Center for Health Security.

Manali Mukherjee, PhD, immunologist, assistant professor, Division of Respirology, Department of Medicine, McMaster University.

Sarah Wulf Hanson, PhD, research scientist, Institute for Health Metrics and Evaluation, University of Washington.

Lisa McCorkell, co-founder, Patient-Led Research Collaborative.

Julia Moore Vogel, PhD, program director, Participant Center, All of Us Research Program, Scripps Research Translational Institute.

The BMJ: “Long COVID outcomes at one year after mild SARS-CoV-2 infection: nationwide cohort study.”

Nature Reviews Microbiology: “Long COVID: Major findings, mechanisms and recommendations.”

CDC National Center for Health Statistics: “Long COVID Household Pulse Survey.”

Nature Medicine: “Unexplained post-acute infection syndromes.”

Patient-Led Research Collaborative.

World Health Organization: “Post COVID-19 condition (Long COVID).”

CDC: “Post-COVID Conditions: CDC Science.”

The European Respiratory Journal: “Circulating anti-nuclear autoantibodies in COVID-19 survivors predict long COVID symptoms.”

Emerging Infectious Diseases: “Postacute Sequelae of SARS-CoV-2 in University Setting.”

International Severe Acute Respiratory and emerging Infection Consortium (ISARIC): “Clinical Characterisation Protocol (CCP).”

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March 15, 2023
Future COVID Vaccines Must Be Better; Science Races to Respond

SOURCES

David L. Hoey, president and CEO of Vaxxas, Cambridge, MA, and Brisbane, Australia.

Pablo Penaloza-MacMaster, PhD, assistant professor of microbiology and immunology, Feinberg School of Medicine, Northwestern University, Chicago.

Jasdave Chahal, PhD, co-founder and chief scientist, Tiba Biotech, Cambridge, MA, and Brisbane, Australia.

Vaxart news release: “Vaxart Announced Positive Top-line Phase II clinical Study Data Demonstrating Safaety and Immunogenicity of Its Wuhan S-Only COVID-19 Pill Vaccine Candidate.”

Mark Herr, spokesperson, Vaxart Inc.

The Commonwealth Fund: “Two Years of U.S. COVID-19 Vaccines Have Prevented Millions of Hospitalizations and Deaths.”

The Lancet Infectious Diseases: “Global impact of the first year of COVID-19 vaccination: a mathematical modelling study.”

CDC: COVID Data Tracker, “Needle Fears and Phobias—Find Ways to Manage.”

U.S. Specialty Formulations news release: “Research Demonstrates Benefits of Oral COVID-19 Vaccine.”

CanSino Biologics Inc. statement: “Inside Information.”

Coalition for Epidemic Preparedness Innovations: Email statement; News releases: “The Race to Future-Proof Coronavirus Vaccines;.” “Coming in from the cold: needle-free patch technology for mRNA vaccines aims to end need for frozen storage and improve access.”

Executive Office of the President: “Statement of Administration Policy.”

Science: “Mosaic RBD nanoparticles protect against challenge by diverse sarbecoviruses in animal models.”

Caltech news release: “Nanoparticle Vaccine Protects Against a Spectrum of COVID-19-causing Variants and Related Viruses.”

U.S. Government Accountability Office. “Operation Warp Speed.”

Bharat Biotech International Limited news release: “Bharat biotech launches iNCOVACC: World’s 1st intranasal COVID vaccine for Primary series and Heterologous booster.”

The Lancet preprints: “Immunogenicity and Tolerability of BBV154 (iNCOVACC®), an Intranasal SARS-CoV-2 Vaccine, Compared with Intramuscular Covaxin® in Healthy Adults: A Randomised, Open-Label, Phase 3 Clinical Trial.”

Cell: “Intranasal pediatric parainfluenza virus-vectored SARS-CoV-2 vaccine is protective in monkeys.”

National Institute of Allergy and Infectious Diseases news release: “NIAID Issues Further Awards to Support Pan-Coronavirus Vaccine Development.”

CEPI news release: “CEPI and DIOSynVax partner in quest to develop broadly protective Betacoronavirus vaccine.”

CDC: “Understanding How COVID-19 Vaccines Work.”

Nature Immunology: “The T-cell immune response against SARS-CoV-2.”

National Institutes of Health: “T cells protect against COVID-19 in absence of antibody response.”

PNAS: “Vaccine-induced systemic and mucosal T cell immunity to SARS-CoV-2 viral variants.”

Cell Reports: “Pre-existing immunity modulates responses to mRNA boosters.”

University of Minnesota Center for Infectious Disease Research and Policy: “Coronavirus Vaccines R&D Roadmap.”

NIH news release: “2NIAID Studies Highlight COVID-10 Natal Vaccine Potential.”

U.S. Specialty Formulations news release: “Research demonstrates benefits of oral COVID-19 vaccine.”

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March 15, 2023
COVID at 3 Years: Where Are We Headed?

March 15, 2023 – Three years after COVID-19 rocked the world, the pandemic has evolved into a steady state of commonplace infections, less frequent hospitalization and death, and continued anxiety and isolation for older people and those with weakened immune systems.

After about 2½ years of requiring masks in health care settings, the CDC lifted its recommendation for universal, mandatory masking in hospitals in September 2022,.

Some statistics tell the story of how far we have come. COVID-19 weekly cases dropped to nearly 171,000 on March 8, a huge dip from the 5.6 million weekly cases reported in January 2022. COVID-19 deaths, which peaked in January 2021 at more than 23,000 a week, stood at 1,862 per week on March 8.

Where We Are Now

Since Omicron is so infectious, “we believe that most people have been infected with Omicron in the world,” says Christopher J.L. Murray, MD, a professor and chair of health metrics sciences at the University of Washington and director of the Institute for Health Metrics and Evaluation in Seattle. Sero-prevalence surveys — or the percentage of people in a population who have antibodies for an infectious disease, or the Omicron variant in this case — support this rationale, he says.

“Vaccination was higher in the developed world but we see in the data that Omicron infected most individuals in low income countries,” says Murray. For now, he says, the pandemic has entered a “steady state.”

At New York University Langone Health System, clinical testing is all trending downward, and hospitalizations are low, says Michael S. Phillips, MD, an infectious disease doctor and chief epidemiologist at the health system.

In New York City, there has been a shift from pandemic to “respiratory viral season/surge,” he says.

The shift is also away from universal source control – where every patient encounter in the system involves masking, distancing, and more – to a focus on the most vulnerable patients “to ensure they’re well-protected,” Phillips says.

Johns Hopkins Hospital in Baltimore has seen a “marked reduction” of the number of people coming to the intensive care unit because of COVID, says Brian Thomas Garibaldi, MD, a critical care doctor and director of the Johns Hopkins Biocontainment Unit.

“That is a testament to the amazing power of vaccines,” he says.

The respiratory failures that marked many critical cases of COVID in 2020 and 2021 are much rarer now, a shift that Garibaldi calls “refreshing.”

“In the past 4 or 5 weeks, I’ve only seen a handful of COVID patients. In March and April of 2020, our entire intensive care unit – in fact, six intensive care units – were filled with COVID patients.”

Garibaldi sees his own risk differently now as well.

“I am not now personally worried about getting COVID, getting seriously ill, and dying from it. But if I have an ICU shift coming up next week, I am worried about getting sick, potentially having to miss work, and put that burden on my colleagues. Everyone is really tired now,” says Garibaldi, who is also an associate professor of medicine and physiology in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins University School of Medicine.

What Keeps Experts Up at Night?

The potential for a stronger SARS-CoV-2 variant to emerge concerns some experts.

A new Omicron subvariant could emerge, or a new variant altogether could arise.

One of the main concerns is not just a variant with a different name, but one that can escape current immune protections. If that happens, the new variant could infect people with immunity against Omicron.

If we do return to a more severe variant than Omicron, Murray says, “then suddenly we’re in a very different position.

Keeping an Eye on COVID-19, Other Viral Illnesses

We have better genomic surveillance for circulating strains of SARS-CoV-2 than earlier in the pandemic, Phillips says. More reliable, day-to-day data also helped recently with the respiratory syncytial virus (RSV) outbreak and for tracking flu cases.

Wastewater surveillance as an early warning system for COVID-19 or other respiratory virus surges can be helpful, but more research is needed, Garibaldi says. And with more people testing at home, test positivity rates are likely an undercount. So, hospitalization rates for COVID and other respiratory illnesses remain one of the more reliable community-based measures, for now, at least.

One caveat is that sometimes, it is unclear if COVID-19 is the main reason someone is admitted to the hospital vs. someone who comes in for another reason and happens to test positive upon admission.

Phillips suggests that using more than one measure might be the best approach, especially to reduce the likelihood of bias associated with any single strategy. “You need to look at a whole variety of tests in order for us to get a good sense of how it’s affecting all communities,” he says. In addition, if a consensus emerges among different measures – wastewater surveillance, hospitalization and test positivity all trending up – “that’s clearly a sign that things are afoot and that we would need to modify our approach accordingly.”

Where We Could Be Heading

Murray predicts a steady pace of infection with “no big changes.” But waning immunity remains a concern.

That means if you have not had a recent infection – in the last 6 to 10 months – you might want to think about getting a booster, Murray says “The most important thing for people, for themselves, for their families, is to really think about keeping their immunity up.”

Phillips hopes the improved surveillance systems will help public health officials make more precise recommendations based on community levels of respiratory illness.

When asked to predict what might happen with COVID moving forward, “I can’t tell you how many times I’ve been wrong answering that question,” Garibaldi says.

Rather than making a prediction, he prefers to focus on hope.

“We weathered the winter storm we worried about in terms of RSV, flu, and COVID at the same time. Some places were hit harder than others, especially with pediatric RSV cases, but we haven’t seen anywhere near the level we saw last year and before that,” he says. “So, I hope that continues.”

“We’ve come very far in just 3 years. When I think about where we were in March 2020 taking care of our first round of COVID patients in our first unit called a biocontainment unit,” Garibaldi says.

Murray addresses whether the term “pandemic” still applies at this point.

“In my mind, the pandemic is over,” he says, because we are no longer in an emergency response phase. But COVID in some form is likely to be around for a long time, if not forever.

“So, it depends on how you define pandemic. If you mean an emergency response, I think we’re out of it. If you mean the formal definition you know of an infection that goes all over the place, then we’re going to be in it for a very long time.”

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March 15, 2023
Gene That Shielded Some Against Black Death May Help, Harm People Today

By Cara Murez

HealthDay Reporter

WEDNESDAY, March 8, 2023 (HealthDay News) — Some people may have a gene that helps protect them from respiratory diseases like COVID-19 — and helped their ancestors fight the plague.

It comes at a cost.

This same gene variation may be linked to an increased risk of autoimmune disease, including rheumatoid arthritis and inflammatory bowel disease, according to British researchers.

“This gene essentially chops up proteins for the immune system,” said lead author Fergus Hamilton, a fellow at the University of Bristol.

“Although we don’t know the exact mechanism influencing disease risk, carriers of alleles that provide more protection against respiratory disease seem to have an increased risk of autoimmune disease,” he said in a university news release. “It is potentially a great example of a phenomenon termed ‘balancing selection’ — where the same allele has different effect on different diseases.”

Past research has found that survivors of the bubonic plague pandemic in the Middle Ages, known as Black Death, carried a variant — or allele — in a gene known as ERAP2. Those who died lacked this variant.

The new study found that humans now have the same variants, which is associated with protection against infections such as pneumonia and COVID.

To study this, researchers looked at infection, autoimmune disease and parental longevity across participants in three large genetic studies.

They looked for links between variation in the ERAP2 gene and risk of autoimmune disease and infection.

“This is a theoretical story of balance — relating to historical and contemporary disease profiles — which reflects our past and is rarely seen in real human examples,” said co-author Nicholas Timpson, a professor of genetic epidemiology at the university’s MRC Integrative Epidemiology Unit.

Identifying links between genetics and susceptibility to disease can pave the way for potential treatments, researchers noted. It also highlights potential challenges, they said.

While scientists are developing therapeutics to target ERAP2 for people with Crohn’s disease and cancer, it is important to consider potential effects on infection risk posed by these agents, the authors said.

Study findings were published March 7 in the American Journal of Human Genetics. Researchers from the Universities of Edinburgh, Oxford, Cardiff, and Imperial College London also worked on the study.

More information

The U.S. National Library of Medicine has more on gene variants.

SOURCE: University of Bristol, news release, March 7, 2023

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March 8, 2023