Article Title: Universal varicella vaccination in Denmark: Modeling public health impact, age-shift, and cost-effectiveness
Image Caption: A) Total and B) breakthrough varicella incidence over time, by vaccination strategy. Panel A: Total varicella incidence, including natural and breakthrough cases, over 50 years after the start of universal childhood varicella vaccination. Panel B: Breakthrough varicella incidence over 50 years. In both panels, varicella incidence with strategies E and F were the same as for strategies C and D, respectively. Strategy A: V-MSD (12 months) + V-MSD (15 months); Strategy B: V-GSK (12 months) + V-GSK (15 months); Strategy C: V-MSD (15 months) + V-MSD (48 months); Strategy D: V-GSK (15 months) + V-GSK (48 months); Strategy E: V-MSD (15 months) + MMRV-MSD (48 months); Strategy F: V-GSK (15 months) + MMRV-GSK (48 months).
Funding: This study was funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. The funder provided support in the form of salaries or consulting fees for CB, SS, TL, CSL, and MP, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interest: MP and SS are employees of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and own stock in Merck & Co., Inc., Rahway, NJ, USA. CB is a contractor with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and was compensated for her work. TL is an employee of MSD Denmark and owns stock in Merck & Co., Inc., Rahway, NJ, USA. CSL was paid an honorarium for consultation on this study.
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“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.”
“ ‘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.”
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.
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.
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.
For nearly a minute, the 4-year-old boy attempts to valiantly escape the hungry pack of stray dogs as they circle around him.
He tries to run, but one of the animals pulls the boy to the ground. Two more dogs close in, offering the victim little respite.
The boy, who has not been publicly identified, is dragged by the pack for several feet, writhing in pain as the strays pounce. He strives to wrestle from their grip, but his small and fragile body cannot compete with the aggressors.
His piercing screams alert his father nearby – but it was too late. The child was declared dead upon arrival at the hospital.
The brutal attack, captured by a security camera in Hyderabad in February, a sprawling city in the central Indian state of Telangana, has horrified the nation of 1.3 billion and placed focus on an issue that long divided opinion: what to do with India’s vast number of stray dogs?
The issue is a sensitive one in a country where there is an ingrained cultural respect for animals and an aversion to culling. Most agree stray dogs are an issue, but there is a fierce debate over how best to respond.
According to the Press Trust of India, there are around 62 million strays in the country, although experts say the real number would be nearly impossible to verify.
Most of these animals – lovably nicknamed ‘Indie’ dogs – live in harmony with humans. Often, residents of gated communities come together to feed them, some even adopting them as family pets.
But over the years, bites and killings by stray dogs have put many cities on edge, with politicians, the media, and citizens scrambling to present various solutions.
Long before the death of the 4-year-old boy in Hyderabad made headlines, local media have run similar tales about India’s “killer dogs” – stories that are then often picked up by international outlets.
“”Man-eater’ dog terror back in Bihar,” wrote The Telegraph India in a story last month after a series of bites in the northern Indian state.
It is illegal to kill stray dogs in India. A 2001 law states strays should instead be picked up, neutered, and vaccinated against rabies, before being released.
But in light of the gruesome attacks, many of which have happened to children, some have attempted to challenge the law.
In 2016, a campaign to kill stray dogs after a series of bites in the southern state of Kerala gained traction in the local news.
But animal rights activists were angered, instead urging authorities to offer clemency and find other solutions. The hashtag #BoycottKerala began trending on social media, and the plan was later abolished.
While the law requires strays to be neutered and vaccinated, experts say there is a lack of strict implementation.
“Of course we have a stray dog problem,” Anjali Gopalan, managing trustee at the All Creatures Great and Small, a Delhi-based non-profit that cares for animals, said.
“Not only do we have a stray dog problem, but we also have a problem with rabies in this country. So, steps have to be taken to deal with both.”
Rabies is a vaccine-preventable disease which can spread to humans if they are bitten or scratched by an infected animal. It is almost always fatal unless a series of jabs can be administered soon after someone is bitten.
Dogs are the source of the vast majority of human rabies deaths, according to the World Health Organization (WHO) and contribute up to 99% of all rabies transmissions to humans. India is endemic for rabies, the WHO said, accounting for 36% of the world’s rabies deaths.
A key way to reduce rabies within a stray dog population is to capture and vaccinate as many animals as possible.
But veterinarian Sarungbam Devi, founder and trustee of Animal India Trust, said India needs to do more.
“At the time of the sterilization, we vaccinate the dog only once and then they are released. That’s all the vaccination a stray dog gets in his lifetime and that’s not enough,” she said.
A lack of resources in the country means it is difficult to push government bodies to increase the inoculation of street dogs against the virus, Devi added.
But when it comes to dog bites, Devi said, education plays the biggest role: “The government hasn’t done anything to increase awareness or educate the masses. We need to educate people, we need to be more vocal and visual about the (anti-bite) programs,” she said.
“People need to know what to do when a dog bites you, how to you prevent it … I don’t think I have ever seen anything on this anywhere.”
The Society for the Prevention of Cruelty to Animals (SPCA) recommends avoiding unfamiliar dogs and wild animals, not running when approached by an unknown dog and always supervising children and dogs, among other things, to avoid bites.
According to the government, more than 6.8 million Indians were bitten by stray dogs in 2020 – and increase from 3.9 million in 2012. And experts say those numbers are likely not the full picture.
CNN has reached out to the Department of Animal Husbandry and Dairying but has not received a response.
“The problem is lack of awareness towards how to live around dogs,” Devi said, adding there needs to be an “intense anti-rabies drive and sterilization program everywhere in India.”
But many Indian cities and states have been successful in bringing down their feral dog population and eradicating rabies.
In the financial capital Mumbai, as many as 95% of the city’s stray dogs have been sterilized owing to “consistent” implementation of re-vaccination and welfare programs, said Abodh Aras, CEO of the non-profit Welfare of Stray Dogs.
A robust public health system for post-bite treatment and regular school programs about dog bite and rabies prevention has also contributed, Aras said.
“There are other places that have success stories. There is Goa that has eliminated rabies, (the state of) Sikkim that has got its state of operations around, and eliminated rabies,” he added. “It needs a combination of government support, will and infrastructure, and animal welfare NGOs working in that area for this model to be successful.”
But not every city has the resources to implement this model.
Take for example Noida, a satellite city of more than half a million on the outskirts of Delhi that is a comparatively wealthy place and home to many middle-class families.
Devi, from the Animal India Trust, said Noida remains “very disorganized,” and her organization is the only non-profit covering the entire city – a colossal and tedious task for a small team, she said.
Gopalan, from All Creatures Great and Small, points to even more difficult operations in rural India, where electricity is lacking and maintaining cold storage for vaccines is an issue.
Following the 4-year-old’s death in Hyderabad, officials promised swift action to prevent future tragedies.
“We have been sterilizing dogs and anti-rabies injections are being given to them,” Greater Hyderabad Municipal Corporation Mayor Vijayalaxmi Gadwal, told local news agency, ANI.
“So far in Hyderabad we have identified more than 500,000 dogs and sent more than 400,000 dogs for sterilization. We are following every guideline which is being given to us by the Supreme Court. We’re also going to adopt these dogs so that the number of stray dogs will be reduced.”
That campaign may have an impact locally. But it many fear it is likely only a matter of time before another pack of dogs somewhere in India takes a child’s life.
The US Centers for Disease Control and Prevention is sending personnel to Africa to help stop outbreaks of Marburg virus disease and is urging travelers to certain countries to take precautions. The CDC is also taking steps to keep infections from spreading to the United States.
Equatorial Guinea and Tanzania are facing their first known outbreaks of Marburg virus, a viral fever with uncontrolled bleeding that’s a close cousin to Ebola. This week, the CDC urged travelers to both countries to avoid contact with sick people and to watch for symptoms for three weeks after leaving the area. Travelers to Equatorial Guinea should take enhanced precautions and avoid nonessential travel to the provinces where the outbreak is ongoing, the agency said.
In the United States, the agency will post notices in international airports where most travelers arrive, warning them to watch for symptoms of the virus for 21 days and to seek care immediately if they become ill. They will also get a text reminder to watch for symptoms.
The CDC is standing up a “center-led” emergency response; it’s not as all-encompassing as when the CDC stands up its Emergency Operations Center, such as for Covid-19 and mpox. But it will refocus the efforts and attention of the staff of its National Center for Emerging and Zoonotic Infectious Diseases to respond to the outbreaks, which are in two countries on opposite sides of Africa, indicating that the deadly hemorrhagic fever is spreading.
Equatorial Guinea, on the coast in West Africa, declared an outbreak of Marburg virus disease in mid-February with cases spread across multiple provinces. As of March 22, Equatorial Guinea had 13 confirmed cases, including nine people who have died and one who has recovered, according to the World Health Organization. Nine CDC staffers are on the ground there. They have established a field laboratory and are assisting with testing, case identification and contact tracing.
Tanzania, on the coast in East Africa, declared an outbreak of Marburg virus disease on March 21, with cases reported in two villages in the Kagera region, according to the CDC. As of March 22, Tanzania has had eight confirmed cases, including five deaths. The CDC has a permanent office in Tanzania that is assisting with the outbreak. It is sending additional staff to support those efforts.
Marburg virus is a rare and deadly virus that causes fever, chills, muscle pain, rash, sore throat, diarrhea, weakness or unexplained bleeding or bruising. It is spread through contact with body fluids and contaminated surfaces. People can also catch it from infected animals. It is fatal in about half of cases who get it. Other countries in Africa have had to quell outbreaks before.
In its early stages, the infection is difficult to distinguish from other illnesses, so a history of travel to either of those countries will be essential to helping clinicians spot it.
Newswise — Worcester, Mass. – March 30, 2023 – A new study led by Worcester Polytechnic Institute (WPI) brings into sharper focus the structural details of the COVID-19 virus, revealing an elliptical shape that “breathes,” or changes shape, as it moves in the body. The discovery, which could lead to new antiviral therapies for the disease and quicker development of vaccines, is featured in the April edition of the peer-reviewed Cell Press structural biology journal Structure.
“This is critical knowledge we need to fight future pandemics,” said Dmitry Korkin, Harold L. Jurist ’61 and Heather E. Jurist Dean’s Professor of Computer Science and lead researcher on the project. “Understanding the SARS-COV-2 virus envelope should allow us to model the actual process of the virus attaching to the cell and apply this knowledge to our understanding of the therapies at the molecular level. For instance, how can the viral activity be inhibited by antiviral drugs? How much antiviral blocking is needed to prevent virus-to-host interaction? We don’t know. But this is the best thing we can do right now—to be able to simulate actual processes.”
Feeding genetic sequencing information and massive amounts of real-world data about the pandemic virus into a supercomputer in Texas, Korkin and his team, working in partnership with a group led by Siewert-Jan Marrink at the University of Groningen, Netherlands, produced a computational model of the virus’s envelope, or outer shell, in “near atomistic detail” that had until now been beyond the reach of even the most powerful microscopes and imaging techniques.
Essentially, the computer used structural bioinformatics and computational biophysics to create its own picture of what the SARS-COV-2 particle looks like. And that picture showed that the virus is more elliptical than spherical and can change its shape. Korkin said the work also led to a better understanding of the M proteins in particular: underappreciated and overlooked components of the virus’s envelope.
The M proteins form entities called dimers with a copy of each other, and play a role in the particle’s shape-shifting by keeping the structure flexible overall while providing a triangular mesh-like structure on the interior that makes it remarkably resilient, Korkin said. In contrast, on the exterior, the proteins assemble into mysterious filament-like structures that have puzzled scientists who have seen Korkin’s results, and will require further study.
Korkin said the structural model developed by the researchers expands what was already known about the envelope architecture of the SARS-COV-2 virus and previous SARS- and MERS-related outbreaks. The computational protocol used to create the model could also be applied to more rapidly model future coronaviruses, he said. A clearer picture of the virus’ structure could reveal crucial vulnerabilities.
“The envelope properties of SARS-COV-2 are likely to be similar to other coronaviruses,” he said. “Eventually, knowledge about the properties of coronavirus membrane proteins could lead to new therapies and vaccines for future viruses.”
The new findings published in Structure were three years in the making and built upon Korkin’s work in the early days of the pandemic to provide the first 3D roadmap of the virus, based on genetic sequence information from the first isolated strain in China.
About Worcester Polytechnic Institute
WPI, a global leader in project-based learning, is a distinctive, top-tier technological university founded in 1865 on the principle that students learn most effectively by applying the theory learned in the classroom to the practice of solving real-world problems. Recognized by the National Academy of Engineering with the 2016 Bernard M. Gordon Prize for Innovation in Engineering and Technology Education, WPI’s pioneering project-based curriculum engages undergraduates in solving important scientific, technological, and societal problems throughout their education and at more than 50 project centers around the world. WPI offers more than 70 bachelor’s, master’s, and doctoral degree programs across 18 academic departments in science, engineering, technology, business, the social sciences, and the humanities and arts. Its faculty and students pursue groundbreaking research to meet ongoing challenges in health and biotechnology; robotics and the internet of things; advanced materials and manufacturing; cyber, data, and security systems; learning science; and more. www.wpi.edu
Newswise — Geneva, March 30, 2023 –More than half of patients who suffer from chronic hepatitis B have the e antigen (HBeAg)-negative form of the disease. Even after many years of antiviral treatment with nucleos(t)ide analogues (NUC), lasting immune control is almost never seen. According to the current state of knowledge, those affected therefore require lifelong therapy. In the world’s first randomized controlled multicenter study – led by Leipzig University’s Faculty of Medicine and in partnership with the Centre for Clinical Studies (ZKS) – researchers have shown that many HBeAg-negative patients can achieve permanent immune control of hepatitis B if they discontinue antiviral therapy after a certain period of time. Their findings are published in the high-impact journal, the Journal of Hepatology.
Hepatitis B is an inflammation of the liver caused by the hepatitis B virus that can lead to serious problems such as liver cirrhosis or liver cancer and is easily transmitted through body fluids. An estimated 350 million are chronically infected, making chronic hepatitis B one of the most common viral infections worldwide. People with chronic hepatitis B usually have to take antiviral medication for their entire life in order to reduce the viral load and normalize inflammation levels in the liver. Antiviral therapy consists of the administration of nucleoside or nucleotide analogues, which in patients with the HBeAg-negative form almost never leads to the permanent immune control that would allow the termination of treatment. The antiviral therapy is associated with high costs for the healthcare system and can cause serious side effects.
Results currently published in the Journal of Hepatology show in a study of 166 HBeAg-negative patients from 20 clinics across Germany that after 96 weeks of observation many patients who discontinued an effective antiviral treatment that they had taken for at least four years achieved immune control of the disease. In 10% of the patients, immune control was demonstrated through loss of previously detectable hepatitis B surface antigen (HBsAg) in the blood, an event which is considered a functional cure of hepatitis B.
By the end of the study, in about 41% of patients, hepatitis B virus levels in the blood were reduced to below the level of 2,000 units per millilitre, which according to international treatment guidelines means that there is no longer an indication for renewed antiviral therapy. Additionally, 77% of patients no longer had elevated liver inflammation levels. In contrast, no patient who continued antiviral treatment showed HBsAg loss.
Study leader Professor Florian van Bömmel, senior physician in the Department of Hepatology at Leipzig University Hospital said, “We were able to show that in some patients discontinuing long-term therapy with nucleoside or nucleotide analogues after at least four years is more effective than continuing it, and that many patients no longer require antiviral therapy at all after discontinuation. In particular, patients who show low HBsAg levels when they discontinue treatment have a high chance of functional cure.”
After discontinuation of treatment, all of the patients initially experienced a resurgence of hepatitis B virus replication and many also experienced transient renewed liver inflammation. Some patients with severe liver inflammation were then restarted on antiviral therapy to prevent liver damage. Patients with liver cirrhosis were not included in the study for safety reasons. No serious adverse events related to discontinuation of therapy occurred during the study. “However, in other studies, severe cases of hepatic inflammation were observed in a few cases after antiviral therapy was discontinued. Stopping NUC treatment should therefore only be carried out under the supervision of an experienced physician,” said the study leader.
Professor van Bömmel and Professor Thomas Berg, head of the Department of Hepatology at Leipzig University Hospital, are confident that the results of the STOP-NUC trial will have a major impact on the overall development of hepatitis B therapy: “We expect that in the future international guidelines for the treatment of hepatitis B will refer to this study. By the middle of this year, results from the extension of the study will be evaluated and will show whether the number of patients with immune control continues to increase in the long term after discontinuation of antiviral treatment.”
Newswise — PORTLAND, Oregon — New research from Oregon Health & Science University and collaborators indicates lab-made antibodies may be able to cure people infected with yellow fever, a virus for which there is no treatment.
The natural immune response to invading pathogens normally involves making protective proteins called antibodies. A study published today in Science Translational Medicine suggests that a single monoclonal antibody infusion can strengthen the body’s fight against yellow fever.
In the study, the yellow fever virus was undetectable in all animals that received monoclonal antibody infusions after being exposed to the virus.
“Two monoclonal antibodies that we evaluated completely removed all signs of infection from research animals,” said the study’s corresponding author, Ben Burwitz, Ph.D., associate professor at OHSU’s Vaccine and Gene Therapy Institute and affiliate associate professor at OHSU’s Oregon National Primate Research Center.
The collaborative research is a joint effort between scientists from OHSU, George Washington University, the biotechnology company Mabloc, LLC, and other organizations. Mabloc plans to use these findings to inform a future clinical trial in humans, in addition to their product development efforts.
“Neglected tropical diseases like yellow fever, dengue and Zika are often overlooked by traditional pharmaceutical development, but we hope monoclonal antibody technology will change that,” said David Watkins, Ph.D., co-senior author on the study, professor of pathology at George Washington University and Mabloc’s chief executive officer.
“By showing such efficacy in a primate model that mimics severe human disease, we hope to advance this to clinical trials and be ready to deploy treatments for the next outbreak of yellow fever,” said the study’s first author, Michael Ricciardi, Ph.D., associate director of translational research at George Washington University and Mabloc’s director of product development.
Increasingly common yellow fever
As many as half of people who get severe yellow fever die from the virus, which causes flu-like symptoms and can lead to jaundice and organ failure in more serious cases. Every year, the virus infects about 200,000 people — killing about 30,000 worldwide.
Currently, most cases occur in tropical and sub-tropical areas of Africa and South America, but global climate change is expected to increase the range of the mosquitoes that spread the virus. Deaths in Africa alone are predicted to increase by 25% by the year 2050.
The disease is preventable with a highly effective vaccine, which has been available since the 1930s. Although the vaccine is safe for the vast majority of people, vaccine hesitancy leaves some vulnerable to infection. It is a live vaccine that uses a weakened form of the virus, which causes a very small percentage of recipients to experience an adverse reaction that has been fatal in rare cases. A treatment could benefit both unvaccinated individuals who get sick and the very few people who experience a vaccine-related reaction.
When they began considering potential yellow fever treatments, the research team initially considered 37 antibodies cloned from people who had been vaccinated against yellow fever. The team then narrowed its focus to two monoclonal antibodies capable of controlling variants of the virus that were involved in recent yellow fever outbreaks.
The team manufactured these two monoclonal antibodies in the lab and studied how protective they could be against the yellow fever virus in two animal species: rhesus macaque monkeys and hamsters. After animals were exposed to the virus, each species was divided into three groups: one group that received the first antibody, another that received the second antibody, and a third that didn’t receive either antibody.
The virus couldn’t be detected in blood samples of any of the animals – eight rhesus macaques and 20 hamsters – that received either monoclonal antibody. All those in the control group developed severe disease. While one treated hamster died of an unknown cause, it neither showed signs of a yellow fever infection nor did it have signs of an adverse reaction to the monoclonal antibody.
Both monoclonal antibody candidates also appeared to be safe. None of the animals that received either experimental treatment displayed liver dysfunction, a tell-tale sign of severe yellow fever infection and yellow fever vaccine-associated disease.
This research was supported by the National Institutes of Health (grants R42 AI155275 and P51 OD01092) and by Mabloc, LLC.
Some of the researchers involved in this study — including Jonah Sacha, Ph.D., of OHSU; and Michael Ricciardi, Ph.D., and David Watkins, Ph.D., of George Washington University — have a significant financial interest in Mabloc, LLC, a company that may have a financial interest in the results of this research and technology. This potential individual and institutional conflict of interest has been reviewed and managed by OHSU.
All research involving animal subjects at OHSU must be reviewed and approved by the university’s Institutional Animal Care and Use Committee (IACUC). The IACUC’s priority is to ensure the health and safety of animal research subjects. The IACUC also reviews procedures to ensure the health and safety of the people who work with the animals. The IACUC conducts a rigorous review of all animal research proposals to ensure they demonstrate scientific value and justify the use of live animals.
REFERENCE: Michael J. Ricciardi, Lauren N. Rust, Nuria Pedreno-Llpez, Sofiya Yusova, Sreya Biswas, Gabriela M. Webb, Lucas Gonzalez-Nieto, Thomas B. Voigt, Johan J. Louw, Fernanda D. Laurino, John R. DiBello, Hans-Peter Raue, Aaron M. Barber-Axthelm, Kimberly Chun, Samantha Uttke, Lidiane M.S. Raphael, Aaron Yrizarry-Medina, Brandon C. Rosen, Rebeca Agnor, Lina Gao, Caralyn Labriola, Michael Axthelm, Jeremy Smedley, Justin G. Julander, Myrna C. Bonaldo, Laura M. Walker, Ilhem Messaoudi, Mark K. Slikfa, Dennis R. Burton, Esper G. Kallas, Jonah B. Sacha, David I. Watkins, Benjamin J. Burwitz, Therapeutic neutralizing monoclonal antibody administration protects against lethal yellow virus infection, Science Translational Medicine, March 29, 2023, https://doi.org/10.1126/scitranslmed.ade5795
Newswise — The COVID-19 pandemic posed an immense challenge on the health care industry in 2020 and 2021. While hospitals were inundated with COVID-19 cases, other illnesses such as respiratory syncytial virus (RSV) saw a decrease in hospital visits, particularly in the fourth quarter of 2020 and the first quarter of 2021.
A Texas A&M University School of Public Health study recently published in the journal Frontiers found that while there were an unusually low number of hospitalizations in 2020, there was an unusual peak in the third quarter of 2021, when hospital admissions for RSV were approximately twice those in a typical year.
“Kids were not going into daycare and getting that exposure (to RSV), and that mirrored the dynamic,” added Natalie Johnson, PhD, associate professor in EOH, and one of the lead authors of the study,
RSV is a common airway pathogen that most frequently results in mild, cold-like respiratory tract infections. In children younger than two years of age, RSV infection can result in severe lower respiratory illness, including acute bronchiolitis or pneumonia.
The seasons are usually a strong predictor of RSV infection, with activity typically occurring in late fall, winter and early spring, peaking from late December to mid-February. According to the researchers, however, the COVID-19 pandemic had an effect on RSV seasonality.
Additionally, the researchers found that the length of hospital stays in relation to RSV, which typically followed a seasonal trend prior to COVID-19, was longer during the pandemic despite the lower number of cases.
“We can only hypothesize that during COVID they were only accepting the extreme cases, and on average the length of stay was longer,” Mendoza-Sanchez said. “We learned that what has happened in the past is informing us that if something similar happens in the future we have to be ready for the peaks in cases.”
Additional authors on the paper include Inyang Uwak, Toriq Mustapha, Mariya Rahman and Tanaya Tonpay, all from the Department of Environmental & Occupational Health, and Annette K. Regan from the School of Nursing and Health Professions at the University of San Francisco.
Among the many difficulties imposed upon America by the pandemic, the scourge of anti-vaccine sentiment—and the preventable deaths caused as result—ranks among the most frustrating, especially for infectious-disease doctors like me.
People who are hospitalized with COVID-19 rarely refuse therapy, but acceptance of vaccines to help prevent infection has been considerably more limited. Seventy percent of Americans have received the initial complement of vaccine injections, and many fewer have received the boosters designed to address viral variants and confer additional protection. Why are so many people resistant to this potentially lifesaving treatment?
Some explanations are unique to our era—the awful weaponization of science in a deeply partisan political environment during the age of social media, for instance. But the concept of vaccine hesitancy is not new. Such hesitancy is, in a larger sense, a rejection of science—a phenomenon that far predates the existence of vaccines.
One of the earliest documented controversies in science denialism comes from the field of astronomy. In the third century B.C., the Greek astronomer Aristarchus of Samos proposed a heliocentric model of the universe. The idea that the Earth and planets might revolve around the sun, rather than the other way around, was shocking at the time, and Aristarchus’s theory was quickly rejected in favor of models such as those put forth by Aristotle and Ptolemy, both of whom insisted that the Earth was the center of the universe. The fact that Aristotle and Ptolemy remain better known today than Aristarchus shows the force of the rejection. It would be some 2,000 years before the notion was seriously reconsidered.
In the 1530s, the Polish astronomer Nicolaus Copernicus developed his own heliocentric model based on astronomical observations. Copernicus is remembered today primarily for this perspective-changing discovery. But it’s worth noting that he delayed publication of his findings until 1543, the year of his death, perhaps for fear of scorn or religious objections.
In the early 17th century, Galileo Galilei, the Italian astronomer known as the “father of modern astronomy,” recognized that explaining the celestial changes in the position of stars and sun over time required that the Earth revolve around the sun. Galileo fully and publicly supported the Copernican theory of a heliocentric universe, and condemnation from the Vatican was swift and harsh. He was tried by the Inquisition and threatened with excommunication if he did not recant. Rather than incur the wrath of the pope, he finally agreed that he was wrong. He spent the remainder of his life under house arrest. It would be another 180 years before the Church admitted that Galileo was right.
Rejections of scientific advances are found throughout the history of medicine. There have been four great advances in medicine over the past 200 years: anesthesia, antisepsis, antibiotics, and immunization. Not every advance was met with resistance. When the benefits of the advance have been obvious, there has tended to be little hesitation. Anesthesia and its cousin, analgesia, for instance, were rapidly accepted; they relieved pain, and the advantages were readily appreciated.
Antisepsis had a stormier path to public acceptance. In the 19th century, English and Irish physicians recognized that puerperal sepsis (a dangerous infection in a mother after delivery of a baby) was likely a contagious condition that was spread from patient to patient either by the medical staff or the local environment. They suggested that improving hygiene would reduce the high rates of mortality that puerperal sepsis caused. In 1843, Oliver Wendell Holmes Sr., a physician (and one of The Atlantic’s founders), presented a paper to the Boston Society for Medical Improvement titled “The Contagiousness of Puerperal Fever.” Holmes suggested that unwashed hands among the medical and nursing staff were responsible for transmitting puerperal fever. This did not sit well with the establishment. A prestigious Philadelphia obstetrician, Charles D. Meigs, declared Holmes’s findings to be nonsense and suggested that an increased number of cases among any physician was just bad luck.
The physician who is most frequently recognized with establishing the contagious nature of this infection is a Hungarian obstetrician, Ignaz Semmelweis. He noted that patients in the Vienna General Hospital who were cared for by physicians had a higher incidence of postpartum sepsis than those who were cared for by midwives. Semmelweis realized that physicians performed autopsies, whereas midwives did not, and that physicians did not wash their hands or clothing before moving from an autopsy to a delivery. (It was routine for them to attend deliveries in their bloodstained clothing, having come directly from the autopsy suite.) When he suggested simple hygiene measures such as handwashing, he was derided and eventually run out of town. The medical establishment was unwilling to accept that physicians—rather than bad air or host weaknesses—were responsible for spreading infections and harming patients.
Science denialism can work in the other direction too. When antibiotics, especially penicillin, were first introduced, they were rightly appreciated as miracle drugs. In the pre-antibiotic era, the leading cause of death among children was infectious diseases. The use of antibiotics was astoundingly successful against many, but not all, childhood diseases. The downside for this enthusiasm for treatment came when patients demanded antibiotics for conditions—such as viruses—that didn’t actually necessitate them. Fifty years ago, telling a patient that they had a virus and that penicillin was therefore of no use led to disappointment, disbelief, and even arguments from patients requesting antibiotics for simple colds. Many doctors gave in because it was simpler than spending time fighting with a patient. A consequence of the more indiscriminate use of antibiotics—which represents its own mini-genre of science denialism—has been increased bacterial resistance.
But of the four great advances, none has so broadly helped humanity, or suffered more from science denialism, than immunization. Most, but not all, of the vaccines that scientists have developed since the first immunizations in the 18th century have been developed against viruses. Of all viral infections, the most feared may well have been smallpox. Over the course of the 20th century alone, an estimated 300 million people died of smallpox. Smallpox is highly contagious and spares no age group or class. Its common form has an estimated overall mortality of roughly 30 percent, but the mortality of hemorrhagic smallpox—a more severe form of the disease—approaches 100 percent. Smallpox is also wildly contagious, a characteristic that is most evident when a previously unexposed population is exposed. Smallpox was unknown in the Americas before European explorers brought cases to the New World. The disease decimated the Indigenous populations of North America and South America as a result.
The early concept of immunization to prevent smallpox may have begun more than 1,000 years ago, in China. The history is contested, but some documents show that children would be made to inhale material from a ground-up, mature smallpox lesion scraped off of the body of the infected—a level of exposure that could trigger a person’s immune response to smallpox without causing a full-blown infection. A later technique, which involved scratching the skin of an uninfected individual with material from another person’s lesion, was observed by the wife of the English ambassador to Istanbul, who then brought this procedure to Europe. She was so impressed that she had her children immunized. Subsequently, an experiment was done in which six prisoners in London were immunized. Despite exposure to smallpox, none of them became ill.
Like many advances in medicine, smallpox immunization was met with some resistance, including worry that immunization might inadvertently spread the disease to others. This was an understandable reaction; the live smallpox virus was used, and a small percentage of inoculated individuals did develop full-blown disease and die. In 1721, there was an outbreak of smallpox in Boston. The writer and clergyman Cotton Mather urged widespread immunization but had only moderate success because of resistance from the local population. (History complicates even the views of those who embrace science: Mather was also an ardent defender of the Salem witch trials.) Years later, a well-known case of immunization resistance occurred in Philadelphia. During an outbreak of smallpox in 1736, Benjamin Franklin’s 4-year-old son, Francis, became infected and died. Francis had not been immunized despite an opportunity to do so, and Franklin said he regretted the decision for the rest of his life.
In the generations that followed, scientists built off of these earlier methods and eventually developed a stable and widely available smallpox vaccine. The global eradication of smallpox as a result remains one of the greatest accomplishments in the history of medicine. The last case of naturally occurring smallpox was reported more than 40 years ago.
Even so, vaccine hesitancy has persisted. In America, new vaccines for other diseases have continued to prompt their own waves of skepticism and hostility. And although science denialism is not pervasive in the way it once was centuries ago, it still rears its ugly head. The arrival of the COVID-19 vaccines brought pernicious vaccine sentiments into the spotlight. The reasons for this vehemence are many. For instance, some people who might accept the efficacy of a vaccine have such a fear of injections that they simply avoid seeking medical care until absolutely necessary. But this represents a minority of those who reject the vaccines.
A more common—and more insidious—force that pushes people away from lifesaving vaccines appears to be swelling distrust in expertise, which is both a political and cultural phenomenon. Vaccine resistance can be peddled by influential people in both liberal and conservative circles, but throughout the pandemic, right-wing anti-government organizations and television personalities in particular have promoted a stew of outrageous conspiracy theories about vaccines. Run-of-the-mill misinformation remains a problem too. Some people continue to believe that the COVID-19 vaccine will infect you and make you sick—this is not the case. Finally, of course, there are concerns about known and unknown side effects from the vaccination. Like many vaccines, the COVID shots are linked to serious health effects in extremely rare circumstances; for instance, Moderna’s and Pfizer’s mRNA shots are associated with a very small risk of heart inflammation. It is virtually impossible to prove that some side effect will not ever occur. But hundreds of millions of people have safely received the COVID vaccine in the United States alone.
Perhaps the greatest disservice to vaccination has been the fraudulent claim that childhood vaccines cause autism. This claim was originally published in an otherwise respected medical journal in the 1990s, and has since been fully retracted. (The author lost his medical license.) Nevertheless, many people still believe this and have put their children at risk for serious illness as a result.
Our advances in science over the past two centuries have truly been extraordinary, but our society still suffers from the forces that reject reason and prevent our ability to take full advantage of discoveries that protect us all. And we need to push back against those who endanger others because they see opportunities for fame or profit in spreading dangerous disinformation. Until that happens, our species will continue to understand the world around us in fits and starts—with too many people dying, even when we know how to save them.
“Papa died last night, but his death is not the end.”
Those are the first words Veronica Fletcher uttered to her three children after her husband, Joseph Fletcher, died from Covid-19 on April 11, 2020.
“We’re going to keep papa’s name alive,” Fletcher, 49, later told her children. “He lives in us.”
The Fletchers’ 17-year-old son, Joshua, recalled the day his mother told him about the death of his “papa”: “It’s so real, but not real at the same time,” he said. He says he felt compelled to step into his father’s shoes as the eldest child.
“Being a better role model for my siblings,” he told CNN. “Instilling things that I learned from my father that they might not have the opportunity to have because they didn’t have as much time with him that I did.”
Joshua, his younger brother, Zachary, 14, and sister, Maddie, 10, are among the estimated 238,500 Covid orphans in the United States whose lives have been upended in the past three years by the loss of a parent or primary caregiver, according to the Imperial College London COVID-19 Orphanhood Calculator. Globally, there have been more than eight million Covid orphans since the World Health Organization declared Covid-19 a pandemic in March 2020.
Orphanhood increases the likelihood of poverty, abuse, delayed development, mental health challenges and reduced access to education, according to the Centers for Disease Control and Prevention.
Veronica Fletcher grew up an orphan – her father was not present during her childhood and her mother died when she was nine.
“To be able to usher my children through this loss, it comes from 40 years of pain and knowing what that little nine-year-old girl needed and received,” said Fletcher as she recalled the day she learned of her mother’s death. “To lose a parent is traumatic, and the way the parents were lost during the pandemic, to have to grieve in isolation, that compounds the pain exponentially.”
Christopher Kocher is honoring those who died from Covid and supporting those who survived through his organization, COVID Survivors for Change. The group offers resources and programs to families like the Fletchers. It also pushes for legislative and cultural change. Kocher says much more needs to be done for Covid orphans.
“I was in New York on 9/11. I know how much the city and the nation stepped up to support those families,” Kocher told CNN. “We need to see something similar here. We’re fighting to make sure that we hear a lot more from the president, from the states around the country and from local communities to make sure that they are providing the support that these children need.”
Targeted efforts are gaining traction in many states, albeit slowly.
California state Sen. Nancy Skinner helped her state become the first in the country to pass legislation in June 2022. She introduced a bill strengthening the HOPE (Hope, Opportunity, Perseverance and Accountability) Account law she authored last year. That law made California the first in the nation to create savings accounts for children who lost a parent or guardian to Covid. The California State Budget Act of 2022-23 included $100 million to fund the HOPE program.
California is one of six states that accounts for half of national caregiver loss. New York is another state and has become the second in the nation to introduce legislation that would fund scholarships for children who lost a parent or caregiver to Covid. Each qualifying student would be eligible for a scholarship that covers the equivalent cost of SUNY tuition, plus room and board, books as well as supplies.
New York’s legislation, if approved, would come too late for Joshua Fletcher’s first year of college. “I got accepted into schools that I wanted to go to, but I couldn’t afford to go to them because papa died,” he said. However, Joshua would be eligible for his remaining years of college.
Asian, Hispanic and Black families are more likely to experience a loss, with Black families, like the Fletcher family, twice as likely to suffer from a Covid death, according to the National Institutes of Health.
“Pain is pain, trauma is trauma,” Veronica Fletcher said. “This power is turning your pain into purpose. Those are the kinds of lessons that are helping my children to find hope, to be resilient, to know that they’re not alone. It helps you to help someone else.”
It’s why Fletcher now finds support through external groups, such as COVID Widow Sisters, which connects grieving wives across the country. Fletcher also plans to start her own organization, Widows Tears Collective, a support group for women who have lost loved ones to the illness.
“Especially early on the pandemic, you didn’t get to say goodbye. You didn’t get to be in the hospital. You didn’t get to hold their hand. That loss impacts you dramatically and sits with you for a really long time,” Kocher said. “When that loss is for a young person, someone who’s losing a parent, it’s a really different kind of loss.”
Newswise — BOSTON – New research from Boston Medical Center found that substance use disorders do not increase the likelihood of dying from COVID-19. Published in Substance Abuse: Research and Treatment, the study showed that the increased risk for severe COVID-19 in people with SUD that has been seen may be the result of co-occurring medical conditions.
Multiple large cohort studies from early in the pandemic have shown higher rates of hospitalization, intubation, and death from COVID-19 in those with SUD, while other studies found no association between SUD and COVID-19-related mortality or mixed results depending on substance use pattern. Given these conflicting data, the Centers for Disease Control and Prevention has classified persons with SUD as suggestive of higher risk for severe COVID-19. The goal of this study was to assess the association between SUD and inpatient COVID-19-related mortality.
“BMC is known for excellent clinical care and innovative research related to substance use disorder. Since the early days of the pandemic, BMC has also been a leader in the treatment of individuals with COVID-19, including persons with complex medical and social needs,” said first author Angela McLaughlin, MD, MPH, an infectious disease fellow at Boston Medical Center. “These findings showing a similar likelihood of COVID-19-related complications in hospitalized patients with and without SUD helps expand knowledge of the infectious complications of SUD.”
As BMC sees a high proportion of patients who use substances, it was an apt location for the study: almost 14% of the study population had SUD, exceeding the national average of 10.8% in people ages 18 or older. Researchers reviewed medical records of 353 adults without SUD and 56 adults with SUD admitted to Boston Medical Center early into COVID-19 pandemic and compared the likelihood of COVID-19 related complications between individuals with and without substance use disorders. They compared the relationship between COVID-19 and mortality, clinical complications, and resource utilization.
“Early in the pandemic, BMC developed protocols to closely monitor and quickly manage COVID-19-related complications in all hospitalized patients,” said senior author Sabrina Assoumou, MD, MPH, an infectious disease doctor at Boston Medical Center and Assistant Professor of Medicine at Boston University Chobanian & Avedisian School of Medicine. “The current findings suggest that such an approach might have benefited many patients, including individuals with substance use disorders.”
In this retrospective cohort study of patients admitted to a safety net hospital during the early phase of the COVID-19 pandemic, SUD was not associated with the primary outcome of COVID-19-associated inpatient mortality. The secondary analysis showed that those with and without SUD had similar COVID-19-related clinical complications, including secondary infections, renal failure requiring dialysis, acute liver injury, venous thromboembolism, cardiac complications, and the composite “any complications.” Of note, some clinical outcomes such as stroke were very uncommon overall. Likewise, there was no difference in resource utilization secondary outcomes between the two groups. In contrast to other studies, this found similar likelihoods of mechanical ventilation and ICU admission in patients with and without SUD. Although patients with SUD presented to the hospital earlier in their disease course, their total hospital length of stay was ultimately similar to patients without SUD. Insights such as these into the clinical complications and resource utilization patterns of patients with SUD and COVID-19 can help clinicians anticipate the trajectory of infection and healthcare needs in this vulnerable group.
There were some notable limitations to the study. The results are from a single site, which might limit generalizability of the findings despite the racial and ethnic diversity of the BMC patient population. Second, the data presented are from the earliest phase of COVID-19 in the United States, so trends may have differed with subsequent waves and as COVID-19 management strategies have evolved over time. Third, there were no specific controls for socioeconomic factors like medical insurance status or income level, as over 75% of the BMC patient population has public payer insurance (Medicare, Medicaid, or Children’s Health Insurance Program) or no insurance. Lastly, differences in COVID-19 outcomes between current versus past SUD could not be detected – this area would benefit from further research.
In conclusion, in this study of hospitalized individuals at an urban safety net hospital with a diverse patient population in the early days of the COVID-19 pandemic, inpatient mortality and morbidity between patients with and without SUD were similar. The findings provide a detailed evaluation of outcomes in a unique patient population that has been disproportionately impacted by COVID-19 and may provide beneficial insights for similar settings across the country. These results point away from SUD as an independent risk factor for severe COVID-19 and further suggest a focus on medical comorbidities to mitigate the effects of COVID-19. Additional studies are needed to further evaluate for differential outcomes in this high-risk population, particularly in an era of newer COVID-19-directed therapies.
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About Boston Medical Center
Boston Medical Centeris a leading academic medical center with a deep commitment to health equity and a proud history of serving all who come to us for care. BMC provides high-quality healthcare and wrap around support that treats the whole person, extending beyond our physical campus into our vibrant and diverse communities. BMC is advancing medicine, while training the next generation of healthcare providers and researchers as the primary teaching affiliate of Boston University Chobanian & Avedisian School of Medicine. BMC is a founding member of Boston Medical Center Health System, which supports patients and health plan members through a value based, coordinated continuum of care.
Darin Wiesner, a professor at Rutgers New Jersey Medical School who studies fungal disease, can comment on the surge of drug-resistant fungal infections at medical facilities across the US.
The following quotes from Wiesner are available to journalists covering the issue.
Several aspects of C. auris should be concerning to immunocompromised patients, including the elderly and chronically ill, that receive care in a healthcare setting.
The fungus can access parts of an immunocompromised patient’s body that cause serious disease and make the treatment extremely difficult. C. auris is resistant to a few of the already small list of available antifungal medications.
At-risk populations congregate at healthcare facilities, C. auris tends to accumulate in areas that sick patients frequent, and the cycle repeats.
C. auris can grow on the skin and in nasal cavities of caregivers, as well as on surfaces of equipment and furniture at healthcare facilities.
Currently, there are only three classes of anti-fungal drugs. C. auris is completely resistant to one of them (azoles) and is evolving resistance to the others (polyenes and echinocandins). Like multi-drug resistant bacteria (e.g., MRSA), C. auris poses a serious risk of depleting treatment options and, consequently, increasing both the cost of treatment and the mortality of infected patients. Thankfully, developing new anti-fungal drugs is a very active area of investigation among academic researchers.
China has approved its first Covid-19 vaccine based on mRNA technology, months after the country lifted strict pandemic measures.
The vaccine was developed by CSPC Pharmaceutical Group, a homegrown firm based in the northern Chinese city of Shijiazhuang, it said in a Wednesday statement to the Hong Kong stock exchange. The vaccine targets the Omicron variant and was tested in China with over 5,500 people, it added.
The approval comes just weeks after China declared a “major and decisive victory” in its handling of the coronavirus outbreak that swept the country in recent months following an abrupt relaxation of its “zero-Covid” policy late last year.
“This is a positive step because there is strong scientific evidence that mRNA vaccines do much better than non-MRA vaccines,” Jin Dong-yan, a professor in molecular virology at the University of Hong Kong, told CNN.
“Whether this product … is as good as other products on market is still to be determined.”
CSPC said in the statement the results had demonstrated the vaccine’s “safety, immunogenicity and efficacy,” but it didn’t offer additional details.
Until now, China has approved only inactivated vaccines made by Sinovac Biotech and Sinopharm Group, two Beijing-based drugmakers.
The inactivated vaccines have been found to elicit lower levels of antibody response compared to ones using the newer messenger RNA technology. Biotech firms Pfizer
(PFE) and Moderna
(MRNA) make rRNA vaccines.
A former Florida lawmaker pleaded guilty Tuesday to wire fraud, money laundering and making false statements in connection with Covid-19 relief fraud, according to a news release from the Department of Justice.
Former Republican state Rep. Joseph Harding acquired more than $150,000 in Small Business Administration loans by lying on loan applications, the department said.
Harding is scheduled to be sentenced on July 25, the release said.
A wire fraud conviction carries a maximum sentence of 20 years in prison, while money laundering and making false statements carry a maximum of 10 and five years, respectively.
Peg O’Connor, an attorney for Harding, said in a statement that her client “made the best decision available to him under the circumstances to protect his family and his future.”
She added that she looks forward to providing a “fuller picture” and “insight into who Mr. Harding is as a person” at sentencing.
Prosecutors previously said Harding listed dormant business entities on his applications, fabricated the numbers of people he employed and submitted fake bank statements.
Harding was elected to the Florida House of Representatives in 2020 and announced his resignation after he was charged in December.
In a statement to The New York Times last year, he said he had pleaded not guilty during an initial court appearance. “I want the public and my constituents to know that I fully repaid the loan and cooperated with investigators as requested,” Harding told the newspaper at the time.
The Florida Republican has drawn the national spotlight before, as a sponsor of the controversial legislation that banned certain instruction about sexual orientation and gender identity in the classroom that opponents dubbed the “Don’t Say Gay” law. The legislation officially named the “Parental Rights in Education” law, signed by Florida Republican Gov. Ron DeSantis in March 2022, set off a national firestorm and drew immediate pushback from LGBTQ advocates.
Investigators have said that billions of dollars of Covid-19 relief funds have been obtained using fabricated, stolen or fake information. The Justice Department’s Covid-19 Fraud Enforcement Task Force has brought several high-profile fraud cases across the country.
Newswise — WEST LAFAYETTE, Ind. — Early COVID-19 pandemic suspicions about dogs’ resistance to the disease have given way to a long-haul clinical data gap as new variants of the virus have emerged.
“It is not confirmed that the virus can be transmitted from one dog to another dog or from dogs to humans,” said veterinarian Mohamed Kamel, a postdoctoral fellow at Purdue University.
During the pandemic’s early days, dogs seemed resistant to the coronavirus, showing little evidence of infection or transmission, said Mohit Verma, assistant professor of agricultural and biological engineering and Purdue’s Weldon School of Biomedical Engineering. “As the virus evolved, or maybe the surveillance technology advanced, there seem to be more instances of potentially asymptomatic dogs.”
These are among the findings that Kamel, Verma and two co-authors summarized in a research literature review “Interactions Between Humans and Dogs in the COVID-19 Pandemic.” The summary, with recent updates and future perspectives, recently appeared in a special issue of the journalAnimalson Susceptibility of Animals to SARS-CoV-2.
Additional co-authors are Rachel Munds, a research scientist at Krishi Inc. and a Purdue visiting scholar in the Department of Agricultural and Biological Engineering, and Amr El-Sayed of Egypt’s Cairo University.
The SARS-CoV-2 virus that originated in Wuhan, China, in 2019 has infected more than 600 million people globally and had claimed more than 6.5 million lives by October 2022.
“COVID-19 has become one of the most important economic, health and humanitarian problems of the 21st century,” the co-authors wrote in the Animals article. Studies have documented the movement of the SARS-CoV-2 virus through various animal species. And about 75 percent of infectious diseases in humans start in animals.
“This spread raises concerns about the possibility of pet animals serving as reservoirs for the virus,” the co-authors wrote.
More than two dozen animal species have been infected by SARS-CoV-2 virus, ranging from cats, dogs and rabbits to deer, cattle and gorillas. More than 470 million dogs were owned worldwide before the COVID-19 outbreak. Their susceptibility to the virus remains poorly understood because they are infrequently tested, said Kamel, who is also a faculty member at Cairo University.
“Compared to cats or other animals, the susceptibility is less,” Kamel said. He cautioned, however, that the susceptibility of dogs to the new variants may have changed to a lesser or greater extent.
“There are a lot of variants. It’s not only one virus,” Kamel said. “The infections differ from the old variant to the new variant.”
Dogs’ apparent resistance to COVID-19 could result from their general low levels of the angiotensin converting enzyme (ACE2), target receptors in their lung cells and related mutations.
“ACE2 is the main part of the virus attachment found on the cells,” Kamel noted.
The Animals journal article also discusses how the spread of an epidemic can be tracked, predicted and contained through a combination of geographic information systems, molecular biology and even detection dogs. Because of their heightened sense of smell, dogs can be trained to detect a wide range of human diseases, Kamel said. Using dogs to detect COVID-19, as reported in the journal article, is fast and less expensive compared to other methods where screening large crowds may be needed.
Verma’s startup, Krishi Inc., is already developing innovative paper-based, rapid-result tests for bovine respiratory disease, antimicrobial resistance and COVID-19. The testing system uses a method called loop-mediated isothermal amplification (LAMP) and is under development in Verma’s lab for produce safety applications. Adapting LAMP for animal testing of SARS-CoV-2 may come next.
Krishi Inc. received an initial investment from Ag-Celerator. Created in 2015, Ag-Celerator is a $2 million innovation fund designed to provide critical startup support for Purdue innovators who bring Purdue’s patented intellectual property or “know-how” technologies to market. The fund is operated by Purdue Ventures with assistance from the Purdue University College of Agriculture, the Purdue Research Foundation Office of Technology Commercialization and the agriculture industry.
The Animals journal article cites multiple studies from Purdue and elsewhere validating the usefulness of LAMP testing. Krishi’s focus thus far has been developing a test for antimicrobial resistance in animals, but the LAMP assay has broader potential, Verma said.
“If we want to do widespread surveillance, can we make our test versatile for any species? LAMP is portable,” Verma said. “Because it can be done in a simple manner and provide results without a lab setup, we can potentially do this on a wider scale and make it cost-effective.”
Currently available commercial at-home coronavirus tests for humans can also be used on dogs and cats. However, these tests may not be sensitive enough to detect the lower viral loads in animals.
“They’re not validated for animals, so we don’t know how well they would work. That’s the gap we’re hoping to bridge with the test that we are developing – better tools of surveillance,” Verma said.
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—
Americans took fewer steps during the height of the Covid-19 pandemic, and they still haven’t gotten their mojo back, a new study found.
“On average, people are taking about 600 fewer steps per day than before the pandemic began,” said study author Dr. Evan Brittain, associate professor of cardiovascular medicine at Vanderbilt University Medical Center in Nashville.
“To me, the main message is really a public health message — raising awareness that Covid-19 appears to have had a lasting impact on people’s behavioral choices when it comes to activity,” he said.
The study used data from the National Institutes of Health’s All of Us Research Program, which is focused on identifying ways to develop individualized health care. Many of the 6,000 participants in the program wore activity trackers for at least 10 hours a day over multiple years and allowed researchers access to their electronic health records.
In the new study, published Monday in JAMA Network Open, researchers compared steps taken by nearly 5,500 people who wore the program’s activity trackers. Most were White women, with an average age of 53.
Step counts collected between January 1, 2018, and January 31, 2020, were considered pre-Covid. Steps tracked after that date until the end of 2021, which is when the study ended, were considered post-Covid.
Results showed no difference in identified step activity based on sex, obesity, diabetes and other illnesses or conditions such as coronary artery disease, hypertension or cancer.
People who took the fewest steps were socioeconomically disadvantaged, under psychological stress and not vaccinated, the study said.
Age made a difference as well, but in an unexpected manner: People over 60 were not impacted by the pandemic, the study found — they continued to keep their steps up.
Oddly, it was younger people between 18 and 30 whose step counts were most impacted, Brittain said. “In fact, we found every 10-year decrease in age was associated with a 243 step reduction per day.”
“If this persists over time, it could certainly raise the risk of cardiovascular disease, obesity, hypertension, diabetes and other conditions strongly linked to being sedentary,” Brittian said. “However, it’s too soon to know whether this trend will last.”
Why would a younger generations lose steps while older people did not?
“I think it’s difficult to interpret because it’s only 600 steps, which you could argue is what some people would get simply walking into work and through their day,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, who was not involved in the research. “I think the question is who is more likely to work from home?”
Younger generations make up the majority of workers in technology, software and other professions that are able to work from anywhere, “whereas older people may have less of those jobs,” Freeman said.
Whatever the reason, the study data shows that people were not moving as much during the pandemic as they used to. That is worrisome, Freeman added.
“If this trend remains, we should really be cognizant that if you’re going to work from home, use either a standing, treadmill or bike desk,” he said, adding that managers of remote employees should “insist people take periodic breaks for people to do exercise, which also is proven to improve mental clarity and acuity,” he said.
Health professionals should always be talking to their patients about activity levels, but “the impact of Covid-19 might make those kinds of messages all the more important to discuss with patients,” Brittain said.
There’s a tantalizing new clue in the hunt for the origins of the Covid-19 pandemic.
A new analysis of genetic material collectedfrom January to March 2020 at the Huanan Seafood Market in Wuhan, China, has uncovered animal DNA in samples already known to be positive for SARS-CoV-2, the coronavirus that causes Covid-19. A significant amount of that DNA appears to belong to animals known as raccoon dogs, which were known to be traded at the market, according to officials with the World Health Organization, who addressed the new evidence in a news briefing on Friday.
The connection to raccoon dogs came to light after Chinese researchers shared raw genetic sequences taken from swabbed specimens collected at the market early in the pandemic. The sequences were uploaded in late January 2023, to the data sharing site GISAID, but have recently been removed.
An international team of researchers noticed them and downloaded them for further study, the WHO officials said Friday.
The new findings – which have not yet been publicly posted – do not settle the question of how the pandemic started. They do not prove that raccoon dogs were infected with SARS-CoV-2, nor do they prove that raccoon dogs were the animals that first infected people.
But because viruses don’t survive in the environment outside of their hosts for long, finding so much of the genetic material from the virus intermingled with genetic material from raccoon dogs is highly suggestive that they could have been carriers, according to scientists who worked on the analysis. The analysis was ledby Kristian Andersen, an immunologist and microbiologist at Scripps Research; Edward Holmes, a virologist at the University of Sydney; Michael Worobey, an evolutionary biologist at the University of Arizona. These three scientists, who have been digging into the origins of the pandemic, were interviewed by reporters for The Atlantic magazine. CNN has reached out to Andersen, Holmes and Worobey for comment.
The details of theinternational analysis were first reported Thursday by The Atlantic.
The new data is emerging as Republicans in Congress have opened investigations into the pandemic’s origin. Previous studies provided evidence that the virus likely emerged naturally in market, but could not point to a specific origin. Some US agencies, including a recent US Department of Energy assessment, say the pandemic likely resulted from a lab leak in Wuhan.
In the news briefing on Friday, WHO Director-General Tedros Adhanom Ghebreyesus said the organization was first made aware of the sequences on Sunday.
“As soon as we became aware of this data, we contacted the Chinese CDC and urged them to share it with WHO and the international scientific community so it can be analyzed,” Tedros said.
WHO also convened its Scientific Advisory Group for the Origins of the Novel Pathogens, known as SAGO, which has been investigating the roots of the pandemic, to discuss the data on Tuesday. The group heard from Chinese scientists who had originally studied the sequences, as well as the group of international scientists taking a fresh look at them.
WHO experts said in the Friday briefing that the data are not conclusive. They still can’t say whether the virus leaked from a lab, or if it spilled over naturally from animals to humans.
“These data do not provide a definitive answer to the question of how the pandemic began, but every piece of data is important in moving us closer to that answer,” Tedros said.
What the sequences do prove, WHO officials said, is that China has more data that might relate to the origins of the pandemic that it has not yet shared with the rest of the world.
“This data could have, and should have, been shared three years ago,” Tedros said. “We continue to call on China to be transparent in sharing data and to conduct the necessary investigations and share results.
“Understanding how the pandemic began remains a moral and scientific imperative.”
CNN has reached out to the Chinese scientists who first analyzed and shared the data, but has not received a reply.
The Chinese researchers, who are affiliated with that country’s Center for Disease Control and Prevention, had shared their own analysis of the samples in 2022. In that preprint study posted last year, they concluded that “no animal host of SARS-CoV2 can be deduced.”
The research looked at 923 environmental samples taken from within the seafood market and 457 samples taken from animals, and found 63 environmental samples that were positive for the virus that causes Covid-19. Most were taken from the western end of the market. None of the animal samples, which were taken from refrigerated and frozen products for sale, and from live, stray animals roaming the market, were positive, the Chinese authors wrote in 2022.
When they looked at the different species of DNA represented in the environmental samples, the Chinese authors only saw a link to humans, but not other animals.
When an international team of researchers recentlytook at fresh look at the genetic material in the samples – which were swabbed in and around the stalls of the market – using an advanced genetic technique called metagenomics, scientists said they were surprised to find a significant amount of DNA belonging to raccoon dogs, a small animal related to foxes. Raccoon dogs can be infected with the virus that causes Covid-19 and have been high on the list of suspected animal hosts for the virus.
“What they found is molecular evidence that animals were sold at that market. That was suspected, but they found molecular evidence of that. And also that some of the animals that were there were susceptible to SARS-CoV2 infection, and some of those animals include raccoon dogs,” said Maria Van Kerkhove, WHO’s technical lead for Covid-19, in Friday’s briefing.
“This doesn’t change our approach to studying the origins of Covid-19. It just tells us that more data exists, and that data needs to be shared in full,” she said.
Van Kerkhove said that until the international scientific community is able to review more evidence, “all hypotheses remain on the table.”
Some experts found the new evidence persuasive, if not completely convincing, of an origin in the market.
“The data does point even further to a market origin,” Andersen, the Scripps Research evolutionary biologist who attended the WHOmeeting and is one of the scientists analyzing the new data, told the magazine Science.
The assertions made over the new data quickly sparked debate in the scientific community.
Francois Balloux, director of the Genetics Institute at University College London, said the fact that the new analysis had not yet been publicly posted for scientists to scrutinize, but had come to light in news reports, warranted caution.
“Such articles really don’t help as they only polarise the debate further,” Balloux posted in a thread on Twitter. “Those convinced by a zoonotic origin will read it as final proof for their conviction, and those convinced it was a lab leak will interpret the weakness of the evidence as attempts of a cover-up.”
Other experts, who were not involved in the analysis, said the data could be key to showing the virus had a natural origin.
Felicia Goodrum is an immunobiologist at the University of Arizona, who recently published a review of all available data for the various theories behind the pandemic’s origin.
Goodrum says the strongest proof for a natural spillover would be to isolate the virus that causes Covid-19 from an animal that was present in the market in 2019.
“Clearly, that is impossible, as we cannot go back in time any more than we have through sequencing, and no animals were present at the time sequences could be collected. To me, this is the next best thing,” Goodrum said in an email to CNN.
In the WHO briefing, Van Kerkhove said that the Chinese CDC researchers had uploaded the sequences to GISAID as they were updating their original research. She said their first paper is in the process of being updated and resubmitted for publication.
“We have been told by GISAID that the data from China’s CDC is being updated and expanded,” she said.
Van Kerkhove said on Friday that what WHO would like to be able to do is to find the source of where the animals came from. Were they wild? Were they farmed?
She said in the course of its investigation into the pandemic’s origins, WHOhad repeatedly asked China for studies to trace the animals back to their source farms. She said WHO had also asked for blood tests on people who worked in the market, as well as tests on animals that may have come from the farms.
“Share the data,” Dr. Mike Ryan, executive director of WHO’s health emergencies program, said Friday, addressing scientists around the world who might have relevant information. “Let science do the work, and we will get the answers.”
Effie Schnacky was wheezy and lethargic instead of being her normal, rambunctious self one February afternoon. When her parents checked her blood oxygen level, it was hovering around 80% – dangerously low for the 7-year-old.
Her mother, Jaimie, rushed Effie, who has asthma, to a local emergency room in Hudson, Wisconsin. She was quickly diagnosed with pneumonia. After a couple of hours on oxygen, steroids and nebulizer treatments with little improvement, a physician told Schnacky that her daughter needed to be transferred to a children’s hospital to receive a higher level of care.
The physical and mental burnout that occurred during the height of the Covid-19 pandemic has not gone away for overworked health care workers. Shortages of doctors and technicians are growing, experts say, but especially in skilled nursing. That, plus a shortage of people to train new nurses and the rising costs of hiring are leaving hospitals with unstaffed pediatric beds.
But a host of reasons building since well before the pandemic are also contributing. Children may be the future, but we aren’t investing in their health care in that way. With Medicaid reimbursing doctors at a lower rate for children, hospitals in tough situations sometimes put adults in those pediatric beds for financial reasons. And since 2019, children with mental health crises are increasingly staying in emergency departments for sometimes weeks to months, filling beds that children with other illnesses may need.
“There might or might not be a bed open right when you need one. I so naively just thought there was plenty,” Schnacky told CNN.
The number of pediatric beds decreasing has been an issue for at least a decade, said Dr. Daniel Rauch, chair of the Committee on Hospital Care for the American Academy of Pediatrics.
By 2018, almost a quarter of children in America had to travel farther for pediatric beds as compared to 2009, according to a 2021 paper in the journal Pediatrics by lead author Dr. Anna Cushing, co-authored by Rauch.
“This was predictable,” said Rauch, who has studied the issue for more than 10 years. “This isn’t shocking to people who’ve been looking at the data of the loss in bed capacity.”
The number of children needing care was shrinking before the Covid-19 pandemic – a credit to improvements in pediatric care. There were about 200,000 fewer pediatric discharges in 2019 than there were in 2017, according to data from the US Department of Health and Human Services.
“In pediatrics, we have been improving the ability we have to take care of kids with chronic conditions, like sickle cell and cystic fibrosis, and we’ve also been preventing previously very common problems like pneumonia and meningitis with vaccination programs,” said Dr. Matthew Davis, the pediatrics department chair at Ann & Robert H. Lurie Children’s Hospital of Chicago.
Pediatrics is also seasonal, with a typical drop in patients in the summer and a sharp uptick in the winter during respiratory virus season. When the pandemic hit, schools and day cares closed, which slowed the transmission of Covid and other infectious diseases in children, Davis said. Less demand meant there was less need for beds. Hospitals overwhelmed with Covid cases in adults switched pediatric beds to beds for grownups.
Only 37% of hospitals in the US nowoffer pediatric services, down from 42% about a decade ago, according to the American Hospital Association.
While pediatric hospital beds exist at local facilities, the only pediatric emergency department in Baltimore County is Greater Baltimore Medical Center in Towson, Maryland, according to Dr. Theresa Nguyen, the center’s chair of pediatrics. All the others in the county, which has almost 850,000 residents, closed in recent years, she said.
The nearby MedStar Franklin Square Medical Center consolidated its pediatric ER with the main ER in 2018, citing a 40% drop in pediatric ER visits in five years, MedStar Health told CNN affiliate WBAL.
In the six months leading up to Franklin Square’s pediatric ER closing, GBMC admitted an average of 889 pediatric emergency department patients each month. By the next year, that monthly average jumped by 21 additional patients.
“Now we’re seeing the majority of any pediatric ED patients that would normally go to one of the surrounding community hospitals,” Nguyen said.
In other cases, it’s the hospitals that have only 10 or so pediatric beds that started asking the tough questions, Davis said.
“Those hospitals have said, ‘You know what? We have an average of one patient a day or two patients a day. This doesn’t make sense anymore. We can’t sustain that nursing staff with specialized pediatric training for that. We’re going to close it down,’” Davis said.
Saint Alphonsus Regional Medical Center in Boise closed its pediatric inpatient unit in July because of financial reasons, the center told CNN affiliate KBOI. That closure means patients are now overwhelming nearby St. Luke’s Children’s Hospital, which is the only children’s hospital in the state of Idaho, administrator for St. Luke’s Children’s Katie Schimmelpfennig told CNN. Idaho ranks last for the number of pediatricians per 100,000 children, according to the American Board of Pediatrics in 2023.
The Saint Alphonsus closure came just months before the fall, when RSV, influenza and a cadre of respiratory viruses caused a surge of pediatric patients needing hospital care, with the season starting earlier than normal.
The changing tide of demand engulfed the already dwindling supply of pediatric beds, leaving fewer beds available for children coming in for all the common reasons, like asthma, pneumonia and other ailments. Additional challenges have made it particularly tough to recover.
Another factor chipping away at bed capacity over time: Caring for children pays less than caring for adults. Lower insurance reimbursement rates mean some hospitals can’t afford to keep these beds – especially when care for adults is in demand.
Medicaid, which provides health care coverage to people with limited income, is a big part of the story, according to Joshua Gottlieb, an associate professor at the University of Chicago Harris School of Public Policy.
“Medicaid is an extremely important payer for pediatrics, and it is the least generous payer,” he said. “Medicaid is responsible for insuring a large share of pediatric patients. And then on top of its low payment rates, it is often very cumbersome to deal with.”
Medicaid reimburses children’s hospitals an average of 80% of the cost of the care, including supplemental payments, according to the Children’s Hospital Association, a national organization which represents 220 children’s hospitals. The rate is far below what private insurers reimburse.
More than 41 million children are enrolled in Medicaid and the Children’s Health Insurance Program, according to Kaiser Family Foundation data from October. That’s more than half the children in the US, according to Census data.
At Children’s National Hospital in Washington, DC, about 55% of patients use Medicaid, according to Dr. David Wessel, the hospital’s executive vice president.
“Children’s National is higher Medicaid than most other children’s hospitals, but that’s because there’s no safety net hospital other than Children’s National in this town,” said Wessel, who is also the chief medical officer and physician-in-chief.
And it just costs more to care for a child than an adult, Wessel said. Specialty equipment sized for smaller people is often necessary. And a routine test or exam for an adult is approached differently for a child. An adult can lie still for a CT scan or an MRI, but a child may need to be sedated for the same thing. A child life specialist is often there to explain what’s going on and calm the child.
“There’s a whole cadre of services that come into play, most of which are not reimbursed,” he said. “There’s no child life expert that ever sent a bill for seeing a patient.”
“When insurance pays more, people build more health care facilities, hire more workers and treat more patients,” Gottlieb said.
“Everyone might be squeezed, but it’s not surprising that pediatric hospitals, which face [a]lower, more difficult payment environment in general, are going to find it especially hard.”
Dr. Benson Hsu is a pediatric critical care provider who has served rural South Dakota for more than 10 years. Rural communities face distinct challenges in health care, something he has seen firsthand.
A lot of rural communities don’t have pediatricians, according to the American Board of Pediatrics. It’s family practice doctors who treat children in their own communities, with the goal of keeping them out of the hospital, Hsu said. Getting hospital care often means traveling outside the community.
Hsu’s patients come from parts of Nebraska, Iowa and Minnesota, as well as across South Dakota, he said. It’s a predominantly rural patient base, which also covers those on Native American reservations.
“These kids are traveling 100, 200 miles within their own state to see a subspecialist,” Hsu said, referring to patients coming to hospitals in Sioux Falls. “If we are transferring them out, which we do, they’re looking at travels of 200 to 400 miles to hit Omaha, Minneapolis, Denver.”
Inpatient pediatric beds in rural areas decreased by 26% between 2008 and 2018, while the number of rural pediatric units decreased by 24% during the same time, according to the 2021 paper in Pediatrics.
“It’s bad, and it’s getting worse. Those safety net hospitals are the ones that are most at risk for closure,” Rauch said.
In major cities, the idea is that a critically ill child would get the care they need within an hour, something clinicians call the golden hour, said Hsu, who is the critical care section chair at the American Academy of Pediatrics.
“That golden hour doesn’t exist in the rural population,” he said. “It’s the golden five hours because I have to dispatch a plane to land, to drive, to pick up, stabilize, to drive back, to fly back.”
When his patients come from far away, it uproots the whole family, he said. He described families who camp out at a child’s bedside for weeks at a time. Sometimes they are hundreds of miles from home, unlike when a patient is in their own community and parents can take turns at the hospital.
“I have farmers who miss harvest season and that as you can imagine is devastating,” Hsu said. “These aren’t office workers who are taking their computer with them. … These are individuals who have to live and work in their communities.”
Back at GBMC in Maryland, an adolescent patient with depression, suicidal ideation and an eating disorder was in the pediatric emergency department for 79 days, according to Nguyen. For months, no facility had a pediatric psychiatric bed or said it could take someone who needed that level of care, as the patient had a feeding tube.
“My team of physicians, social workers and nurses spend a significant amount of time every day trying to reach out across the state of Maryland, as well as across the country now to find placements for this adolescent,” Nguyen said before the patient was transferred in mid-March. “I need help.”
Nguyen’s patient is just one of the many examples of children and teens with mental health issues who are stayingin emergency rooms and sometimes inpatient beds across the country because they need help, but there isn’t immediately a psychiatric bed or a facility that can care for them.
It’s a problem that began before 2020 and grew worse during the pandemic, when the rate of children coming to emergency rooms with mental health issues soared, studies show.
Now, a nationwide shortage of beds exists for children who need mental health help. A 2020 federal survey revealed that the number of residential treatment facilities for children fell 30% from 2012.
“There are children on average waiting for two weeks for placement, sometimes longer,” Nguyen said of the patients at GBMC. The pediatric emergency department there had an average of 42 behavioral health patients each month from July 2021 through December 2022, up 13.5% from the same period in 2017 to 2018, before the pandemic, according to hospital data.
When there are mental health patients staying in the emergency department, that can back up the beds in other parts of the hospital, creating a downstream effect, Hsu said.
“For example, if a child can’t be transferred from a general pediatric bed to a specialized mental health center, this prevents a pediatric ICU patient from transferring to the general bed, which prevents an [emergency department] from admitting a child to the ICU. Health care is often interconnected in this fashion,” Hsu said.
“If we don’t address the surging pediatric mental health crisis, it will directly impact how we can care for other pediatric illnesses in the community.”
Funding for children’s hospitals is already tight, Rauch said, and more money is needed not only to make up for low insurance reimbursement rates but to competitively hire and train new staff and to keep hospitals running.
“People are going to have to decide it’s worth investing in kids,” Rauch said. “We’re going to have to pay so that hospitals don’t lose money on it and we’re going to have to pay to have staff.”
Virtual visits, used in the right situations, could ease some of the problems straining the pediatric system, Rauch said. Extending the reach of providers would prevent transferring a child outside of their community when there isn’t the provider with the right expertise locally.
Increased access to children’s mental health services
With the ongoing mental health crisis, there’s more work to be done upstream, said Amy Wimpey Knight, the president of CHA.
“How do we work with our school partners in the community to make sure that we’re not creating this crisis and that we’re heading it off up there?” she said.
There’s also a greater need for services within children’s hospitals, which are seeing an increase in children being admitted with behavioral health needs.
“If you take a look at the reasons why kids are hospitalized, meaning infections, diabetes, seizures and mental health concerns, over the last decade or so, only one of those categories has been increasing – and that is mental health,” Davis said. “At the same time, we haven’t seen an increase in the number of mental health hospital resources dedicated to children and adolescents in a way that meets the increasing need.”
Most experts CNN spoke to agreed: Seek care for your child early.
“Whoever is in your community is doing everything possible to get the care that your child needs,” Hsu said. “Reach out to us. We will figure out a way around the constraints around the system. Our number one concern is taking care of your kids, and we will do everything possible.”
Nguyen from GBMC and Schimmelpfennig from St. Luke’s agreed with contacting your primary care doctor and trying to keep your child out of the emergency room.
“Anything they can do to stay out of the hospital or the emergency room is both financially better for them and better for their family,” Schimmelpfennig said.
Knowing which emergency room or urgent care center is staffed by pediatricians is also imperative, Rauch said. Most children visit a non-pediatric ER due to availability.
“A parent with a child should know where they’re going to take their kid in an emergency. That’s not something you decide when your child has the emergency,” he said.
After Effie’s first ambulance ride and hospitalization last month, the Schnacky family received an asthma action plan from the pulmonologist in the ER.
It breaks down the symptoms into green, yellow and red zones with ways Effie can describe how she’s feeling and the next steps for adults. The family added more supplies to their toolkit, like a daily steroid inhaler and a rescue inhaler.
“We have everything an ER can give her, besides for an oxygen tank, at home,” Schnacky said. “The hope is that we are preventing even needing medical care.”
Chinese billionaire and proclaimed dissident Guo Wengui was arrested Wednesday and charged with defrauding thousands of followers out of more than $1 billion through complex investment schemes, US prosecutors announced Wednesday.
Guo, a staunch critic of the Chinese government who is exiled in Manhattan and close to former Donald Trump adviser Steve Bannon, was taken into custody in New York on Wednesday morning. He is charged with defrauding or misappropriating investor money using different schemes, including his media company GTV Media Group, a farm loan program through Himalaya Farm Alliance, and a cryptocurrency called Himalaya Coin.
Guo is also known as Ho Wan Kwok and Miles Guo.
Prosecutors said instead of using the money the way he promised potential investors, Guo directed the funds to invest in a hedge fund to benefit GTV and a relative, to cover the maintenance payments for his $37 million, 145-foot luxury yacht, a New Jersey mansion and a custom-built Bugatti sports car valued at $4.4 million. Prosecutors said in a letter to the judge that they are seeking his detention, arguing he poses a serious risk of flight.
CNN has reached out to Guo’s lawyer for comment.
Guo co-founded two nonprofit organizations, the Rule of Law Foundation and the Rule of Law Society, that prosecutors allege he used to attract a following who believed in many of his ideas.
Those nonprofits were linked to a group promoting the theory that the novel coronavirus was likely engineered in a Chinese lab. The Rule of Law organizations were co-founded by Guo and Bannon.
Bannon has not been charged in this case.
Bannon was arrested in 2020 on Guo’s yacht on unrelated fraud charges stemming from a border wall fundraising effort. Bannon was pardoned by Trump but indicted on similar state charges. Bannon has pleaded not guilty.
Prosecutors said they have seized $634 million from 21 bank accounts and a Lamborghini Aventador SVJ Roadster.
In addition to criminal charges of conspiracy, wire fraud, securities fraud, international money laundering and obstruction of justice, Guo was also sued by the Securities and Exchange Commission.
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Macao, China CNN
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Like many of his peers, Dan McAulay was furloughed from his job as a pilot during the pandemic.
Being based in Macao, a city that had one of the world’s strictest approaches to the coronavirus pandemic, he found himself with a lot of time on his hands.
McAulay and his wife, Rebeca Fellini, started learning how to distill alcohol as a lockdown hobby. And by the end of the nearly three years that Macao was a relative fortress, they had grown their pastime into a bona fide business – a gin brand called Owl Man, a play on the Chinese pronunciation of the city’s name “Ah Mahn.”
Now, McAulay is back in the skies with Air Macau and Fellini manages the distillery’s day-to-day business.
Even though their business was born during lockdown, they – like so many other businesses around the city – are pinning their hopes on the return of tourism.
Macao, an hour’s ferry ride from Hong Kong, is the only place in China where gambling is legal.
Often called the “Vegas of Asia,” in pre-pandemic times it wasn’t unusual to see a high-spending “whale” helicopter in and out of the city for a single afternoon at the craps table.
As a result, the city’s primary economy is the casinos and the businesses supporting them, from hotels to spas to high-end shops.
Macao only has about 600,000 residents – compared to seven million in Hong Kong – but brings in six times as much revenue as Las Vegas in a typical year.
Before the pandemic, 80% of Macao’s government revenue came from the gaming industry. Big players like Wynn, Venetian and MGM all have a significant presence in the city.
Covid threw that all into a tailspin. Nearly three years of intermittent lockdowns and blocked travel from the mainland and Hong Kong had a devastating effect on the city’s primary source of income.
But it also provided time for innovation.
“The government realized they can’t focus all their efforts on gaming and (tourists from) the mainland. Gastronomy is one of their big pushes,” explains McAulay.
“Being the only distillery in Macao, it’s working out amazing for us. The hotels and casinos are encouraged to support local food and beverage companies. It has given us quite a strong start.”
He isn’t the only entrepreneur who used the tourism slowdown to rethink his business model.
Asai, who uses only his first name professionally, owns several Portuguese restaurants and cafes around the territory. As a former Portuguese colony, Macao is known for food traditions like egg tarts, African chicken and bacalao (codfish fritters).
But Asai wants visitors to know there’s still an active, thriving Portuguese community in Macao – and they’re offering more than the usual favorites.
Egg custard tarts, or pasteis de natas in Portuguese, are one of the most popular souvenirs from Macao, with long lines at establishments like Lord Stow’s and Margaret’s.
Pasteis de Chaves is a small, trendy-looking cafe that wouldn’t be out of place in Brooklyn. Though it does sell egg tarts, its name comes from the signature offering – beef stuffed pastries that offer a savory complement to the sweet eggy ones.
Across the road, Three Sardines is a romantic, dimly lit spot specializing in petiscos, a Portuguese equivalent of tapas with small plates like fried octopus and grilled peppers.
“Competition is high for Portuguese restaurants, but many are localized twisted versions of Portuguese food,” says Asai, who has been in Macao for 18 years and stayed through the pandemic. “We try to offer more traditional and unique experiences. This is a niche and helped us survive the pandemic.”
Now, he is one of many local business owners looking outward for the first time in several years as tourists slowly trickle back to Macao.
Like Owl Man, Asai’s restaurant group has received government support as Macao diversifies its food and drink scene.
For instance, he and head chef Pedro Almeida worked with the Macau Government Tourist Office (MGTO) on a video to explain the origin of egg tarts and how they’re different in Macao and Portugal.
As the first international tourists began returning to Macao in February 2023, it was clear that a lot had changed.
Many small neighborhood restaurants closed during lockdown, and those that have reopened have had trouble staffing up after so many workers left the city permanently.
But new attractions have opened as well, with casinos trying to diversify their offerings and become more family-friendly.
The city’s first-ever outdoor zip line, ZipCity, opened at Taipa’s Lisboeta casino complex in January 2023. The timing worked out well, as mainland Chinese tourists flooded the city during Lunar New Year – a representative for the company says that ZipCity operated “at 90% capacity” during that holiday week.
Despite the pandemic, ongoing construction projects were still completed – if not necessarily on schedule.
Popular Japanese immersive art experience TeamLab opened an outpost at the Venetian in June 2020, and a new British-themed resort, The Londoner, opened in 2021 complete with penthouse suites designed by David Beckham.
Arguably the city’s most well-known landmark, the ruins of St. Paul’s Church, has been reinvigorated by a new on-site VR experience that enables visitors to see what the church looked like during different historical periods.
The city is rolling out incentives to bring back those tourists, as well.
People coming over via ferry from Hong Kong qualify for a buy-one-get-one free boat ticket if they’re staying at least one night in a hotel – an incentive to stay longer and not just make it a day trip.
Most businesses and vendors in Macao, including taxi drivers, will accept Hong Kong dollars – while very few of their counterparts in Hong Kong will accept the Macanese pataca.
Macao’s tourism authority also announced programs aimed at international travelers, including deals on package trips.
On the ground, things look lively.
Weekend ferries from Hong Kong have been selling out, and popular areas like Senado Square and the Guia Fortress – which is part of the city’s UNESCO-listed historical center – are thronged with visitors.
That includes casinos as well. On a recent mid-week visit, tables at the MGM and Venetian casinos were full of both gamblers and gawkers.
Macao dropped its mask mandate on February 26, with Hong Kong following suit a week later. However, many casino-goers still sported masks indoors once it became voluntary, perhaps due to the close quarters at blackjack tables.
For now, though, tourism is mostly regional.
According to data from Macao’s tourism authority, the majority of visitors arriving in January 2023 were from mainland China, Hong Kong, Taiwan, the Philippines and Indonesia.
In January 2019, 3.4 million tourists came to Macao, with most from mainland China. In January 2023, 1.4 million visited, most during the Lunar New Year holiday.
Hometown airline Air Macau has been steadily ratcheting up capacity to add more flights from Singapore and Taipei, two of Macao’s biggest markets. More mainland China routes will return by March 26.
Low-cost Asian carriers like Cambodia Airways and Thai Vietjet also brought back their pre-pandemic air links.
“I think everyone expected (tourism) to bounce back, but talking to all our friends in the hotels and casinos, they’re saying their fourth quarter predictions have bounced back faster than they anticipated,” says McAulay, the Owl Man co-founder.
