Category Archives: Corona Virus

During COVID, the level of several enzymes in the liver elevates. Presence of these enzymes in a higher amount in the liver means it is damaged.

As per a study, COVID-19 associated hepatic injury should be defined as Alanine amino transaminase or Aspartate amino transaminase exceeding 3 times the upper limit of the normal value, and ALP, -Glutamyl transpeptidase or total bilirubin of these enzymes the patients were categorised as hepatocellular, cholestatic and mixed type.

In addition to this, people with chronic liver conditions can be severely affected by the viral attack. With serious health complications already in the body, the immune system which is already highly compromised is unable to protect the body and thus the risk of the infection increases.

Apart from these, the medications that are administered to treat COVID can also pose a serious risk for the health of the liver.

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Coronavirus explainer: Potential effects of COVID on liver health; know the key indicators - Times of India

WASHINGTON President Joe Biden on Wednesday will call on Congress to suspend federal gasoline and diesel taxes for three months an election year move meant to ease financial pressures at the pump as the public is increasingly concerned about high gas prices and inflation.

The Democratic president will also call on states to suspend their own gas taxes or provide similar relief, the White House said.

At issue is the 18.4 cents-a-gallon federal tax on gas and the 24.4 cents-a-gallon federal tax on diesel fuel. If the gas savings were fully passed along to consumers, people would save roughly 3.6% at the pump when prices are averaging about $5 a gallon nationwide.

It's unclear, though, if Biden could push such a proposal through Congress, where many lawmakers, including some in his own party, have expressed reservations. And even many economists view the idea of a gas tax holiday with skepticism.

Barack Obama, during the 2008 presidential campaign, called the idea a "gimmick" that allowed politicians to "say that they did something." He also warned that oil companies could offset the tax relief by increasing their prices.

Biden energy adviser Amos Hochstein pushed back on Wednesday, saying consumers could save about 50 cents per gallon if Congress and the states heed the president's call.

"That's not a gimmick," Hochstein, senior adviser for global energy security at the State Department, said on CNN. "That's a little bit of breathing room for the American people as we get into the summer driving season."

It was not immediately clear if the White House has the votes in Congress to suspend the federal tax.

High gas prices pose a fundamental threat to Biden's electoral and policy ambitions. They've caused confidence in the economy to slump to lows that bode poorly for defending Democratic control of the House and the Senate in November.

Biden's past efforts to cut gas prices including the release of oil from the U.S. strategic reserve and greater ethanol blending this summer have done little to produce savings at the pump, a risk that carries over to the idea of a gas tax holiday.

Biden has acknowledged how gas prices have been a drain on public enthusiasm when he is trying to convince people that the U.S. can still pivot to a clean-energy future. In an interview with The Associated Press last week, Biden described a country already nursing some psychological scars from the coronavirus pandemic that is now worried about how to afford gas, food and other essentials.

"If you notice, until gas prices started going up," Biden said, "things were much more, they were much more optimistic."

The president can do remarkably little to fix prices that are set by global markets, profit-driven companies, consumer demand and aftershocks from Russia's invasion of Ukraine and the embargoes that followed. The underlying problem is a shortage of oil and refineries that produce gas, a challenge a tax holiday cannot necessarily fix.

Mark Zandi, chief economist at Moody's Analytics, estimated that the majority of the 8.6% inflation seen over the past 12 months in the U.S. comes from higher commodity prices due to Russia's invasion and continued disruptions from the coronavirus.

"In the immediate near term, it is critical to stem the increase in oil prices," Zandi said last week, suggesting that Saudi Arabia, the United Arab Emirates and a nuclear deal with Iran could help to boost supplies and lower prices. Republican lawmakers have tried to shift more blame to Biden, saying he created a hostile environment for domestic oil producers, causing their output to stay below pre-pandemic levels.

Senate Republican leader Mitch McConnell mocked the idea of a gas tax holiday in a February floor speech. "They've spent an entire year waging a holy war on affordable American energy, and now they want to use a pile of taxpayers' money to hide the consequences," he said.

Congressional Democrats largely appeared cool to the idea of a gas tax holiday, which Speaker Nancy Pelosi and others have long worried would simply allow oil companies to reap additional profits with no guarantee the savings would be passed along to consumers at the pump.

Rep. Peter DeFazio, D-Ore., chairman of the House Transportation and Infrastructure Committee, said late Tuesday that he is urging colleagues to see the gas tax holiday "for what it is: a short-sighted proposal that relies on the cooperation of oil companies to pass on miniscule savings to consumers."

But Dan Kildee, D-Mich., said he is a longtime supporter of a federal gas tax holiday.

"I admit to some frustration because I think it would have been more effective if we had done this a few months ago," Kildee said. "But it's never too late to do the right thing."

One Democratic aide, who insisted on anonymity to frankly discuss the situation Wednesday, said it appears unlikely the proposal could pass the House without first clearing the evenly split Senate.

Administration officials said the $10 billion cost of the gas tax holiday would be paid for and the Highway Trust Fund kept whole, even though the gas taxes make up a substantial source of revenue for the fund. The officials did not specify any new revenue sources.

The president has also called on energy companies to accept lower profit margins to increase oil production and refining capacity for gasoline.

This has increased tensions with oil producers: Biden has judged the companies to be making "more money than God." That kicked off a chain of events in which the head of Chevron, Michael Wirth, sent a letter to the White House saying that the administration "has largely sought to criticize, and at times vilify, our industry."

Asked about the letter, Biden said of Wirth: "He's mildly sensitive. I didn't know they'd get their feelings hurt that quickly."

Energy companies are scheduled to meet Thursday with Energy Secretary Jennifer Granholm to discuss ways to increase supply.

___

Associated Press writers Lisa Mascaro, Matthew Daly and Kevin Freking contributed to this report.

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Biden to call for 3-month suspension of gas and diesel taxes - Star Tribune

Introduction

Healthcare workers (HCWs) are the foundation of the response to a pandemic. Also termed as frontline workers, not only are they at a health risk but also suffer from emotional and psychological stress.

The objective of the study was to determine the emotional impact of novel coronavirus on healthcare workers.

An online survey was completed by 239 HCWsfrom five different countries during the peak of the coronavirus disease 2019 (COVID-19) outbreak amidst the lockdown. Their feelings and concerns as well as the safety measures they adopted were identified.

The response rate was 100%. Most of the respondents were 20-40 years old (85.36%)and working as doctors (73.22%); 44.77% were working at middle grade. The majority felt confused (19.67%), whereas others felt stressed/overworked (17.15%), unhappy (16.74%), scared (13.81%), nervous (13.39%), motivated (8.79%), and privileged (5.86%). A few felt pressurized to perform their duty (4.6%), and 69.87% felt that it was their moral obligation to continue their duty, whereas 13.39% felt administrative pressure for the same. Of the respondents, 53.97% feared transferring the disease to their family and friends, while others feared the lack of personal protective equipment (PPE) (13.39%). According to the majority of the respondents (25.94%), support from family and friends had them going through the crisis. The most common safety measure adopted by the HCWs was strict hand hygiene (43.51%). The HCWs (28.87%) felt that adequate and easy access to PPE would have helped them better during the pandemic.

Healthcare institutions are responsible for protecting HCWs or frontline workers during pandemics so they can continue with their duty. From our study, we have concluded that simple protective measures as uninterrupted and easy access to PPE would have helped HCWs deal with their stress and concerns.

Since the severe acute respiratory syndrome (SARS) outbreak in 2003, the 21st century has seen numerous pandemics [1]. Epidemiologically speaking, these infections have no borders to spread because of extensive international travel [2], hence infecting huge numbers all around the globe.

Similarly, the year 2020 has been faced with a new pandemic starting in December 2019 in Wuhan, China, as unusual pneumonia caused by a new coronavirus [3,4]. This is the third outbreak caused by a coronavirus, the first and second being SARS and Middle East respiratory syndrome (MERS), respectively. The novel coronavirus 2019 is officially named SARS-CoV-2 [3]. It was declared a global emergency of international concern by the World Health Organization (WHO) on January 30, 2020 [3].

As of April 28, 2020, the total number of confirmed cases of the disease has been 2,954,222, with 202,597 deaths globally [5]. On the other hand, China alone has had 82,875 confirmed cases and 4,633 deaths as of May 2, 2020 [6].

When the pandemic gained global attention, a sudden decline in personal protective equipment (PPE) supplies [7], startling media reports, a huge influx of patients into hospitals, and a shortage of utilities secondary to bulk buying in lieu of an impending crisis and comparison with previous Coronaviridae outbreaks lead to uncertainty, vulnerability, panic, fear, distress, anger, and feelings of loss of control. Then, social distancing and finally a lockdown were set in place, which made coping with the pandemic even more difficult as peoples financial circumstances changed.

As with any other pandemic, there is a dual effect seen with this virus; not only is there fear and panic in the population but also an increased burden on the healthcare system including healthcare workers (HCWs) [2]. As the experience with SARS showed that HCWs were the most infected with high mortality [1,8-10], fear and uncertainty are markedly present among the HCWs. Other feelings varied from anxiety, to stress, to frustration, to stigmatization [3,11]. Frontline workers were relocated to different departments and were asked to work in different institutions as a part of task force reassignment to deal with the suspected surge, as was previously observed during the SARS outbreak [11].

Frequently changing guidelines on infection control procedures and public health recommendations stirred confusion and anxiety [11].

We wanted to study the emotional impact of novel coronavirus 2019 on HCWs and how they chose to address these concerns.

This prospective, cross-sectional study was conducted using an open online survey filled by HCWs from hospitals caring for COVID-19 patients in the UK, the USA, Pakistan, Libya, and Saudi Arabia. The survey was conducted from April 23, 2020, to May 18, 2020. HCWs from all fields were eligible for participation. The survey was completely anonymous, and responses were kept confidential. The survey was completed by 239 participants. The work has been reported in line with the Strengthening The Reporting Of Cohort Studies in Surgery (STROCSS) criteria [12].

We aimed at assessing the feelings of HCWs during the SARS-CoV-2 pandemic, the reason behind their feelings, how they addressed their concerns, and their suggestions.

Demographic data including age, healthcare category, grade, and department (for physicians and nurses) were recorded and separately used to analyze risk factors.

Data analysis was done using the SPSS software version 25.0 (IBM Corp., Armonk, NY, USA).

Of the 239 participants, the completion rate was 100%. A total of 204 (85.36%) respondents were between 20 and 40 years, 33 (13.81%) between 41 and 60 years, and two (0.84%) more than 60 years (Figure 1, Table 1).

Of the 239 respondents, 175 (73.22%) were physicians, 32 (13.39%) were nurses, 14 (5.86%) were operating department practitioners (ODPs), nine (3.77%) were administrative staff, three (1.26%) were laboratory/radiology personnel, and two (0.84%) each of paramedics, clinical assistants, and pharmacists (Figure 2, Table 2).

Most of the HCWs belonged to the middle grade (107 (44.77%)), whereas junior and senior grades constituted 63 (26.36%) and 69 (28.87%) of the respondents, respectively (Figure 3, Table 3).

Physicians and nurses were optionally required to record their department. Out of the 175 physicians,163 answered this question, and the majority of them (55) belonged to general surgery, followed by general practitioners (13), anesthetists (10), and orthopedic surgeons (9). Seven physicians were from medicine;six each from pediatrics, accident and emergency, and otolaryngology;five each from nutrition and radiology; four each from gynecology/obstetrics, dermatology, and neurosurgery; three each from urology, intensive care, and dentistry;two each from pathology, nephrology, and maxillofacial; and one each from infectious diseases, ophthalmology, endocrinology, cardiology, neurology, elderly care, vascular surgery, physical medicine and rehabilitation, and public health.

The majority of the respondents felt confused (47 (19.67%)) during the pandemic. Forty-one (17.15%) felt stressed/overworked, 40 (16.74%) felt unhappy, and 33 (13.81%) felt scared. Other feelings included feeling nervous(32 (13.39%)), being motivated (21 (8.79%)), being privileged (14 (5.86%)), and feeling pressurized to perform duty (11 (4.60%)) (Figure 4, Table 4).

Of the HCWs, 68.87% (167) felt it to be their moral obligation to continue duty, while others felt administrative pressure (32 (13.39%)) for continuation. Twenty-five (10.46%) HCWs chose financial incentives as the main reason to continue working during the pandemic, and 15 (6.28%) had other reasons (Figure 5, Table 5).

Fear of spreading the disease to their family and friends was prevalent among the HCWs. Overall, 129 (53.97%) respondents chose this as their major concern. Lack of personal protective equipment (PPE) bothered 32 (13.39%) of the respondents. The HCWs were concerned about contracting the disease (17 (7.11%)), lack of established guidelines (11 (4.60%)), lack of a vaccine (8 (3.35%)), inadequate screening (8 (3.35%)), lack of knowledge about the virus or disease (7 (2.93%)), being overworked/understaffed (7 (92.93%)), and lockdown (7 (2.93%)). The lack of established treatment for the disease caused unrest among five (2.09%) of the respondents. Others feared media reports (4 (1.67%)), conflict among staff members (2 (0.84%)), and improper isolation (2 (0.84%)) (Figure 6, Table6).

The responses to how HCWs addressed their concerns included support from family and friends (62 (25.94%)), teamwork (47 (19.67%)), senior support (37 (15.48%)), established hospital guidelines (31 (12.97%)), relatively small number of patients testing positive (20 (8.37%)), hospital meetings (15 (6.28%)), support groups (5 (2.09%)), hospital psychiatry support (2 (0.84%)), and ongoing HCW benefits (1 (0.42%)). A total of 19 respondents had other ways to help them out during the crisis (Figure 7, Table 7).

Strict hand hygiene was adopted by 104 (43.51%) HCWs as a safety measure. Thirty-eight (15.90%) considered all patients as carriers, 32 (13.39%) adopted strict PPE use, 26 (10.88%) resorted to self-isolation/social distancing, and 18 (7.53%) had separate scrubs for hospital duty. Seven (2.93%) HCWs went on leave, and six (2.51%) strictly followed updates on the disease. Eight of them adopted other measures (Figure 8, Table 8).

When asked what would have helped them better deal with the situation, 69 (28.87%) responded with adequate and easily accessible PPE, and 67 (28.03%) thought better-established guidelines on screening, isolation, and treatment should have been in place. Thirty-seven (15.48%) suggested strict hand hygiene monitoring; for 33 (13.81%), a vaccine or treatment would have been reassuring, while eight ( 3.35%) wished for a financial incentive, seven (2.93%) asked for a compensatory time off, four (1.67%) suggested a voluntary opt-out of duty, and three (1.26%) carved for a little appreciation from authorities. Eleven (4.60%) had other suggestions (Figure 9, Table 9).

Our survey including 239 participants revealed a high prevalence of confusion and stress/being overworked in HCWs involved in the care of COVID-19 patients (19.67% and 17.15%, respectively). This is comparable to studies done during the SARS outbreak [13]. During a pandemic, HCWs are prone to a multitude of feelings [3,11]. Feeling unhappy, scared, nervous, motivated, privileged, and pressurized to perform duty were reported by 16.74%, 13.81%, 13.39%, 8.79%, 5.86%, and 4.60%, respectively. Previous studies during the SARS pandemicreported similar outcomes [3]. The long-term psychological implications of a pandemic have been studied with SARS and need to be kept in mind and assessed during the current pandemic [14,15]. HCWs should be trained in dealing with stress during an infectious outbreak to optimize their response and efficiency.

Doctors formed the majority of the respondents (73.22%), followed by nurses (13.39%). Most of the respondents were between 20 and 40 years of age (85.36%), and 44.77% of them were in the middle grade of their careers.

Another important aspect highlighted by our study was that 69.87% of the HCWs felt motivated to perform their duty during the pandemic despite all the fear, anxiety, and confusion. Because of their direct contact with COVID-19 patients and the fact that this disease has cross communicability [3], 53.97% of the HCWs feared transferring the disease to their family members and friends. Our survey also found out that support from family and friends (25.94%) and teamwork (19.67%) helped HCWs continue to perform their duty despite mounting pressure and fear.

As with any other infectious disease, hand hygiene was opted for by a mere 43.51% of the respondents as the primary safety measure, the numbers not as significant as would have been expected from HCWs. We want to stress the need for further infection control training and strict hand hygiene compliance monitoring for effective infection control and prevention. We would like to suggest that future pandemic response training should include infection control training as an integral part.

Our survey identified that measures as simple as adequate and easily accessible PPE would have made a huge difference in terms of reassuring HCWs as mentioned by 28.87% of the respondents. As observed initially, the sudden shortage of PPE was a rather important factor in causing emotional distress among HCWs as was noted earlier during previous infection outbreaks [7,11]. On the other hand, an almost equal number of respondents (28.03%) thought it would have been better if there were well-established guidelines on screening, isolation, and treatment of COVID-19 patients. Dealing with an unknown pathogen and a rather unfamiliar disease pattern makes it difficult, but diverting resources toward research, as observed during the coronavirus pandemic, was of paramount importance.

This survey demonstrated the emotional impact of SARS-CoV-2 on HCWs. The mental and emotional well-being ofHCWs is of paramount significance if they were to work efficiently. It is the responsibility of healthcare institutions to safeguard their HCWs and provide them with the means to cope with stress and anxiety. Working under stressful conditions during an infectious outbreak would lead to long-term psychological morbidity in HCWs, as previously identified.

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The Emotional Impact of Novel Coronavirus on Healthcare Workers: A Cross-Sectional Study - Cureus

As coronavirus cases continue to rise in Utah and the rest of the country, Summit County is one of five places in the state with a high coronavirus transmission risk.

The county in May was the first to have its designation increased from low to medium as cases reached the double digits nearly every day. As of Friday, 15 of Utahs 29 counties were rated as having medium to high transmission risks, according to the Centers for Disease Control and Preventions COVID database. Salt Lake and Tooele counties were in the top risk category with Summit County on Thursday with Grand and San Juan counties also receiving a high designation on Friday.

There were 250 confirmed COVID cases in the county between May 16 and May 31, according to the Summit County Health Departments COVID dashboard. The data also shows 116 additional cases 103 of which were reported in the unvaccinated population between June 1 and June 7.

Phil Bondurant, the countys health director, speculated the higher number of unvaccinated cases may be because those who are sick are likely experiencing severe symptoms, which leads to more COVID tests being administered.

He said individuals who are vaccinated often report mild, allergy-like symptoms that some people dont associate with the virus. In certain cases, an individual may choose to self-isolate or take other precautions, but those who dont suspect theyre sick may continue the cycle of spread and contribute to the uptick, Bondurant said.

Cases have been increasing on the West Coast over the last few months and he compared it to the rise in cases the East Coast experienced in late April. However, Bondurant said, the case numbers locally may be skewed because at-home testing kits can be inaccurate and its hard for health officials to gauge who is using them. Summit County is also testing at higher rates than the rest of Utah following the closure of state testing sites at the end of March.

The good news is hospitalization rates, which are considered an important metric in the fight against COVID, appear to be stable and indicate the countys situation is still manageable, the health director said. There have been nine hospitalizations with one person in the intensive care unit in the last 30 days and one COVID-related death has been reported since March, according to the Health Department.

Approximately 47% of people living in Summit County who are eligible to receive the COVID-19 vaccine have received a booster shot as of Friday. Close to 88% of residents have completed their vaccination series and 100% have received at least one dose of a vaccine.

Bondurant said several factors play a role in why the county hasnt been able to reach the 50% mark. First, many people may be waiting to receive their booster in the fall when they anticipate theyll have the highest level of protection against COVID or they consider themselves at a lower risk during the summer. Others may expect theyre going to catch the virus either way and dont want to go through the inconvenience of the shot, according to the health director.

Bondurant admits hed like to see the booster number higher and said the Health Department is continuing messaging about the importance of the vaccine, while also recognizing its a personal choice.

Its likely a COVID vaccine similar to a seasonal flu shot, or one combining the two, will be offered sometime soon, he said. Until then, the CDC recommends a second booster for adults over 50 and people 12 and older who are moderately immunocompromised.

Everybody is aware and everyone knows what COVID is and how to protect yourself, the risks, those different things, Bondurant said. People know where [the booster and vaccine is] available so at this point we continue to take those appointments and help people make the decision thats best for them and their families.

With summer here and tourists likely on their way, Summit County health officials urge Parkites and visitors to follow precautions to limit their exposure to COVID. Individuals who are unsure if they have contracted the virus are also encouraged to get tested. Testing is available from 9 a.m. to 1 p.m. on Thursdays in Coalville and Tuesdays in Kamas as well as 9 a.m. to 4 p.m. on weekdays in Park City.

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Summit County one of five in Utah with high coronavirus transmission risk - The Park Record

Long COVID continues to offer more questions than answers 27 months into the coronavirus pandemic, though researchers are slowly gaining a better understanding.

Long-term effects from SARS-CoV-2 infection, known more commonly as long COVID, has been the topic of more than 1,650 papers published in the National Library of Medicine since 2020.

When asked about long COVID, most physicians will offer up their experience and/or research with a caveat -- more research is needed to know for sure.

Were really just starting to work this whole thing out, said Dr. Matthew Sims, director of infectious disease research at Beaumont Health. Its complicated, its confusing. To be honest, I think were going to find that long COVID is the same sort of problem we see with other things and all the research thatll end up being done on long COVID, because its such a big issue, may help other diseases like fibromyalgia or chronic fatigue syndrome, that are really hard to figure out right now. We dont know.

Researchers have made some progress however. Below are some common questions and answers related to long COVID.

What is long COVID?

The typical definition of long COVID is long-term symptoms from SARS-CoV-2 that might be experienced weeks, months or even years after primary infection.

As for specific symptoms that linger, those vary.

A recent survey conducted by the Center for Health and Research Transformation (CHRT) at the University of Michigan found breathing issues were the most common ongoing symptom, followed by loss or distorted sense of smell or taste, and lingering anxiety, depression, or other mental health issues.

Other common symptoms were nervous system symptoms, neurologic problems, diabetes, heart problems, kidney damage, and fatigue.

The Cover Michigan Survey is a public opinion telephone and online survey that includes a random sample of Michigan adults. Its results were analyzed by CHRT staff, who said many of their findings were supported by national data and additional research.

I like to think this is sort of the tip of the iceberg with long COVID, because everything about this virus and this pandemic and this disease is so new and every day were still learning more stuff, said Melissa Riba, director of research and evaluation at CHRT.

In July 2021, long COVID became a disability under the Americans with Disabilities Act. An individualized assessment is necessary to determine whether a persons long COVID condition substantially limits them.

How common is it?

The Cover Michigan Survey found more than one in three Michiganders who reported a COVID-19 diagnosis identified themselves as a COVID long hauler. While the sample size was limited -- 138 individuals with COVID, of which 48 reported long COVID -- it matched or followed trends found in other studies.

Stretching globally, the University of Michigan School of Public Health analyzed 50 studies and more than 1.6 million people and found the prevalence of long COVID to be around 43%.

With the overall rates, if you look at most of the literature, it generally falls among the range of between 25% and 43%, with most sources falling within a more narrow range between like 30% to 35%, said Jonathan Tsao, a project manager at CHRT.

Its not yet clear which demographics are more or less susceptible to long COVID, though researchers are gaining clarity on that issue.

The risk factors for getting long COVID are somewhat similar to those people who are at increased risk for severe disease, said Dr. Liam Sullivan, an infectious disease specialist at Spectrum Health. That being said, theres a lot of people whove had mild COVID cases who have had issues with long COVID as well. So thats not really been fully delineated yet.

A Swedish study of more than 205,000 COVID patients founds that 32% of those admitted to an ICU developed long COVID. Thats compared to 6% of those hospitalized but not placed into intensive care, and 1% of outpatients.

Other groups that have reported disproportionate levels of long COVID are women, individuals 40 to 54, and persons with preexisting conditions, according to a 2021 study conducted in California and published by the CDC.

In Michigan, CHRT found women were four times as likely to report long COVID, and diabetics were twice as likely, compared to their counterparts.

Does the vaccine offer protection against long COVID?

A study published last month in Nature Medicine used 2021 Veterans Affairs health records to assess potential vaccine-induced protection against long COVID. The St. Louis, Missouri study determined COVID vaccination reduced risk of long COVID by about 15%.

It was one of, if not the largest, study to date. Researchers looked at records from 34,000 vaccinated people with breakthrough infections, 113,000 non-vaccinated people who got COVID, and more than 13 million people who had not gotten COVID.

The study revealed no difference in specific lingering symptoms or the severity of symptoms.

Dr. Sullivan said you have to be careful extrapolating those results to the general population however, when the study population were veterans with an average age in their 60s with underlying risk factors.

Getting vaccinated doesnt eliminate your risk for long COVID, he said. You still have risk for long COVID; what is starting to probably become clear is the risk is probably lower and that people dont get quite as severe long COVID, but that question still has to be more fully answered.

Sullivan said he anticipates the results of a larger study being conducted by CDC and some partner universities to better define and understand the scope of long COVID.

Whatre the economic impacts of long COVID?

The latest Cover Michigan Survey found long haulers are more likely to be in a worse financial situation than a year ago, compared to those who recovered from COVID and those who never got infected.

Because long haulers may be unable to function at their pre-COVID capacity, they are more likely to take longer medical leave, work reduced hours, have their salary reduced, or quit their jobs, researchers found.

A national survey of more than 1,000 COVID patients found that 44% of workers experiencing long COVID reduced their weekly work hours. A majority of respondents said they needed to take medical leave due to long COVID symptoms.

Researchers who analyzed Michigans long COVID data said theres a need for further study on the impact of state-wide efforts to assist long haulers. They recommend:

By publishing its survey results, CHRT researchers said they hope to raise awareness among lawmakers and business leaders as to the prevalence of long haulers, as well as for individuals who are suffering and feeling like theyre alone with their long-term symptoms.

We want to raise an alarm, raise a flag to say hey, this is potentially going to be and could be a really big deal for policymakers, for the state, for the economy, for the health care system and we need to be prepared, Riba said.

If you have any COVID-19 questions that youd like answered, please submit them to covidquestions@mlive.com to be considered for future MLive reporting.

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11 counties in U.P., northern Michigan have high COVID-19 levels; CDC says, recommends masking

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Long COVID answers are coming into focus, slowly - MLive.com

The Chief Clinical Officer of the HSE has said he is "very concerned" about the rise in the number of people in hospital with, or because of, Covid-19.

It comes as 606 confirmed cases of Covid-19 were reported in the country's hospitals this morning.

As of 8am there were 153 more people in hospital with Covid today than there were last Monday.

There were 453 people with confirmed cases in hospital on Monday 13 June.

Speaking on RT's Today with Claire Byrne, Dr Colm Henry said the rise is largely driven by a sub-type of the Omicron variant.

"This sub-type enjoys what is called a growth advantage over previous sub-types and is now displacing it as the dominant variant here. It's about 100% of cases in Portugal and now over 70% here."

Dr Henry said that although it is much more transmissible, it does not seem to be more virulent or aggressive.

"While hospitalisations are going up, we are seeing ICU numbers steady which is of some assurance," he said.

"Those who previously had immunity from previous variants, be they Delta or otherwise, can get infected again but they are much less likely to get seriously ill."

'Not too late to get vaccinated'

Dr Henry said there has been an increase in outbreaks in nursing home settings and residential care facilities but "nothing like we saw when we peaked in March following the surge of Omicron cases with earlier sub-variants but nevertheless, we have seen a rise at our operational clinical meeting this morning".

There has also been a rise in cases among healthcare workers.

Dr Henry said they are hearing that "they are not particularly sick but because they test positive, it does have that impact on services".

There has also been a rise in hospital-acquired infections, Dr Henry said.

On vaccinations and hospital cases, Dr Henry said: "The harsh reality is that if you look at hospitalisations, 606 this morning, unfortunately over half have not received their booster and over a third haven't even got vaccinated in the first place."

He said it is not too late to get vaccinated and "people who are unvaccinated in the first place have no protection from serious illness, no protection from being hospitalised and going to ICU or worse. It's not too late for those people to get vaccinated".

Latest wave of infection was 'predictable'

Dr Gerald Barry, Assistant Professor of Virology at University College Dublin, said the rise in case numbers in hospitals is reflective of what is going on in the general population.

He told RT's Morning Ireland that we are experiencing a further wave of Covid-19 and while around half of the cases identified in hospital are 'incidental' - that is patients are in hospital for another reason - infections are being picked up due to the ongoing testing in hospital settings.

Dr Barry said that this wave of infection was predictable up to eight weeks ago and talk of the reintroduction of mandatory mask wearing now was like "closing the stable door when the horse had bolted".

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He said it was likely that we were close to the peak of the current wave and he couldnt be sure that a mandatory mask wearing order would have much impact at this stage.

Dr Barry said the public should have been informed a month ago that this wave was coming. He said the focus then should have been about mask wearing, increased antigen testing and people adjusting their behaviour, to help reduce the peak of infection.

He said the virus is still causing a huge burden on the general population and the Government and the HSE needed to be more proactive in their ongoing communication and response to help reduce that burden.

Current wave to last 'two or three weeks'

Professor of Experimental Immunology at Trinity College Dublin, Kingston Mills, said he does not think there is a public appetite for mask wearing but that if everybody was wearing masks, it would make an impact on the transmission of the virus.

He said that there needs to be an "all or nothing" approach and that Covid is not seasonal.

He said that the current 'mini wave' could go on for two or three weeks, but long term we cannot give up on vaccines and boosters.

Professor Mills told RT's Drivetime that the big problem with hospitals is that the system is being stressed; healthcare workers are being infected and this is putting pressure on other healthcare procedures that have to be reduced, such as elective procedures, which is impacting people who do not have Covid.

Amid concerns that new variants may evade the vaccines currently in use, Professor Mills said updated vaccines are being produced and if they are rolled out in the autumn, with the flu vaccine, they will be closer to the strain of the disease that is circulating.

He said that another wave could come in the autumn but it totally depends on the virus and its mutation.

Dr Eoghan De Barra, consultant in infectious diseases at Beaumont Hospital in Dublin, said for the first time in a long time he is seeing patients admitted because of Covid rather than incidental Covid, where they tested positive while in hospital for another reason.

Dr De Barra said it is largely immunocompromised people, who have had some level of vaccination.

"They're not as sick as in earlier waves but still needed hospital care," said Dr De Barra.

He said it was really hard to say if we have reached the peak of this wave.

"When I see very immunocompromised patients, who have been very careful over [the] past two years, come in with Covid, I suspect there is a very high level in the community because they're the real tip of the iceberg of infection," he said.

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HSE 'concerned' over rise in Covid-19 hospital numbers - RTE.ie

WASHINGTON The White House on Thursday outlined the early stages of its plan for making coronavirus vaccines available this month to roughly 18 million children younger than 5, should the doses be cleared by federal regulators for the last group of Americans yet to be eligible.

With the goal of the first shots being given the week of June 19, the Biden administration has already made 10 million doses available to states and health providers, with roughly 85 percent of children in that age group living within five miles of possible vaccination sites, according to White House estimates shared with reporters.

Half of the 10 million doses were made available for order last week, the other half this week, with equal numbers of Pfizer-BioNTech and Moderna vaccines, the two that federal regulators are reviewing and could authorize as soon as next week.

Lets actually take a moment to understand what a historic moment this is, said Dr. Ashish K. Jha, President Bidens coronavirus response coordinator. It would mean that for the first time, essentially every American from our oldest to our youngest would be eligible for the protection that vaccines provide.

Health officials may confront a complicated persuasion campaign in many parts of the country, after an initial wave of vaccinations among eager families who have waited much longer than families of older children.

Uptake of the vaccine in other age groups offers a discouraging suggestion: Just over a third of children ages 5 to 11 have received at least one dose of a vaccine, a number that some health experts worry could forecast even lower interest among parents of younger children.

Orders from states have been somewhat tepid so far, according to data that senior administration officials provided to reporters in a briefing on Wednesday evening. Of the five million doses offered last week, 58 percent of those made by Pfizer-BioNTech have been ordered, as have roughly a third of those made by Moderna.

The officials, who spoke on the condition of anonymity to preview the formal announcement on Thursday, said the initial orders were typical of Covid-19 vaccination campaigns thus far, as states typically increase their orders over time.

A Kaiser Family Foundation survey conducted in April found that just 18 percent of parents with children under 5 said they would get them vaccinated right away, while 38 percent said they would wait and see. Their hesitation could be at least partly due to the fact that the virus is typically less risky for young children.

But Dr. Vivek H. Murthy, the surgeon general, said the risks were still significant. More than 30,000 children under 5 have been hospitalized with the virus, and almost 500 have died, outcomes he said could be prevented by vaccination.

As of Wednesday, new confirmed cases in the United States have been roughly flat at around 110,000 a day on average over the past two weeks, according to a New York Times database, after rising from lower than 30,000 a few months ago. Infections, though, are thought to be widely underestimated. Death counts have been volatile in recent weeks but remain below 400 per day on average.

We are not done with the pandemic. The virus is still here, Dr. Murthy said. Were still losing several hundred people a day to this virus.

He warned parents of a possible glut of misinformation targeting the shot for younger kids, the subject of an advisory his office issued last year.

Please make sure the information you are relying on is coming from trusted sources like your doctor, your local childrens hospital, your department of health, medical associations like the American Academy of Pediatrics, and the F.D.A. and C.D.C., he said, referring to the Food and Drug Administration and the Centers for Disease Control and Prevention.

Dr. Jha said on Thursday that health officials expected many children under 5 to be vaccinated by pediatricians and primary care physicians, a contrast to other age groups. But he and other officials on Thursday said they had organized a network of other locations that would work to get shots to families, including pharmacies and childrens hospitals.

To reach smaller pediatric offices and rural providers, the White House said Thursday, doses are being packaged by the hundred.

Government programs such as Medicaid, the Childrens Health Insurance Program, and the Women, Infants and Children Program will work with families to encourage vaccination. Other groups, including the American Academy of Pediatrics, the Association of Childrens Museums and the National Diaper Bank Network, will provide educational materials.

Delivery of the vaccines is contingent on the F.D.A. authorizing pediatric doses a step that could take place as soon as next week and the C.D.C. recommending them, which would formally initiate the campaign. The F.D.A. and its outside panel of vaccine advisers are set to meet Wednesday to discuss the shots for young children; the C.D.C.s own expert committee is scheduled to meet days later.

Dr. Rochelle P. Walensky, the C.D.C. director, would be the last to sign off.

Dr. Jha said he expected vaccinations to begin in earnest the following week, but suggested it could take time for some families to gain access.

Realistically, it means we could see shots in arms of kids under 5 as early as the week of June 20, he said of the federal review timeline, adding that the federal Juneteenth holiday on that Monday would mean many offices would begin administering the shots on Tuesday, June 21.

The vaccination program is going to ramp up in the days and weeks that follow with more and more doses and more and more appointments becoming available, he said.

Moderna is seeking authorization of its two-dose shot for children under 6, while Pfizer is asking regulators to clear its three-dose vaccine for those under 5.

Federal officials have said they are not pre-empting regulatory actions by announcing distribution plans for the vaccine before it is authorized. Instead, they have said, they are working to prepare families and physicians for the possible rollout. Last year, the White House was criticized for subverting the regulatory review that usually precedes vaccination campaigns when it announced a broad booster shot campaign before F.D.A. officials or their outside advisers had weighed in, a decision that proved divisive.

The deliberations over the vaccine for the youngest children are not expected to provoke the same kind of dissent. Parents were briefly given hope over the winter when F.D.A. officials worked to make an initial two doses of Pfizer-BioNTechs shot available to children as they studied a third dose. That plan backfired when data showed that two doses did not provide significant protection against the Omicron variant.

Moderna is proposing a two-dose regimen for children 6 months through 5 years old, using one-fourth the strength of an adult dose. Pfizer and BioNTech are working on a three-dose regimen for children 6 months through 4 years old, at one-tenth the strength of the adult dose.

Sarah Cahalan contributed reporting from Chicago.

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Covid-19 Testing and Mandate News - The New York Times

Babies whose mothers were infected with the coronavirus during pregnancy may face a higher risk of brain development disorders such as autism and bipolar disorder, a new study that examined more than 7,500 births suggests.

The finding, published Thursday in the journal JAMA Network Open, adds to the urgency to get coronavirus transmission under control even though newer variants are less likely to cause severe cases of COVID-19.

Other viruses, such as influenza and measles, are thought to make babies more vulnerable to conditions such as autism, schizophrenia and depression if they are exposed in utero. Researchers at Massachusetts General Hospital and Harvard Medical School wondered whether the same might be true about SARS-CoV-2, the coronavirus that causes COVID-19.

There are more than a decade of studies that suggest viral infection during pregnancy might be associated with neurodevelopmental disorders, so there was reason to be concerned likewise with this virus, said Dr. Roy Perlis, director of the Center for Quantitative Health at Massachusetts General Hospital and the studys senior author.

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The researchers examined data from electronic health records of deliveries that took place in eight medical centers in Massachusetts in the early months of the pandemic, between March and September 2020. The records tracked the babies development for a year after birth, looking for specific codes that would indicate a diagnosis of a developmental disorder related to motor function, speech or language, among other things.

The researchers found that among 7,550 babies whose mothers were infection-free during their pregnancies, 3% were diagnosed with a brain development disorder before their first birthdays. Among the 222 babies who were exposed to SARS-CoV-2 in utero, 6.3% received a diagnosis by the time they turned 1.

After the researchers accounted for other factors that could affect a childs risk for a neurodevelopmental issue such as preterm births, the mothers age and the babys gender they calculated that babies with prenatal exposure to SARS-CoV-2 were 86% more likely to be diagnosed in their first year compared with babies who werent exposed before they were born.

Perlis emphasized that the overall risk of developing these disorders remains low for all babies.

He added that one year is not enough to completely understand how prenatal coronavirus exposure affects children. Still, he said, he was surprised to find any link in the first place.

Candidly, I would have been much happier if we had seen nothing at all, he said.

In a commentary that accompanies the study, Dr. Torri Metz suggested that the coronavirus might not be directly responsible for the babies developmental issues.

We wonder whether it is the virus itself or the societal changes and stresses of the pandemic that are adversely affecting childhood outcomes, wrote Metz, a maternal-fetal medicine specialist at University of Utah Health.

But Dr. Kristina Adams Waldorf, an obstetrician-gynecologist who studies infectious diseases in pregnancy at University of Washington Medicine, said the findings were similar to research looking at infections caused by other viruses.

We know from previous studies, including one involving millions of pregnancies in Sweden, that exposure to different kinds of infections such as influenza during pregnancy can impact neurodevelopment of the child, said Adams Waldorf, who was not involved in the new study.

With the coronavirus, further research will be necessary to see whether the severity of a mothers infection matters.

Unfortunately, it is very possible that asymptomatic or mild infections might also be linked to neurodevelopmental disorders in the child, she said.

Regardless, the medical advice for pregnant women remains unchanged.

This should be another wake-up call for pregnant women to get vaccinated, and boosted, and stay masked and take as many precautions as they can, Adams Waldorf said.

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Coronavirus infection during pregnancy linked to brain development problems in babies - Los Angeles Times

The three sizable urban centers in the United States where the coronavirus is spreading fastest right now have something in common: They are major warm-weather tourist destinations.

Miami-Dade County, Fla., Honolulu County, Hawaii, and San Juan, P.R., are all averaging at least 85 new cases a day per 100,000 residents, with test positivity rates above 20 percent, according to a New York Times database. By contrast, the nation as a whole is averaging 34 newly reported cases a day per 100,000 residents, with a positivity rate of 13 percent.

As of Wednesday, new confirmed cases in the United States have been roughly flat at around 110,000 a day on average over the past two weeks, according to a New York Times database, after rising from lower than 30,000 a few months ago. And those are just the reported cases; widespread use of at-home testing means that many positive test results never make it into official tallies, experts say, and many people with mild or no symptoms may never be tested at all.

Much of the U.S. is experiencing summer weather, yet Covid-19 cases are surging, said Dr. Sandra Albrecht, an assistant professor of epidemiology at Columbia University. So I wouldnt expect to see this pattern look any different for warm weather destinations.

The only places in the country with higher recent figures than those three urban centers are smaller communities in Puerto Rico or Hawaii and a few isolated rural counties elsewhere.

Some U.S. regions that were hit early by the latest surge, like the Northeast, have been showing signs of improvement lately. But Miami-Dade has gotten steadily worse since early April, with its daily new-case average rising more than tenfold, hospitalizations more than tripling and deaths ticking upward.

The C.D.C. now considers it, along with much of Florida, to be a high-virus-level area where extra precautions are recommended, including wearing masks on public transportation and in indoor public spaces.

Dr. Mary Jo Trepka, who heads the epidemiology department at Florida International University, pointed to several factors that could be driving the surge, including flocks of spring-break tourists, recent big events like the Miami Grand Prix race, and widening public apathy about the pandemic.

I think people are no longer taking precautions as they did before, Dr. Trepka said. People were masking more here in the county, and we are seeing less of that. People are being less careful, because they are tired.

Mayor Daniella Levine Cava dropped all of Miami-Dades pandemic safety mandates in February, around the time the C.D.C. shifted its strategy on measures such as masks and social distancing. At the time, the federal agency said, many such restrictions were no longer needed in most of the country, although counties should calculate their own risk as conditions change.

When the latest surge took hold in April, Ms. Levine Cava urged residents to get vaccinated, wear masks, disinfect surfaces and maintain social distance, but the county has not made any of those measures mandatory.

In a statement on Wednesday, Ms. Levine Cava once again called on residents to take precautions on their own: get vaccinated and boosted, get tested if they show symptoms, and stay home if they feel sick. The best tools to fight the virus are the same ones we know and continue to use, she wrote.

Ms. Levine Cava noted that Miami-Dade was the most vaccinated county in Florida: and those efforts have paid off with fewer hospitalizations than in past surges. But caution was still warranted.

We have not beaten this virus, but we know how to control it, she wrote.

Mayor Rick Blangiardi of Honolulu County has taken a similar approach.

Coronavirus is not going away, he wrote in a statement on Wednesday. I encourage everyone to continue to demonstrate personal responsibility and wear your masks when around others, get tested if you are not feeling well and please make sure to get your booster.

Mr. Blangiardi said his administration was not considering reinstating mask mandates or other restrictions but that it would consider all possible solutions to any situation that warrants a response.

The county, which includes the islands of Oahu, Molokai and Lanai, has experienced a significant surge akin to Miami-Dades since early April, but in Honolulus case there are signs that it may have peaked. New virus cases have declined slightly over the past two weeks to 85 cases a day per 100,000 residents, and the positivity rate stopped climbing in mid-May.

Hawaii had some of the strictest travel restrictions in the country, requiring everyone arriving to the state to complete a 14-day quarantine. In March, it lifted its travel restrictions, allowing travelers from the continental United States to enter without testing and became the last state in the nation to remove its indoor masking requirement.

A month later, the states tourism industry recorded its highest traffic figures since the beginning of the pandemic, with more than 800,000 visitors arriving in the Hawaiian Islands, according to the states Department of Business, Economic Development and Tourism.

Mike McCarthy, the departments director, said in a statement that the tourism sector was showing strong recovery from the Covid-19 pandemic. He said he expected a gradual resumption of international travel by Japanese citizens typically a major share of visitors to Hawaii to strengthen the rebound.

In Puerto Rico, Gov. Pedro Pierluisi lifted nearly all pandemic restrictions in March, and new confirmed cases soon started rising. But tourism to the island has bounced back: Though arrivals from cruise ships had not yet reached prepandemic levels, business travel for meetings and conventions was improving, Discover Puerto Rico, the islands official tourism website, said in late April.

Kenira Thompson, president of the coalition of scientists and vice president for research at Ponce Health Sciences University in Puerto Rico, said that older and immunocompromised people there should consider continuing to wear masks in crowded places, and that those who are eligible for booster shots should seek them out.

Dr. Alain Labrique, the director of the Johns Hopkins University Global Health Initiative, said the summer tourism season meant large gatherings and increased contacts between people, a recipe for the easy spread of infection, even if fewer people are experiencing serious illness.

Covid-19 hasnt disappeared as much as our patience for precautions has, he said.

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Miami-Dade, San Juan and Honolulu Have Become Covid Hot Spots - The New York Times

Throughout the pandemic, the SARS-CoV-2 virus has laid bare weak points in the worlds health care systems. This has been true in arguably every country and every community, but the fractures have been especially apparent in rural areas, where poor access to health care long predated the pandemic.

In this three-part story, Undark explores the gaps in rural health care systems around the world, following the daily work of a village health worker in a small township in central Zimbabwe; a newly graduated rural doctor on a required year-long stint at a remote clinic in northern Ecuador; and a family doctor at a private practice in upstate New York.

Rural life in each of these countries is vastly different, and the challenges that the health care workers face, in some cases, also vary. In Hoja Blanca, Ecuador, for instance, its a three-day round trip just to send a Covid-19 test for analysis, requiring travel by motorcycle, bus, and ferry, and in Makusha Township, Zimbabwe, the health care worker gets around on a bike. Meanwhile, doctors in New York State have access to couriers and can hop in a car for house calls. There are also inequalities when it comes to vaccine availability, funding, and even access to basic medicines like ibuprofen.

But Covid-19 has also revealed common problems. There are far fewer doctors and nurses in these remote areas compared to their urban counterparts. Each rural community feels the pinch of badly broken health care systems on the national level. Covid misinformation and disinformation, as well as pandemic fatigue, reaches even the most remote areas. And as the pandemic lingers, all of the health care workers, no matter their country of origin, continue to toil to keep their villages safe.

This reporting project was created in partnership with Undark and produced with the support of the International Center for Journalists and the Hearst Foundations as part of the ICFJ-Hearst Foundations Global Health Crisis Reporting Grant.

On a recent Sunday, Lucia Chinenyanga, 42, navigates her bicycle through the bumpy terrain of Makusha Township in Shurugwi District in rural Zimbabwe, 200 miles outside the countrys capital city of Harare.

Chinenyanga, a village health worker, is headed to a nearby home to educate a family on vaccines and other Covid-19 protection measures. On her way, she meets Robert Nyoka, a local. As they talk, he expresses concern about his pregnant wife receiving her second dose of the Covid-19 vaccination.

Chinenyanga assures him its safe. Your wife can receive her second jab, she says. But should she feel any slightest side effect afterwards, she must report to the nurses to check her.

As a village health worker, Chinenyanga oversees and responds to the health needs of people in Makusha Townships Ward 9. She works at the local clinic. Her tasks include education around tuberculosis, home-based care for the elderly, monitoring pregnant women, and health awareness programsespecially on Covid-19 vaccines. The position required three weeks of training conducted by the Ministry of Health and Child Care, which coordinates health workers. She has worked in the village since 2019, the year before the pandemic hit Zimbabwe.

While nearly two-thirds of Zimbabwes 15.3million people lived in rural areas like Makusha Township as of 2020, rural health facilities in the country are often under-resourced, with fewer nurses and doctors compared to urban hospitals. Village health workers such as Chinenyanga fill the gap. And although the village health workers play an essential role in the primary health care system, providing care for the marginalized or remote communities in rural areas, they receive little paythe equivalent of $42 every month from nongovernmental organizations that work with the government.

The health sector in Zimbabwe is a mix of public and private facilities; the latter are costly, charging more and offering better services compared to government-run institutions. In Shurugwi, there are three private facilities, but most local residents cannot afford those services due to poverty and opt for the public clinics. Others rely entirely on the services of health workers who do community rounds. Shurugwi consists of 13 wards, with a population of 23,350 according to a 2014 census.

The pandemic has stretched the system even more. Over the past months, Covid-19 has increasingly become a dominant problem, killing high numbers of community members, Chinenyanga says in January following a spike in Covid-19 cases in the country. The deaths came with shortages of pretty much every necessity: quarantine facilities, personal protective equipment, medicines, and doctors. Like many places around the world, the country has also struggled with people sharing fake news about the dangers of vaccination.

Enforcing Covid-19 protocols can be draining for Chinenyanga. Every day she has to convince the rural villagers, mostly small-scale gold miners in the area, many of whom are skeptical of vaccines, to mask up, practice physical distancing, sanitize, and avoid gatherings at places like pubs, where people tend to forgo prevention measures.

Despite some pockets of vaccine hesitancy, as ofJune 7,2022, a total of4.3million Zimbabweans have been fully vaccinated for Covid-19, amounting to about28percent of the population.More than a millionhave received a booster shot.

In Shurugwi, people grew scared when family members started dying of Covid-19, Chinenyanga says. One family would lose both the wife and the husband at the same time. This is when locals started understanding that Covid-19 wasnt just a flu, but a deadly disease which had come to our community.

***

When Zimbabwe gained independence from the United Kingdom in 1980, the new countrys health sector adopted a strong focused health care system, moving from only providing more advanced health care services for the urban population to involving more vulnerable sections of the society in rural areas. Health workers like Chinenyanga now play a pivotal role in the countrys health systems, says Samukele Hadebe, a senior researcher at the Chris Hani Institute, a South African think tank.

In rural areas, the health workers must be empowered with both finances and resources to do their job effectively, he adds, as a majority of people rely on them.

If you come from a health background you will realize those who have succeeded in building universal health care or a viable health care system, it is not the specialist doctors, he says. Wherever there is a successful health care system, it is actually the basic community health care, the one that in some countries where they dont even earn salaries. Those are the people fighting to just get recognized. Those are the people who manage the fundamental work.

But over the years, Hadebe says, Zimbabwes government neglected the rural health sector by not taking care of its health care professionals and paying them inadequate salaries, which pushed many qualified workers to leave the country for better opportunities overseas. In Zimbabwe, the infrastructure is gone, he adds, and health workers from the basic to the specialist are leaving the country. Why? Not just because of the salaries, but because someone will leave the country because they are worried about social security.

Zimbabwes 2010 Health System Assessment from USAID, a U.S. federal agency focused on foreign development, shows that there was a dramatic deterioration in Zimbabwes key health indicators beginning in the early 1990s. The current life expectancy for Zimbabwe in 2022 is just under 62 years, a 0.43 percent increase from 2021, according to projections from the United Nations.

With little hospital funding from the government, village health workers have to do their work with limited resources. Clinics likeChinenyangasin Makusha are poorly resourced and cannot accommodate patients with severe Covid-19 or other critical ailments, as there are no relevant medicines or oxygen tanks.

Even larger hospitals in Zimbabwe dont always provide oxygen to every patient, especially if the patient cant pay. You must have money upfront, Hadebe says. And how many people can access that? So, its a dire situation.

Itai Rusike, who heads the Community Working Group on Health in Zimbabwe, agrees that most rural health care facilities in the country were not equipped to deal with severe cases of Covid-19. In addition to the lack of oxygen tanks, he says, we also do not have intensive care units in our rural health facilities. Most of the rural facilities have no doctors, he adds, and the nurses who do work in rural areas may also not be well-equipped and skilled enough to deal with severe cases of Covid-19.

In November 2021, the Minister of Finance and Economic Development, Mthuli Ncube, announced that the country had acquired 20 million doses of vaccines. China reportedly committed in mid-January to donating 10 million doses over the course of 2022, which can be used for both initial and booster shots.

Rusike says that to ramp up the vaccination drive program, community outreach is needed, especially in rural areas. We need to take vaccination to the people, he says, rather than just wait for the people to come to the health facility and get vaccinated.

I think it is important, especially in remote locations, we come up with innovative strategies to take vaccination to the people, he adds. We know there are certain hard-to-reach areas where we can even use motorbikes to make sure that people can be vaccinated where they are, in their communities.

***

In addition to resource shortages, Chinenyanga has experienced another serious challenge most days in her work: vaccine misinformation and disinformation.

The problem is common across rural Zimbabwe, according to Rutendo Kambarami, a communication officer at UNICEF, who says that the most common reason communities are not taking the vaccine is fear.

Even though much of Zimbabwes population lives in rural areas, they still are connected on social media through mobile devicesand the mobile devices and social media platforms allow for plenty of access to inaccurate information and outright conspiracies about vaccines. So we realized that we needed to give more information in order to dispel misinformation, she said at a December workshop on Covid and mental health for journalists in Zimbabwe.

Village health workers, as front line workers, and even the teachers were saying: We needed to do more interpersonal communication within those areas. So, front line workers play an incredibly huge role in terms of even misinformation and disinformation.

As Chinenyanga wraps up her day, after visiting several homes, she agrees that social media has contributed to misinformation. The people she serves in the Makusha community often share with her unproven remedies to treat Covid-19. She lists some of the misinformation that shes seen so far. People believe in steaming, that it helps. They also believe that eating Zumbani, a woody shrub that grows in the country, also prevents Covid-19, she says.

Still, she manages to smile as she leans against her bicycle. She says she loves her job and its usefulness to the community. As village health workers, our role is to share information we are taught by the Ministry of Health, she says. We prioritize prevention as the most effective tool against Covid-19.

Karen Topa Pilalooks around the windowless reception area in the small health care station of Hoja Blanca, Ecuador, its pale yellow walls stained with patches of mold. When did the electricity go out last night? Topa Pila, a doctor in this remote corner of the country, asks. Her co-workers shrug, throwing worried glances at a small container filled with ice packs. Its only 8:30 a.m. one morning in December 2021, but outside its already over 70 degrees.

Topa Pila closes a cooler containing 52 Covid-19 nasal swabs. Those tests need to be refrigerated and we only have one fridge, which is exclusively for vaccines, she says. Her team has nowhere to store the tests, she adds, and so to avoid getting them spoiled in the jungle heat, the clinic wants to use up all of them on the same day. The very next morning, a health care worker is going to take them to the laboratory in the district hospital.

Topa Pila, 25, and her team arrived in Hoja Blanca, a village of 600 located in the heart of Ecuadors Esmeraldas province, in September 2021. As freshly graduated health care professionals, they all are required to serve an ao rural, working one year in a rural community in order to get their professional license or advance into postgraduate courses in medicine. (The Ministry of Public Health implemented the ao rural in 1970, and the practice is also common across Latin America.) Topa Pilas team is the third deployed in Hoja Blanca since the start of the pandemic. The Hoja Blanca station is also responsible for six other communities, made up of mestizos, Indigenous Chachis, and Afro-Ecuadoriansabout 3,000 people in total. Some of the communities are so remote that to reach them, the health care workers traverse thick rainforest and then travel by canoe for a whole day.

Ecuador has suffered big losses from the pandemic. In the early months,corpseslittered the streets of the countrys biggest city, Guayaquil. By June 2020, the mortality rate from the virus reached8.5 percent, one of the highest in the world at the time. As of June 5, 2022, the countryrecorded35,649 official Covid deaths, although the real count is likely far higher.

Many public health experts agree that Covid-19 has also surfaced deep-rooted systemic problems in Ecuadors rural health care system. In 2022, Ecuador, the smallest of the Andean nations, reached more than 18 million inhabitants; an estimated 36 percent live in rural communities. As with private health care providers, the countrys public health care system is fragmented, divided among various social security programs and the Ministry of Public Health. There are about 23 physicians and 15 nurses per 10,000 people on average. But only a small portion of the countrys health care professionalsroughly 9,800, by the estimate of Dr. John Farfn of the National Association of Rural Doctors serve the more than 6.3 million rural Ecuadorians.

Although Ecuador is relatively financially stable, many Ecuadorians lack access to adequate medical care and the country has some of the highest out-of-pocket health spending in South America. In rural areas, access to hospitalas well as clinics like Hoja Blancasis hampered by bad infrastructure and long distances to facilities. Before the pandemic, Ecuador was undergoing budget cuts to counter an economic crisis; public investment in health care fell from $306 million in 2017 to $110 million in 2019. As a result, in 2019, around 3,680 workers from the Ministry of Public Health were laid off. Ecuador has also experienced long-standing inconsistencies in health leadership. Over the last 43 years, the country has had 37 health ministersincluding six since the start of the pandemic.

Before the Ministry of Public Healths selection system placed Topa Pila for her service, she had never been to Hoja Blanca, and it took her more than eight hours to get there. She says that when she first arrived at the modest health care station, she thought, This is going to collapse.

Early in the pandemic, Ecuador weathered shortages in everything: face masks, personal protective equipment, medications, and even health care workers. By April 2020, the government had relocated dozens of doctors and nurses from rural areas to urban hospitals and health centers, leaving many communities without medical attention.

At one point, says Gabriela Johanna Garca Chasipanta, a doctor who spent her ao rural in Hoja Blanca between August 2020 and August 2021, her team didnt even have basic painkillers like acetaminophen or ibuprofen. It was an infuriating experience, she says. I even had to buy medication out of my own pocket to give to some patients, the ones who really needed it and didnt have the economic means to get it. Some rural outposts had to resort to desperate DIY solutions during the worst months of the pandemic, says Esteban Ortiz-Prado, a global health expert at the University of Las Americas in Ecuadorjury-rigging an oxygen tank to split it between four patients, for instance, and using plastic sheets to create isolation tents in a one-room health center.

The pandemic has strained rural doctors in other ways, too. In 2020 and 2021, Ecuadors National Association of Rural Doctors received many complaints of delayed salaries, some more than three months late. There were rural health care workers who were even threatened by their landlords that they were going to be evicted, saysFarfn, a doctor and former association president.

Even under better conditions, remote health care outposts are only equipped to provide primary care. Anything more serious requires referral to the district hospital, which in Hoja Blancas case means a 300-mile round trip to the parish of Borbn.

The health administration used to take into account Ecuadors geographical and cultural diversity and the poor infrastructure in rural areas. But in 2012, the government restructured the system into nine coordination zones that public health experts say no longer follow a geographical logic. You cannot make heads or tails of it, saysFernando Sacoto, president of the Ecuadorian Society of Public Health. This is not just a question of bureaucracy, but also something that has surely impacted many peoples health.

Although there have also been significant developments in the health care sector in the past 15 yearsincluding universal health coverage and a $16 billion investment in public health from 2007 to 2016it mostly focused on the construction of hospitals, says Ortiz-Prado. But the countrys leadership didn't pay too much attention to prevention and primary health care, he adds. The system was not built to prevent diseases, but was built to treat patients.

In 2012, the government also dismantled Ecuadors Dr. Leopoldo Izquieta Prez National Institute of Hygiene and Tropical Medicinewhich was responsible for emerging diseases research, epidemiological surveillance, and vaccine production, among other things. (It was replaced by several smaller regulatory bodies, one of which failed completely, according to Sacoto.) The majority of a nationwide network of laboratories shut down as well. Sacoto and other experts believe that if the government had continued investing in the Institute rather than dismantling it, it would have lessened the severity of the pandemics impacts in Ecuador.

Initial plans to track and trace Covid-19 cases faltered; the country had barely any machines to process PCR tests, the gold-standard Covid-19 tests. During the first days of the pandemic, samples collected in Guayaquil were taken to Quito by taxi, Sacoto says, because that was the only place PCR tests were being analyzed. But public transportation to rural communities is limited, so even the few rural residents who had access to tests sometimes waited two weeks for test results.

***

Topa Pilas team tries to convince everyone they cross paths withthe butchers wife, people waiting for the bus, men at the cockfighting arenato take a Covid-19 test. While the PCR results are faster than they used to be, they still take a week, as one of the health care workers has to personally shuttle the samples to Borbna 3-day roundtrip that involves a motorcycle, two different buses, and crossing a river with a shabby ferry. Up until yesterday, we had Covid-19 rapid tests. Today, the [district] leader took all the tests we had, says Topa Pila. The district hospital had requested the rapid tests, she adds, because theyve run out of tests and they need them.

Since Hoja Blanca is fairly isolated, the community has had very few Covid-19 cases, and all were mild. Topa Pila fears having any patients in a critical condition, Covid-19 or otherwise, because all she can do is ask the villagers and ferry operator for help with transport. There are no ambulances. We dont have oxygen because the tank we have over there is expired and you cant use it anymore, she says. Weve asked for replacement but nothing has happened.

The way Topa Pila sees it, its a lot to ask of the inexperienced health care workers on their ao rural. We start from zero without knowing anything every year, she says, recalling that the previous team had already left by the time she arrived in Hoja Blanca. And all of those patients whose treatments have been supervised by a doctor for a year lose their treatments, because they knew the doctor would come to their house, she says. We arrive and dont know where they live, since as you can see there are no addresses here. The Covid-19 pandemic has further distanced the rural doctors from their patients, she adds. Between the lockdowns and the coronavirus, other health matters like childhood vaccinations have been put off.

As in other parts of Latin America, the Covid-19 crisis in Ecuador also allowed corruption to fester. Sacoto says he believes the health care sector has become a bargaining chip among politicians. There really are mafias embedded in, for example, public procurement, he says, because the public procurement system is so convoluted that only the person who knows how the fine print works benefits. Between March and November 2020, the countrys Attorney Generals office reported196corruption cases related to the Covid-19 pandemic, including allegations of embezzlement and inflated pricing of medical supplies.

Lately, there have been signs of improvement. After taking office in May 2021, the government of Guillermo Lasso has accelerated vaccination efforts against Covid-19, approved a new program to tackle childrens malnutrition, and announced a Ten-Year Health Plan to improve health equity.

Sacoto says he remains skeptical whether these plans will translate to concrete and lasting actions. A good start would be decentralizing the health care system by building more rural clinics, he says, which could build up a network for preventative care for everything from childhood malnutrition to future pandemics. Ortiz-Prado says the country should better integrate its fragmented health care systems to make it easier for patientsand their recordsto move between them when needed. And it needs to improve the working conditions and salaries of rural health care workers to make the work more appealing, Farfn says, while also creating more permanent positions focused on rural communities. There is a lack of concern, lack of budget, he says, adding, Its a vicious circle, and sadly, governments are trying to apply Band-Aid solutions for the health issues here.

But all of that is in the future. Now, back at the Hoja Blanca health care station, the lights flicker back on in less than a day. The vaccines in the fridge are safe. But the 52 Covid-19 tests are still at risk: A health care worker must take the cooler to the lab in Borbn. There were heavy rains the night before, though, and water levels havent dropped enough for the river ferry to restart operations. Its just the first leg of what will ultimately be a 13-hour journey, and the icepacks are quickly melting amid the balmy equatorial heat.

Before Covid-19, there were no doctors in the village of Otego in central New York. Now there is one. During the pandemic, Mark Barreto quit his job at the Veterans Affairs hospital 89 miles away in Albany and opened a family medicine practice in his basement.

Just 910 people live in Otego, which sits along the Susquehanna River in Otsego County, a pastoral landscape of rolling hills and narrow creek valleys. Barreto lives on a dead-end road, a single street with pastureland on both sides. The downstairs waiting room looks like it could be anywhere in rural Americaa row of identical burgundy chairs against a pale beige wall, kids art hanging above.

In early December 2021, two of Barretos neighbors make an appointment. April Gates and her spouse Judy Tator are both in their 70s. They live around the corner. A friend joined them for Thanksgiving dinner and subsequently came down with Covid. Two weeks later, neither woman has symptoms and both got negative results with at-home tests. But theyre worried. Theyve come to take PCR tests, plus get a blood pressure check for Tator.

You dont have to be symptomatic. Its never bad to get tested if youve had a positive exposure, says Barreto. Are we being overly precautious? Maybe. But particularly with your cardiac history, youre at higher risk.

I worry most about giving it to someone else, Gates says. Thats the biggest thing.

New York State has an estimated 20.2 million residents. Two years into the pandemic, over one quarter of the population has had Covidmore than 5 million cases and more than 71,000 deaths, according to the state department of health. In the first six months of the pandemic, New York hospitals were overwhelmed with more Covid patients than beds. While they've continued to be overstretched, thelimiting factoris staffing. A similar situation has played out across the country: Medical personnel have quit in record numbers, according to the U.S. Bureau of Labor Statistics. Turnover rates were four times higher for lower-paid health aides and nursing assistants than physicians, peaking in late 2020, JAMA reported in April.

The problems are most acute in rural areas that were already chronically understaffed. We have a health care shortage in the county, in the region, says Amanda Walsh, director of public health for Delaware County, just across the river from Otego. Walsh and her nursing staff averaged 12 hour days, seven days a week, for all of 2020. It was an insane amount of time, she says. The hours only eased after the state established phone banks with remote contract tracers, and Walsh started sending her team home by six, even though the work wasnt done.

In Barretos office, after 40 minutes chatting with Gates and Tator about their health concerns, Barreto swabs both patients, walks them out, and then calls a courier to pick up the tests. While he waits, he pulls up the Otsego County webpage. The Covid dashboard shows 7,235 total cases, and the county recently broke its record for most active cases, at 386. Before December, that number had never climbed above 300.

Barreto swivels away from his desk. In the first months of Covid, he says, medical systems that were already dysfunctional simply fell apart. Commuting to Albany on empty highways, hed pass a digital DOT sign reprogrammed to read: Stay home, save lives. He took the message to heart, wondering, he recalls: What is my role as a health care provider? Because we're expected to put ourselves in harm's way to help people. The problem is we didn't know what to do to help them.

For 15 years working in hospitals, Barreto had been dissatisfied with how he saw patients treated. He notes two problems. One is getting access in a reasonable amount of time. And two is continuity of care, he says. The ongoing relationship is key, someone who knows your full story, he says, because thats what your medical history is, its a story.

When Covid hit, he adds, things only got worse.

***

With each successive wave of Covid, the disease spikes in cities and then rolls out to rural areas. Towards the second half of 2020, both case rates and mortality rates were highest in rural counties, according to USDA researchespecially those only with communities of 2,500 people and under. The study pinpointed four contributing factors: older populations, more underlying health conditions, less health insurance, and long distances from the nearest ICU.

In December, omicron followed the same pattern, peaking in New York City two weeks before it really hit Otsego County, says Heidi Bond, who directs the countys department of public health. By early January, active cases in Otsego County shot up to 1,120 before the county abruptly stopped reporting the data. The health department was swamped, Bond says, and it was not possible to get an accurate number with the limited contact tracing and case investigation that is being done.

Sparsely populated regions like central New York, which have smaller health departments and hospitals, are easily overwhelmed during surges, says Alex Thomas, a sociologist at SUNY Oneonta who studies rural health care. Otsego County has fewer than 10 public health staff working on Covid, and 14 ICU hospital beds. Neighboring Delaware County has no ICUs.

In a 2021 study of New York public health staff, Thomas and his team found that 90 percent felt overwhelmed by work, and nearly half considered quitting their jobs. A survey from the Centers for Disease Control and Prevention of about 26,200 public health employees found similar results, with anxiety, depression, PTSD, and suicidal ideation among the fallouts. Thomas predicts dire consequences: We have a serious public health emergency, and there's nobody to take care of it.

Covid revealed long-term flaws in the system, and Barreto predicts the U.S. health care system will eventually collapse on itself. Bond has a more positive perspective: Health care is stronger now after the trial by fire, largely because we know a tremendous amount more than we did two years agoabout Covid, but also about how to help institutions adapt to evolving medical needs.

Before Covid, Bond adds, public health was certainly not a priority at the state or local level. Few elected officials wanted to invest enough or plan for providing robust care for a future crisis. Establishing better partnerships with community organizations let her team overcome these funding deficiencies. Having those in place moving forward, you know, things will happen much more quickly, she says, because we know who to reach out to, to just lend us a hand.

In Otsego County, dealing with the fallout of Covid became a community effort. Volunteers sent up a local Facebook group to share information and services; it quickly had more than 1,000 members. The local hospital organized an ad hoc County Health and Wellness Committee that met biweekly on Zoom. And between 50 and 100 locals representing medicine, public health, and social service agencies, non-profits, and churches exchanged information and ideas and then stepped up to help, says Cynthia Walton-Leavitt, a pastor at a church in Oneonta.

Still, Bond says she worries that public opinion will hamper her departments ability to prepare for the future. What I worry about is the fatigue, the kind of mental fatigue of Covid, she adds. We can't let our guard down.

***

Before Christmas, Barreto drives about 15 minutes to Oneonta to see his own doctor. Oneonta is the biggest city in six counties with 13,000 residents and has the closest hospital to Barretos home practice.

Barreto brings a list of questions, knowing how hard it can be to squeeze out answers from his doctor in the allotted 15 minutes. There are always two agendas. There's your agenda as a doctor, why you wanted to see the patient, he says. And then there's a patient's.

After his appointment, Barreto grabs breakfast and then heads to his first house call of the day. He says he enjoys making home visits like an old-time country doctor. He crisscrosses three counties to see patients, 50 miles in any direction, and gives them his cell number, encouraging them to call whenever they need him. He sees two or three people per daycompared to eight to 15 in former hospital jobs.

Barreto guides his minivan to the interstate and then climbs out of the valley to visit Al Raczkowski, age 88. A former combat medic, Raczkowski still struggles with PTSD, has partial heart failure and some dementia, and requires weekly visits from nurses and therapists through a palliative care agency.

The family has no yardthe hemlocks grow right to the door. Barreto knocks then peeks in. Raczkowski stands in his semi-finished basement wearing a winter coat. Hes not wearing his hearing aid so Barreto shouts: Al, is Maureen here? Do you know why I came?

Raczkowski sits down on a futon. You're here to check on me, he says. With that, Barreto gets to work. The room is crowdedfirewood and tools jumbled by a woodstove, cardboard boxes, cases of soda and seltzer. A miniature Christmas tree stands on one table, an unfinished instant soup cup on another. Barreto unearths a stool and sets up his laptop beside the soup.

Do you remember why were wearing these masks? Barreto asks. Raczkowski isn't sure. Remember about Covid? Were wearing these masks to prevent spreading disease. Raczkowski nods.

Maureen, Al's wife, appears and shuffles to a seat. For the next hour, the three converse as Barreto performs his examination, mostly asking Raczkowski questions that Maureen answers. How are things with the care agency? Without their help I dont even think we would be here, Maureen tells him. Living on this mountain for 76 years. The nurses give Raczkowski showers, check his blood pressure and vitals, and keep him company.

Barreto asks how the medication is going. Its OK, Raczkowski says, but youd do better with a bottle of brandy.

Maureen complains about her husbands other health care. She drove him 80 miles to the Albany VA to try his new hearing aid, only to learn it had been mailed. As for the new psychiatrist? She closed our case, Maureen says. An appointment scheduled for September never happened, she adds, and no one ever answered her phone calls.

After Raczkowskis appointment, back in his car, Barreto vents frustration: If you look at a hospital system, and you count the number of medical personnel, versus the number of administration, there's a skew that shouldn't be there. All that oversight, he adds, doesn't help your relationship with your patient. It doesn't help them get the medicine.

Then he winds back down the mountain road to his next appointment.

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On Three Different Continents, Rural Health Strains under the Weight of the Coronavirus - Scientific American