Category Archives: Covid-19

Issued on: 30/06/2022 - 19:04

The World Health Organization said Thursday it expected "high levels" of Covid-19 in Europe this summer and called on countries to monitor the spread as cases tripled in the past month.

"As countries across the European region have lifted the social measures that were previously in place, the virus will transmit at high levels over the summer", WHO Europe regional director Hans Kluge told AFP.

"This virus won't go away just because countries stop looking for it. It's still spreading, it's still changing, and it's still taking lives."

With the milder but more contagious Omicron subvariant BA.5 spreading across the continent, the 53 countries in the WHO European region are currently registering just under 500,000 cases daily, according to the organisation's data.

That is up from around 150,000 cases daily at the end of May.

Austria, Cyprus, France, Germany, Greece, Luxembourg and Portugal were the countries with the highest incidence rates, with almost all countries in the region seeing a rise in cases.

After registering around 4,000 to 5,000 deaths per day throughout most of the winter, Europe is currently seeing around 500 deaths per day, about the same level as during the summer of 2020.

"We hope that the strong vaccine programmes most member states have implemented together with prior infection will mean that we avoid the more severe consequences that we saw earlier in the pandemic", Kluge said.

"However, our recommendations remain," he stressed.

The WHO urged people experiencing respiratory symptoms to isolate, to stay up to date with their vaccinations and wear masks in crowded places.

Kluge also urged member states to keep testing for the virus.

"We must keep looking for the virus because not doing so makes us increasingly blind to patterns of transmission and virus evolution," Kluge said.

He also called on countries to increase their vaccination rates.

"High population immunity and the choices made to lower risk to older people is key to preventing further mortality this summer," he said.

(AFP)

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Europe to see high levels of Covid-19 this summer, WHO says - FRANCE 24 English

In December 2021, the WHO Global Learning Laboratory issued a call for submissions for action briefs from countries which described initiatives, large or small, that aimed to improve or simply maintain the delivery of quality care during the COVID-19 pandemic.

Four action briefs and one knowledge brief describe in detail the learnings from low- and middle-income countries including Kenya, Ethiopia, and India, that developed initiatives to maintain and improve the quality of care provided to patients during the COVID-19 pandemic. The actions and learnings described in the briefs cover the period from September 2019 to September 2020. These knowledge products are published on the WHO Global Learning Laboratory platform.

The action briefs cover the areas of:

If you wish to read more, please click here to view the content of these action briefs on the Global Learning Laboratory website.

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Quality of care in the COVID-19 context: a multi-country perspective - World Health Organization

Three quarters of adults now have a bank or mobile money account; gender gap in account ownership narrows

WASHINGTON, June 29, 2022The COVID-19 pandemic has spurred financial inclusion driving a large increase in digital payments amid the global expansion of formal financial services. This expansion created new economic opportunities, narrowing the gender gap in account ownership, and building resilience at the household level to better manage financial shocks, according to theGlobal Findex 2021 database.

As of 2021, 76% of adults globally now have an account at a bank, other financial institution, or with a mobile money provider, up from 68% in 2017 and 51% in 2011. Importantly, growth in account ownership was evenly distributed across many more countries. While in previous Findex surveys over the last decade much of the growth was concentrated in India and China, this years survey found that the percentage of account ownership increased by double digits in 34 countries since 2017.

The pandemic has also led to an increased use of digital payments. In low and middle-income economies (excluding China), over 40% of adults who made merchant in-store or online payments using a card, phone, or the internet did so for the first time since the start of the pandemic. The same was true for more than a third of adults in all low- and middle-income economies who paid a utility bill directly from a formal account. In India, more than 80 million adults made their first digital merchant payment after the start of the pandemic, while in China over 100 million adults did.

Two-thirds of adults worldwide now make or receive a digital payment, with the share in developing economies grew from 35% in 2014 to 57% in 2021. In developing economies, 71% have an account at a bank, other financial institution, or with a mobile money provider, up from 63% in 2017 and 42% in 2011. Mobile money accounts drove a huge increase in financial inclusion in Sub-Saharan Africa.

The digital revolution has catalyzed increases in the access and use of financial services across the world, transforming ways in which people make and receive payments, borrow, and save,saidWorld Bank Group President David Malpass.Creating an enabling policy environment, promoting the digitalization of payments, and further broadening access to formal accounts and financial services among women and the poor are some of the policy priorities to mitigate the reversals in development from the ongoing overlapping crises.

For the first time since the Global Findex database was started in 2011, the survey found that the gender gap in account ownership has narrowed, helping women have more privacy, security, and control over their money. The gap narrowed from 7 to 4 percentage points globally and from 9 to 6 percentage points in low- and middle-income countries, since the last survey round in 2017.

About 36% of adults in developing economies now receive a wage or government payment, a payment for the sale of agricultural products, or a domestic remittance payment into an account. The data suggests that receiving a payment into an account instead of cash can kickstart peoples use of the formal financial system when people receive digital payments, 83% used their accounts to also make digital payments. Almost two-thirds used their account for cash management, while about 40% used it to save further growing the financial ecosystem.

Despite the advances, many adults around the world still lack a reliable source of emergency money. Only about half of adults in low- and middle-income economies said they could access extra money during an emergency with little or no difficulty, and they commonly turn to unreliable sources of finance, including family and friends.

The world has a crucial opportunity to build a more inclusive and resilient economy and provide a gateway to prosperity for billions of people,saidBill Gates, co-chair of the Bill and Melinda Gates Foundation, one of the supporters of the Global Findex database.By investing in digital public infrastructure and technologies for payment and ID systems and updating regulations to foster innovation and protect consumers, governments can build on the progress reported in the Findex and expand access to financial services for all who need them.

In Sub-Saharan Africa, for example, the lack of an identity document remains an important barrier holding back mobile money account ownership for 30% of adults with no account suggesting an opportunity for investing in accessible and trusted identification systems. Over 80 million adults with no account still receive government payments in cash digitalizing some of these payments could be cheaper and reduce corruption. Increasing account ownership and usage will require trust in financial service providers, confidence to use financial products, tailored product design, and a strong and enforced consumer protection framework.

The Global Findex database, which surveyed how people in 123 economies use financial services throughout 2021, is produced by the World Bank every three years in collaboration with Gallup, Inc.

Regional Overviews:

EAP

InEast Asia and the Pacific, financial inclusion is a two-part story of what is happening in China versus the other economies of the region. In China, 89% of adults have an account, and 82% of adults used it to make digital merchant payments. In the rest of the region, 59% of adults have an account and 23% of adults made digital merchant payments54% of which did so for the first time after the beginning of the COVID-19 pandemic. Double-digit increases in account ownership were achieved in Cambodia, Myanmar, the Philippines, and Thailand, while the gender gap across the region remains low, at 3 percentage points, but the gap between poor and rich adults is 10 percentage points.

ECA

InEurope and Central Asia, account ownership increased by 13 percentage points since 2017 to reach 78% of adults. Digital payments usage is robust, as about three-quarters of adults used an account to make or receive a digital payment. COVID-19 drove further usage for the 10% of adults who made a digital merchant payment for the first time during the pandemic. Digital technology could further increase account use for the 80 million banked adults that continued to make merchant payments only in cash, including 20 million banked adults in Russia and 19 million banked adults in Trkiye, the regions two largest economies.

LAC

Latin America and the Caribbeansaw an 18 percentage -point increase in account ownership since 2017, the largest of any developing world region, resulting in 73% of adults having an account. Digital payments play a key role, as 40% of adults paid a merchant digitally, including 14% of adults who did so for the first time during the pandemic. COVID-19 furthermore drove digital adoption for the 15% of adults who made their first utility bill payment directly from their account for the first time during the pandemicmore than twice the developing country average. Opportunities for even greater use of digital payments remain given that 150 million banked adults made merchant payments only in cash, including more than 50 million banked adults in Brazil and 16 million banked adults in Colombia.

MENA

TheMiddle East and North Africaregion has made progress reducing the gender gap in account ownership from 17 percentage points in 2017 to 13 percentage points42% of women now have an account compared to 54% of men. Opportunities abound to increase account ownership broadly by digitalizing payments currently made in cash, including payments for agricultural products and private sector wages (about 20 million adults with no account in the region received private sector wages in cash, including 10 million in the Arab Republic of Egypt). Shifting people to formal modes of savings is another opportunity given that about 14 million adults with no account in regionincluding 7 million womensaved using semiformal methods.

SA

InSouth Asia, 68% of adults have an account, a share that has not changed since 2017, though there is wide variation across the region. In India and Sri Lanka, for example, 78% and 89% of adults, respectively, have an account. Account usage has grown, however, driven by digital payments, as 34% of adults used their account to make or receive a payment, up from 28% in 2017. Digital payments present an opportunity to increase both account ownership and usage, given the continued dominance of casheven among account ownersto make merchant payments.

SSA

InSub-Saharan Africa, mobile money adoption continued to rise, such that 33% of adults now have a mobile money accounta share three times larger than the 10% global average. Although mobile money services were originally designed to allow people to send remittances to friends and family living elsewhere within the country, adoption and usage have spread beyond those origins, such that 3-out-of-4 mobile account owners in 2021 made or received at least one payment that was not person-to-person and 15% of adults used their mobile money account to save. Opportunities to increase account ownership in the region include digitalizing cash payments for the 65 million adults with no account receiving payments for agricultural products, and expanding mobile phone ownership, as lack of a phone is cited as a barrier to mobile money account adoption. Adults in the region worry more about paying school fees than adults in other regions, suggesting opportunities for policy or products to enable education-oriented savings.

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COVID-19 Drives Global Surge in use of Digital Payments - World Bank Group

SIOUX FALLS, S.D. (KELO) The COVID-19 death toll has gone up by two in South Dakota from the previous week.

According to the South Dakota Department of Health COVID-19 dashboard, 2,938 people have died during the pandemic, up two from 2,936 the previous week. The deaths were two men. New deaths were reported in the 70-79 (2) age range.

Active cases are now at 3,101, up from the previous report (2,780).

As of June 29, 56 of South Dakotas 66 counties are listed as having high or substantial community spread. High community spread is 100 cases or greater per 100,000 or a 10% or greater PCR test positivity rate.

There are now 53 people hospitalized due to COVID-19, down from last week (65). Throughout the pandemic, there have been 11,029 total people who have been hospitalized.

There were 1,254 confirmed and probable COVID-19 cases reported.

The states total case count is now at 244,523, up from last week (243,269). That total does not include at-home positive results as those are not required to be reported to the state.

The latest seven-day PCR test positivity rate for the state is 24.2% for June 21 27.

The number of recovered cases is at 238,484.

There have been 1,720 Delta variant cases (B.1.617.2 and AY lineages) detected in South Dakota through sentinel monitoring. There have been 176 cases of the B.1.1.7 (Alpha variant), 4 cases of P.1. (Gamma variant) and 2 cases of the B.1.351 (Beta variant).

The number of Omicron cases is now at 1,168. The state is also reporting 108 Omicron BA.2 cases.

For COVID-19 vaccines, 74% the population 5-years-old and above has received at least one dose while 60% have completed the vaccination series. For booster doses, 33% of those eligible have completed their booster dose.

There have been 720,872 doses of the Pfizer vaccine administered, 500,070 of the Moderna vaccine and 38,206 doses of the Janssen vaccine.

There have been 1,259,148 total doses administered in South Dakota with 527,530 total persons receiving the vaccine.

Excerpt from:

COVID-19 in South Dakota: Active cases over 3,000; Hospitalizations down - KELOLAND.com

Republican Sen. Ted Cruz of Texas took aim at Sesame Street's "Elmo" after the popular children's show puppet promoted COVID-19 vaccines for children on Twitter.

A minute-long clip posted on the show's Twitter page showed Elmo speaking with his loving TV puppet dad, Louie, about feeling "a little pinch" when got a shot. Louie then says he had questions about Elmo getting the vaccine, which he took to Elmo's pediatrician.

"I learned that Elmo getting vaccinated is the best way to keep himself, our friends, neighbors, and everyone else healthy and enjoying the things they love," Louie said.

"Elmo" retweeted the original tweet from the Sesame Street page, echoing that his vaccination will benefit his loved ones.

But the puppet's message didn't sit well with the junior senator from Texas.

Sesame Street Muppet 'Elmo' attends the Sesame Workshop's 13th Annual Benefit Gala at Cipriani 42nd Street, May 27, 2015, in New York. Sen. Ted Cruz speaks during a campaign event for Yesli Vega, a candidate for the 7th Congressional District, June 20, 2022, in Fredericksburg, Va.

WireImage/Getty Images

Cruz took to Twitter where he said Elmo "aggressively" advocates for vaccinating young children without citing scientific evidence.

The senator's tweet linked to a June press release in which Cruz announced he and 17 fellow members of Congress called on the Food and Drug Administration to answer 19 questions about the COVID-19 vaccine for kids.

"Why has the FDA recently lowered the efficacy bar for COVID vaccines for youngest children?" one question asks.

While the Sesame Street video with Elmo and Louie does not directly offer scientific evidence for the COVID-19 children's vaccine, a voice promotes asking questions about the vaccine and directs viewers to GetVaccineAnswers.org at the end of the video.

"Thanks, @sesamestreet for saying parents are allowed to have questions!" Cruz wrote, in an apparent flippant reaction.

The website mentioned in the Sesame Street video offers that research and clinical trials demonstrate the vaccine is safe and effective for children.

This is not the first time Cruz has gone after a Sesame Street character online.

An actor dressed as Sesame Street character "Big Bird" speaks during an Apple Inc. event at the Steve Jobs Theater in Cupertino, Calif., March 25, 2019.

Bloomberg via Getty Images

In November, Elmo's fellow Sesame Street puppet, Big Bird, tweeted about getting the COVID-19 vaccine. At the time, Cruz called it "government propaganda."

Cruz's latest attack on a muppet comes less than two weeks after the Centers for Disease Control and Prevention approved the nationwide rollout of COVID-19 vaccines for children older than six months.

On Wednesday, the U.S. government bought 105 million COVID-19 shots from Pfizer for $3.2 billion with a late summer to fall delivery date.

Pfizer and Moderna produce the two vaccines approved for children under five years old.

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GOP's Ted Cruz feuds with Elmo over kids getting COVID-19 vaccines - ABC News

BOSTON (WWLP) The Massachusetts League of Community Health Centers (CHC) will receive $12.5 in grant funding to support 35 Community Health Centers state wide in continued COVID-19 testing and vaccination efforts.

Originally, $5 million for CHCs was included in a supplemental budget signed by Governor Baker in February 2022, but due to high demand for health services, an additional $7.5 million is being awarded from a COVID-19 response reserve established in that supplemental budget.

All CHCs that applied will be receiving funds ranging from $120,000 to $450,000. The money will be used for COVID-19 testing and vaccinations along with supply cost, mobile testing sites and renovations of facilities to create dedicated vaccination and testing space.

As Massachusetts continues to lead the nation in vaccination rates, we are continually investing in neighborhood-based organizations like community health centers who know how to reach the populations they serve,said Governor Charlie Baker. These organizations are a fundamental piece of Massachusetts health care system, and this funding will allow them to address the specific needs of the individuals they serve.

The Community Health Centers receiving grants are:

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Community health centers awarded grants for COVID-19 testing, vaccines - WWLP.com

Background

Similar to coronavirus disease 2019 (COVID-19), the pathogenesis of inflammatory rheumatic diseases includes cytokines dysregulation and increased expression of pro-inflammatory cytokines. Although current data from international studies suggest that rheumatic diseases are associated with a higher risk of COVID-19 infection and worse outcomes, there is limited literature in Saudi Arabia. This study aims to evaluate the outcomes and length of hospital stay of COVID-19 patients with inflammatory rheumatic diseases in Saudi Arabia.

This was a single-center retrospective cohort study that included 122 patients with inflammatory rheumatic diseases and documented coronavirus disease 2019 (COVID-19) infection from 2019 to 2021. Patients with suspected COVID-19 infection, non-inflammatory diseases, such as osteoarthritis, or inflammatory diseases but without or with weak systemic involvement, such as gout, were excluded.

The vast majority (81.1%) of the patients were females. Rheumatoid arthritis was the most common primary rheumatological diagnosis. The admission rate was 34.5% with an overall mortality rate of 11.5%. Number of episodes of COVID-19 infection, mechanical ventilation, cytokine storm syndrome, secondary bacterial infection, number of comorbidities, rituximab, diabetes mellitus, hypertension, chronic kidney disease, and heart failure were significantly associated with a longer hospital stay. Additionally, hypertension, heart failure, rituximab, mechanical ventilation, cytokine storm syndrome, and secondary bacterial infection were significantly associated with higher mortality. Predictors of longer hospitalization were obesity, numberof episodes of COVID-19 infection, mechanical ventilation, number of comorbidities, and chronic kidney disease, whereas, hypertension was the only predictor of mortality.

Obesity, number of episodes of COVID-19 infection, mechanical ventilation, number of comorbidities, and chronic kidney disease were significantly associated with higher odds of longer hospitalization, whereas, hypertension was significantly associated with higher odds of mortality. We recommend that these patients should be prioritized for the COVID-19 vaccine booster doses, and rituximab should be avoided unless its benefit clearly outweighs its risk.

Since the outbreak of coronavirus disease 2019 (COVID-19), in Wuhan, China, many studies have been conducted to investigate the effect of COVID-19 on the course of multiple diseases. Although it is primarily a respiratory disease that manifests as pneumonia, it could potentially affect other organs and systems including the heart, kidney, gastrointestinal tract, nervous and immune systems, and blood [1].

COVID-19 usually manifests as mild-to-moderate self-limiting respiratory symptoms, such as fever, cough, shortness of breath, and loss of taste and smell. On the other hand, in a severe form of the disease, some patients may require hospitalization and intubation with mechanical ventilation [2,3]. Several factors have been associated with poor outcomes in COVID-19, including old age and preexisting comorbidities, such as diabetes mellitus (DM), hypertension (HTN), and chronic pulmonary diseases [4,5]. Current data suggest that rheumatic diseases impose an additional risk of COVID-19 infection and are associated with poorer outcomes. This risk varies based on the underlying rheumatic disease, comorbidities, and treatments [6].

Autoimmune connective tissue diseases are chronic diseases with female predominance. The most common connective tissue diseases aresystemic lupus erythematosus (SLE), scleroderma, myositis, rheumatoid arthritis (RA), and Sjogrens syndrome [7,8]. The pathogenesis of these conditions is highly complicated, and it includes excessive production of pro-inflammatory cytokines, and therefore, high disease activity could result in flares with severe systemic symptoms and increased inflammatory markers. Similarly, COVID-19 has been associated with cytokine dysregulation and increased expression of pro-inflammatory cytokines, which can cause cytokine storm syndrome (CSS) [9,10]. Furthermore,patients who are already on immunosuppressants are more vulnerable to infection [11,12].

Due to the variability of the results among different studies concerning the outcomes of rheumatic patients with COVID-19, and due to limited literature in Saudi Arabia, we aimed to study the impact of autoimmune connective tissue diseases and immunosuppressants on COVID-19 severity, hospitalization, intensive care unit admission rates, and mortality in Saudi Arabia.

We sought to evaluate the outcomes (as mortality/survival) and length of hospital stay (if hospitalization was needed) of polymerase chain reaction (PCR)-positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with known inflammatory rheumatic diseases.

This was a single-center retrospective cohort study that took place in King Abdulaziz Medical City (KAMC), Ministry of National Guard-Health Affairs (MNG-HA), Riyadh, Kingdom of Saudi Arabia.KAMC is an academic government-funded tertiary hospital that combines clinical care, training, academics with research, and state-of-the-art medical technologies.

All adult patients with systemic inflammatory rheumatic diseases and PCR-proven COVID-19 infection, from 2019 to 2021 were included. Initially, 192 patients were identified, but after applying the inclusion and exclusion criteria, only 122 were eligible. Patients with suspected COVID-19 infection, non-inflammatory diseases, such as osteoarthritis and fibromyalgia, or inflammatory diseases but without or with weak systemic involvement, such as gout, were excluded.

The required data were obtained by screening electronic medical records(via the KAMC electronic system - BestCare; Seoul, South Korea: ezCaretech Co.) of allrheumatology patients who were seen in the clinic or admitted to the hospitalfrom 2019 to 2021. The following data were collected: demographics, comorbidities (such as diabetes mellitus, hypertension, and chronic kidney disease), primary rheumatological diagnosis, symptoms of COVID-19, number of episodes of COVID-19 infection (patients with more than one COVID-19 infection after recovery of the first COVID-19), steroid dose, immunosuppressants, length of admission (in weeks), length of ICU admission, mechanical ventilation, cytokine storm syndrome, secondary bacterial infection, and outcomes (as mortality or survival). To know the number of episodes of COVID-19 infection, reinfection was defined as having a positive PCR test for SARS-CoV-2 after having two negative PCR tests in a previously infected patient. Cytokine storm syndrome was defined as a serum ferritin level of at least 10g/L, and secondary bacterial infection was defined as having a positive, respiratory or blood, bacterial culture after COVID-19 diagnosis.

Statistical Package for the Social Sciences (SPSS) version 22 (Armonk, NY: IBM Corp.) was used for data analysis. Categorical variables were presented as frequencies and percentages, whereas, numerical variables were presented as meanstandard deviation. Due to the small sample size, Fisher's exact test was used instead of chi-square to test the association between categorical variables, and independent sample t-test was used to test the association between numerical variables. Multivariate logistic regression analysis was done to assess the predictors of COVID-19 infection mortality and hospitalization by calculating the adjusted odds ratios, and odds ratios were reported with 95% confidence interval. A test was considered significant if two-sided p-value was <0.05.

The study was approved by the Institutional Review Board of King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia (#RC20/665/R). Informed consent was waived because of the retrospective nature of this study. Access to the data was restricted to the researchers. The confidentiality of all patients was protected, and no names or medical record numbers were used. Privacy and confidentiality were assured and all the data, both hard and soft copies, were kept in a secure place within the National Guard-Health Affairs premises.

The demographics of the patients are shown in Table 1.There were a total of 192 rheumatology patients with COVID-19, only 122 of whom were eligible for inclusion. The vast majority (n=99, 81.1%) of the patients were females with a mean age of 48.316 years and an average BMI of 30.86.4 kg/m2. RA, SLE, psoriasis, and antineutrophil cytoplasmic antibodies (ANCA)-positive vasculitis were the most common primary rheumatological diagnoses, accounting for 41.8%, 24.6%, 8.2%, and 5.7% cases, respectively (Figure 1).The most notable associated comorbidities were HTN, DM, hypothyroidism, chronic kidney disease (CKD), heart failure (HF), and bronchial asthma, accounting for 32.0%, 27.9%, 11.5%, 10.7%, 6.6%, and 5.7% cases, respectively (Figure 2).

Lower respiratory tract symptoms, such as cough and shortness of breath, were the most prominent COVID-19 symptoms with a percentage of 48.4%. Other common COVID-19 presenting symptoms were upper respiratory tract (45.1%) and gastrointestinal symptoms (10.7%). Only five (4.1%) patients had a history of two COVID-19 infections. The majority (65.6%) of the patients did not require hospitalization. However, 16.4% required admission for 7 days, 11.5% for eight to 30 days, and 6.6% for >30 days.

The overall mortality rate was 11.5%. A small fraction of the patients (n=17) required ICU admission. Of those, 14 required intubation with mechanical ventilation with a mortality rate of 85.7%. Secondary bacterial infection was only identified in eight (6.6%) patients, four of whom have died. None of the patients who developed CSS (n=4) have survived.

On Fisher's exact test, having more than one COVID-19 infection, intubation with mechanical ventilation, CSS, secondary bacterial infection, and having more than one comorbidity were significantly associated with longer hospital stay (p=0.006, <0.001, 0.006, 0.01, and <0.001, respectively) (Table 2).Moreover, patients with DM, HTN, CKD, and HF were significantly more likely to have longer hospital stay (p=0.001, 0.003, 0.003, and 0.011, respectively). However, only HTN and HF were significantly associated with higher mortality (p=0.002 and 0.006, respectively) (Table 3).

As a part of their treatment regimen for an underlying rheumatological disease, 60.7% of the patients were on prednisone, 46.7% were on hydroxychloroquine, 28.7% were on methotrexate, 9.8% were on anti-TNF (infliximab or etanercept), 9.0% were on mycophenolate and azathioprine, and 4.9% were on rituximab and tocilizumab. Of the aforementioned immunosuppressants, only rituximab was significantly associated with longer hospitalization and mortality (p=0.046, 0.001). No significance was found between steroid dose and hospital length of stay (p=0.605) or mortality (p=0.821) (Tables 2, 3).

Females had more favorable survival compared to males (p=0.025). Intubation with mechanical ventilation, CSS, secondary bacterial infection, and hospital length stay were associated with higher mortality rates (p0.001, <0.001, 0.006, and 0.001, respectively). Having a higher number of comorbidities was not associated with higher mortality (p=0.11) (Table 3).

In multivariate regression model, obesity (odds ratio {OR}=60.669, 95% confidence interval {CI} 3.53-1042.413, p=0.005), number of COVID-19 infection (OR=59.08, 95% CI 2.532-1378.362, p=0.011), intubation with mechanical ventilation (OR=23.238, 95% CI 3.15-171.434, p=0.002), number of comorbidities (OR=7.11, 95% CI 1.911-26.454, p=0.003), CKD (OR=6.178, 95% CI 1.706-22.38, p=0.006), and HTN (OR=5.291,95% CI 1.266-22.112, p=0.022) were significantly associated with higher odds of hospitalization (Table 4).The only comorbidity that was significantly associated with higher odds of mortality was HTN (OR=5.291, 95% CI 1.266-22.112, p=0.022) (Table 5).

Autoimmune connective tissue diseases are chronic inflammatory diseases with highly complicated pathogenesis that includes excessive production of pro-inflammatory cytokines. Similarly, COVID-19 has been associated with cytokine dysregulation and increased expression of proinflammatory cytokines [9-11]. Patients who are already on immunosuppressive medications are logically more vulnerable to infections [11,12]. Current data suggest that rheumatic diseases are associated with an additional risk of COVID-19 infection and poorer outcomes [6]. In this study, we explored the impact of autoimmune connective tissue diseases and immunosuppressive medications on COVID-19 severity, hospitalization, intensive care unit admission, and mortality rates in Saudi Arabia.

Our patients had a mean age of 48.316 years with females being predominant (81.1%). This is attributed to the fact that inflammatory autoimmune diseases generally have female predilection [7,8]. This is in accordance with other studies, as DSilva et al. who studied the outcomes of 52 COVID-19-infected patients with rheumatic diseases, also reported female predominance. Compared to previously published studies, our patients had a relatively younger mean age [13,14]. Overall hospital mortality of COVID-19 is generally between 15% and 20% and can reach up to 60% in older patients. However, it highly varies across cohorts, reflecting differences in the completeness of testing and case identification, variable thresholds for hospitalization, and differences in outcomes [15-17]. Hospital mortality ranges from less than 5% in patients younger than 40 years to 35% in 70-79 years and greater than 60% in 80-89 years [18]. In our study, the mortality rate was 11.5%, and the mean age was 48.3 which is in compliance with some of the studies. To clarify, Montero et al. reported a mortality rate of 16% [12]. The two percentages are close, and probably our study would have a higher mortality rate if it was delayed further. In contrast, Sharmeen et al. mentioned a mortality rate of 5.9% [19]. Although both Montero and Sharmeen studies have published their works in August 2020, the mortality rates are utterly different. It is hard to judge whether, for example, patients with low mortality rates have been vaccinated and therefore had a milder form of the disease or specific immunosuppressive regimen could have protected those patients. Another factor that could potentially contribute to the differences in mortality rate is the mean age. In our study, the mean age was 48.3 years, whereas, in Montero and Sharmeen they were 60.9 and 57 years, respectively [12,19]. This could not explain the low mortality rate reported in Sharmeen's study.It is also important to mention that our mortality rate might not reflect the actual percentage due to the small sample size and the following limitations: 1) we do not have a unified database for all patients throughout Saudi Arabia and so we could not include patients from other hospitals. 2) Many patients were non-eligible for follow-up in our institution (MNG-HA, KAMC), and so, they might have died outside our institution. 4) Many patients might have died after we collected the data. 3) Many patients, even if eligible, lives outside Riyadh and so cannot be followed up. In our country,Saudi Arabia, at least 56,707,289 doses of COVID vaccines have been administered so far though the mortality rate in our study is still high [20].

The need for admission of COVID-19 patients in the general population depends mainly on their age and preexisting comorbidities, such as chronic respiratory diseases and DM [21,22]. The likelihood of hospitalization increases with age up to a maximum of 18.4% in patients 80 years old [23].In our study, the admission rate was 35%, which is much higher than the global admission rate of the general population. This high percentage could partially be explained by the fact that we included all rheumatology patients with documented COVID-19 from 2019 to 2021. At the beginning of the pandemic, with the lack of clear guidelines, institutions tended to admit COVID-19 positive patients till their swaps came negative. This is a possible explanation for the high admission rate seen in our study. Previously published studies are in agreement with our high admission rate. To emphasize, Gianfrancesco et al. reported an admission rate of 46% [15]. Similarly, Montero et al. also mentioned a high admission rate that is 68% [12]. In addition to what we mentioned above, another explanation could be disease-specific factors as patients with inflammatory diseases might need more medical attention. This is not only limited to rheumatology patients, it is also seen with other autoimmune diseases. To clarify, Sahraianet al. reported a hospitalization rate of 25% in multiple sclerosis patients infected with COVID-19, which is also much higher than the admission rate of the general population in the age group associated with multiple sclerosis patients [24].

In our study, number of COVID infections, CSS, secondary bacterial infection, number of comorbidities, DM, HTN, CKD, and HF were significantly associated with a longer hospital stay. A lot of these factors are in agreement with other studies. For example, DSilva et al. reported several factors that have been significantly associated with longer hospital stay including older age, number of comorbidities, and DM [14]. Moreover, Stradner et al. also reported the same thing. They found that old age and comorbidities, such as HTN, DM, cardiovascular and pulmonary diseases, and end-stage kidney disease were significantly associated with longer hospitalization [25].

Some reports found that rituximab use is not associated with worse outcomes or course of disease in patients with COVID-19. In our study, the only medication that was significantly associated with longer hospitalization and higher mortality was rituximab. Similarly, Tepasse et al., Stradner et al., and Alpizar-Rodriguez et al., in their studies, concluded that rituximab is associated with a higher risk of severe disease and/or mortality in patients with COVID-19 infection [25-27]. Ideally, immunoglobulin levels should be obtained in all patients prior to rituximab prescription. Unfortunately, to the best of our knowledge, our institution does not mandate immunoglobulin levels prior to rituximab prescription, which could explain the high mortality rate and hospitalization in our study. Though it is crucial to keep in mind that our findings are consistent with the literature [25-27]. Possibly due to the small sample size, we have not found any significance with steroid use nor with other immunosuppressants. However, in Gianfrancesco's study, prednisone 10 mg/day was associated with a higher hospitalization rate. Conversely, it has been found that TNF- inhibitoruse was associated with less hospitalization rate [15].

The susceptibility to and severity of COVID-19 is highly influenced by patients comorbidities, such as hypertension, and dysregulated innate immune response as in patients with inflammatory autoimmune diseases [9,11,12,28,29]. This might be due to enhanced expression of angiotensin-converting enzyme 2 (ACE2) receptors on the surface of several organs and epithelial cells. COVID-19 infects epithelial cells through binding with ACE2 and initiates inflammation, endothelial activation, tissue damage, and disordered cytokine release [29,30]. Although, in our study, all the included patients were known to have inflammatory rheumatologic diseases, according to literature, those patients are more likely to be infected with and to develop severe COVID-19. To emphasize, DSilva et al. reported that in COVID-19 patients, the need for intubation with mechanical ventilation was more common in patients with known rheumatologic diseases compared to the general population. Patients with autoimmune inflammatory diseases already have high cytokines and immune dysregulation [14]. The high levels of cytokines intensify the destructive progression that leads to additional epithelial cells dysfunction and inflammation [29,31,32]. Altogether, these disorders ultimately lead to multi-organ failure and death. Comorbidities and suppressed immunity have been found as primary reasons for the exacerbated rate of infection and mortality of COVID-19 [29,30,33]. This is another explanation for the high mortality rate as a lot of those patients are chronically on immunosuppressants. In COVID-19 patients, cellular immunity fails to provide adequate protection due to the viruss ability to escape the innate immunity and induce a functional decline in T-cell counts [29]. The literature identifies TNF- and IL-6 receptor inhibitors to be effective in treating COVID-19 among patients with rheumatic diseases as during recovery of COVID-19, decreased levels of IL-6 and TNF- increase the total T-cell counts [34,35]. In our study, we have not found any protective role for TNF- and IL-6 receptor inhibitors, probably due to the small sample size.

The studied population should be prioritized for the booster dose of COVID-19 vaccine. Those patients are particularly at increased risk of severe infection, and so they should have more precautions. Rituximab should be avoided unless it is the only option with the benefit clearly outweighing the risk. Prompt seeking medical attention is also recommended to prevent morbidity and mortality.

This study is mainly affected by its single-centered retrospective design and the small sample size. The small sample size limited our statistical analysis as we could not perform Kaplan-Meier survival curve. The results could have been affected by the fact that vaccination-related data were not available and so the effect of vaccination on patients outcomes was neglected in the study. We plan to do a follow-up study to assess the effect of vaccination on the outcomes of inflammatory rheumatic diseases.

Over a third (34.5%) of the patients required hospital admission. Predictors of longer hospitalization were obesity, number of COVID-19 infections, mechanical ventilation, number of comorbidities, HTN, and CKD, whereas, HTN was the only predictor for mortality. Furthermore, rituximab was significantly associated with longer hospitalization and higher mortality. Based on what we found, we recommend that patients with inflammatory rheumatic diseases should be prioritized for the COVID-19 vaccine booster dose, and rituximab should be avoided unless its benefit clearly outweighs its risk.

Read more:

Outcomes of COVID-19 in Inflammatory Rheumatic Diseases: A Retrospective Cohort Study - Cureus

Pfizer announced that tweaking its COVID-19 vaccine to better target the omicron variant is safe and works just days before regulators debate whether to offer Americans updated booster shots this fall.

The vaccines currently used in the U.S. still offer strong protection against severe COVID-19 disease and death especially if people have gotten a booster dose. But those vaccines target the original coronavirus strain and their effectiveness against any infection dropped markedly when the super-contagious omicron mutant emerged.

Now with omicrons even more transmissible relatives spreading widely, the Food and Drug Administration is considering ordering a recipe change for the vaccines made by both Pfizer and rival Moderna in hopes that modified boosters could better protect against another COVID-19 surge expected this fall and winter.

Pfizer and its partner BioNTech studied two different ways of updating their shots targeting just omicron, or a combination booster that adds omicron protection to the original vaccine. They also tested whether to keep todays standard dosage 30 micrograms or to double the shots strength.

In a study of more than 1,200 middle-aged and older adults whod already had three vaccine doses, Pfizer said over the weekend that both booster approaches spurred a substantial jump in omicron-fighting antibodies.

Based on these data, we believe we have two very strong omicron-adapted candidates, Pfizer CEO Albert Bourla said in a statement.

Pfizers omicron-only booster sparked the strongest immune response against that variant.

But many experts say combination shots may be the best approach because they would retain the proven benefits of the original COVID-19 vaccine while adding new protection against omicron.

And Pfizer said a month after people received its combo shot, they had a 9- to 11-fold increase in omicron-fighting antibodies. Thats more than 1.5 times better than another dose of the original vaccine.

And importantly, preliminary lab studies show the tweaked shots also produce antibodies capable of fighting omicrons genetically distinct relatives named BA.4 and BA.5, although those levels werent nearly as high.

Moderna recently announced similar results from tests of its combination shot, what scientists call a bivalent vaccine.

The studies werent designed to track how well updated boosters prevented COVID-19 cases. Nor is it clear how long any added protection would last.

But the FDAs scientific advisers will publicly debate the data on Tuesday, as they grapple with whether to recommend a change to the vaccines recipes ahead of similar decisions by other countries.

More here:

Pfizer says tweaked COVID-19 shots boost omicron protection - Boston Herald

During a recent trip to London, I saw almost no one wearing a maskexcept for American tourists, who were easily identifiable because they wore them even when they were outside. Restaurants have recovered and are packed; reservations are down only 13 percent from before the pandemic, compared with 40 percent in New York. For me, a visiting American comparing London to his homeland, the impression is that the cityand the countryhas moved on from COVID-19.

But England has not moved on from its failed initial response to COVID-19 and the decisions surrounding it, which remain controversial. Starting in February 2020, the country pursued a libertarian strategy of trying to reach herd immunity, before lurching to a severe lockdown in late March. England cycled through lockdowns of varying severity over roughly the next year. People were ordered to stay at home, and nonessential businesses were closed; at times, it was an offense to leave your home without a reasonable excuse. The National Health Service (NHS) attempted an effort at test and trace from May 2020 to January 2021, but this proved to be completely useless.

I happened to be marooned in London throughout most of 2020, having arrived only days before the initial lockdown was imposed on March 23. I remember how empty Londons streets were during that period, except for the speeding ambulances. While I never caught COVID-19, my doctor didperhaps because of the NHSs lack of personal protective equipment and overall lack of preparedness for a pandemic. Prime Minister Boris Johnson nearly died from the virus. And it was recently revealed, in a scandal known as Partygate, that during lockdown, when group gatherings were forbidden, Johnson hosted parties in the prime ministers residence at No. 10 Downing St. Wine was wheeled in from a nearby shop in a suitcase. Johnson survived a recent no-confidence vote by his own Conservative Party but so narrowly that his premiership remains threatened.

The debate in England about these COVID-19 policies is immensely sensitivegiven the staggering number of deathsand highly politicized, with the Labour press arguing the government did not do enough during COVID-19 and some of the Tory press arguing the government did too much by enacting lockdowns.

Devi Sridhars Preventable: How a Pandemic Changed the World & How to Stop the Next One is a notable contribution to the still-raging debate. Sridhar, a professor of global public health at the University of Edinburgh, is broadly associated with the Labour-aligned stancethat is, the need to suppress the virus even if this was achieved through the curtailment of individual liberties such as freedom of movement. She has advised Scottish First Minister Nicola Sturgeon, as well as the World Health Organization, on COVID-19 and is a divisive figure in the U.K. because of these associations and her support for strict border closures.

Preventable itself is a wide-ranging book. It is in part a work of advocacy for a more muscular response by governments to pandemics and a work of analysis, comparing different countries methods of trying to control the spread of COVID-19.

Because these different responses come not only from state capacity but also ideology, reaction to Sridhars book has been accordingly split. The U.K. progressive, anti-populist press is mostly supportive. The Guardian, where she is a contributor, was glowing. The Financial Times, which seems to advocate trusting the expertsparticularly one as establishment as Sridhar (she co-wrote a book with Chelsea Clinton)as an almost moral duty, was even more positive, getting straight to the political point in its review: Preventable argues that the poor leadership skills of populist leaders (such as Johnson, Donald Trump and Brasils Jair Bolsonaro) condemned some of the countries best equipped to fight the pandemic to failure in 2020.

The story in the Tory press, which tends to be skeptical of COVID-19 lockdown measuresand Sturgeonwas very different. The Spectator, in an article titled Please dont do a hit job: An interview with Devi Sridhar, proceeded to do exactly that and was personal in its conclusion: Now virtually the whole worldwith the exception of hermit kingdom Chinais living with Covid, being a former pin-up for Zero Covid is no longer quite such good box office. A pre-publication article in the Spectator was even nastier, listing the book in a guide to all the titles which wont be flying off the bookshelves in the forthcoming months. (It actually was a bestseller.) The article concluded: With such an avalanche of epidemiological musing remember the words of Christopher Hitchens: Everyone has a book in them and that, in most cases, is where it should stay.

The truth however is that Sridhars book is highly nuanced and the author too intellectually heterodox and empirically oriented to be constrained by a single ideological perspective. There is no doubt she felt countries should have developed a COVID-19 control strategy. But unlike lockdown true believers, Sridhar is very candid that containment policies such as school closures involve trade-offs and can cause harm. As she writes, School closures have far reaching and detrimental effects. Many children, especially in poorer countries, will never return to formal schooling again.

It is tempting to now relitigate COVID-19 policy decisions made then by citing recent academic research questioning the efficacy of lockdowns. Both pro- and anti-lockdown camps have become amateur epidemiologists. Though they argue endlessly about science, neither side acknowledges the glaring political contradictions in each of their approaches: Zero-COVID adherents tend to be globalists who dream of a borderless world (for people, goods, services, and finance)except when it comes to COVID-19, where free movement and activity must be tightly prescribed. Anti-lockdown populists pretty much feel the opposite in every respect.

One could read and critique Sridhars initial policy advicefavoring a more aggressive response to the pandemic, including tight border controls, social distancing, and the banning of nonessential travelwith the benefit of hindsight, but this would not be a very fruitful approach or a good use of the readers time. For one, Sridhar changes her thinking in response to changing evidence. As an example, she updated her analysis of the cost and benefits of school closures as more data came in showing the developmental harm closures caused to children and the limited risk of COVID-19 transmissions from schools.

More broadly, it is a fact that countries differed in the efficacy of their initial policy response to COVID-19 even if these policies didnt always work in the long term. Some, like Taiwan, were able to contain the virus and had low early death rates. Others, such as the United States, which devotes more resources to health care than any other country in the world, could not mount an effective response at all.

Indeed, the core of Preventable, and what I believe will be its lasting contribution, is how and why countries responded to COVID-19 differently. Rich countries did not necessarily handle the pandemic better than poor ones, showing that something else is at work besides money. The specifics are complex, which is why the book exceeds 400 pages.

Sridhars framework is essentially political. [W]ith the right politics and leadership, much of the suffering and death [from COVID-19] was largely preventable, she writes. It is worth looking more closely at the initial policy successes of some countries and failures of others, as detailed in Preventable.

South Korea. South Koreas response to COVID-19 was informed by its recent experiences with another virus: MERS (Middle East respiratory syndrome) in 2015. That experience did not go well: South Korea had the largest outbreak outside of the Middle East. As a result of MERS, South Korea put policies and planning in place for pandemics that proved critical when COVID-19 hit.

South Koreas plans did not rely on a national lockdown, and schools were largely kept open, though social distancing was deployed. Instead, Sridhar writes, the core of the South Korean response has been the test/trace/isolate system and by March 2020 it had the highest per capita test rate in the world with results back within twenty-four hours. In comparison, she notes, during this period the U.K. was only offering testing in hospitals.

If someone tested positive, South Korean public health teams traced that persons activity over the previous week using phone and credit card data and closed-circuit TV. They were then asked to isolate at home or in specialized isolation centers, where their symptoms were continuously monitored to see if they required hospitalization. South Korea, according to Sridhar, attributed its low death rate to this monitoring system. The low oxygen levels stemming from COVID-19 may not be detectable by patients themselves, and so often in the United States patients showed up at hospitals when they were already gravely ill.

Sridhar terms the South Korean model, which is based on testing rather than lockdowns, reasonably effective. But, as she points out, it also involved something else: trust in the government and that it wouldnt misuse the personal data it had gathered.

Senegal. Senegal is another one of the books case studies of success and one barely known in the global north. As of March 2021, it ranked second, right after New Zealand, in FP Analytics COVID-19 Global Response Index.

President [Macky] Sall knew to go early, go hard and keep it simple, Sridhar writes. Once COVID-19 was confirmed in the county, Sall closed schools and air travel and shut down large gatherings. This applied to mosques, with many choosing to worship from home.

Sridhar praises the countrys messaging efforts, including the use of religious leaders and musicians who released a single about beating the virus, Daan Corona. Senegals success also built on a more traditional disease management and surveillance infrastructure developed for infectious diseases such as Ebola.

As Sridhar writes, What Senegals story shows is that even in the context of limited resources and scientific uncertainty, certain countries reacted quickly and effectively to prevent a crisis. Senegals success rested on leadership, messaging, testing, but also financial support for those who were impacted by COVID-19 restrictions and had no way to earn a living, allowing them to isolate.Italy. Two regions in Italy, Lombardy and Veneto, make for a clear case study within the same country of differing COVID-19 policy responses and their impact. Veneto took a strict containment approach accompanied by mass testing. Lombardys focus was on treating cases once they occurred rather than trying to prevent them. The results of these different strategies: Lombardys case fatality rate was three times that of Veneto, as of April 2020.

In Sridhars telling, these outcomes were not surprising, and what happened next in Lombardy was almost inevitable: As the pandemic worsened and Lombardy became a death zone, it implemented almost medieval extreme lockdown measures. There was almost no exit from or entry into afflicted areas. She was not surprised by this turn of events: Around the world, before vaccines became widely available, mitigation strategies [allowing the virus to spread] have always resulted in lockdown measures.

New Zealand. New Zealand was distinctive in the Anglophone world for successfully pursuing a COVID-19 elimination strategyof trying to eliminate the virus altogether rather than just flattening the curve through containment. (Australia attempted this, too.) To accomplish this, New Zealand closed its borders to everyone but citizens and long-term residents, who themselves were forced to quarantine in hotels if they chose to enter the country. In March 2020, the country entered a state of emergency with a stay-at-home lockdown.

The elimination strategy was successful: The country went 102 days without cases. But Sridhar also points out that it was not without its challenges, which she itemizes: Not everyone cooperated with lockdown and test and trace; lockdown took a psychological toll; and the closed border ruined tourism and separated families. Despite these misgivings, Sridhar titles her section on the country, The Paradise of New Zealand.

Sweden. Sridhar contrasts New Zealands approach with that of Sweden, which is typically held up as the poster child for the success of a laissez-faire or anti-lockdown approach. Underlying its hands-off approach to COVID-19 was the public health authorities belief that the only sustainable way to deal with this kind of respiratory pathogen would be to let it flow through the population and avoid the economic and social costs of lockdown.

Hence, Sweden did not pursue lockdowns or test and trace for that matter. Schools and restaurants stayed open and so did the border. These policies were in stark contrast to the containment measures deployed by other Scandinavian countries.

Did the Swedish lax approach work? Sridhar writes: The debate is polarized. In her analysis, Swedens gamble did not pay off. Swedes paid a heavy price in that lives were lost unnecessarily. And, as the year progressed, Sweden went the same way as its Scandinavian neighborsinto suppression, she writes.

Among the analyses in Preventable of COVID-19 responses across countries and regions, one consistent finding is that poorer countries that took the approach of aggressively trying to contain the pandemicsuch as Greece or the Czech Republicfared better than richer countries, such as France, that were more hands-off, at least initially.

It is true that many of the countries that handled the first wave well, such as South Korea, New Zealand, and Senegal, struggled as time went on. But their strategies bought time until vaccines were available. And their economies were not as devastated as those of countries with laxer policies, according to Sridhar: [T]hose countries that responded effectively and controlled the virus, like Taiwan, South Korea, Denmark and Norway, had faster economic recovery compared with countries like Britain, Spain and Sweden.

But there is a puzzle in these overall patterns of response. It is clear from Sridhars telling that countries that undertook a coordinated national response involving test and trace and isolation handled the initial outbreak much better than the disorganized response of the United States and the U.K. Yet it is the latter two countries that were first able to develop effective vaccines.

Is this just a coincidence?

There is a reason to think not. The answer to this puzzle is found outside of Preventable, or even epidemiology writ large, and instead is provided by a niche area of political science studying economic development and varieties of capitalism.

Chalmers Johnson in his book MITI and the Japanese Miracle describes two economic systems, plan-rational vs. market-rational economies, a distinction common in the literature on the varieties of capitalism. Plan-rational economies are characterized by their governments focus on planning, with economic growth the overarching goal. (The Soviet Union was plan ideological, according to Johnson, so not part of this grouping.) In plan-rational economies, the state has a developmental orientation, and there is a great deal of state intrusion into the economy. Market-rational economies, in contrast, are centered on market efficiency, with the government playing primarily a regulatory rather than a planning role.

For Johnson, Japan was the exemplifier of the plan-rational system, with the United States the standard-bearer of the market-rational system. There are strengths and weaknesses in each system.

When there is a crisis where there is no consensus about what the long-term goal should be, and therefore how to plan for it, the plan-rational system stumbles. The market-rational system is better at coming up with new answers. Johnson writes that the great strength of the market-rational system lies in its effectiveness with dealing with critical problems. [Its approach] helps to promote action when problems of an unfamiliar or unknown magnitude arise.

Johnson doesnt discuss pandemics, but his dual-system typology, which is found elsewhere in political science, applies in this case. Plan-rational economies were distinguished by their planning and state effectiveness at controlling the pandemicbut only initially. In contrast, the more flexible market-rational U.S. and U.K. systems came through when it came to developing vaccines.

This typology of plan rational vs. market rational doesnt map precisely to countries responses to the pandemic, but it roughly does, with COVID-19 control standouts of Taiwan and South Korea falling into the camp of plan rational.

The typology can be seen again in countries behavior once vaccines were developed. The United States and U.K. reverted to typeor rather, continued as typewith no planning for the next crisis. There were to be no more Operation Warp Speeds in the United States. In alignment with market efficiency, the U.K. made aggressive moves to rapidly sell off its vaccine manufacturing and innovation center, which had proved so useful in vaccine development. (Kate Bingham, who led the U.K. vaccine task force, denounced the governments overall approach.)

And China, too, continues on its pre-chosen path. Even though vaccines are now readily available, it insists on pursuing a zero-COVID strategy, an authoritarian policy imposed at great cost.

The question is whether the United States can broaden its market-efficient economic approach, which has many strengths, to include planning capabilities, too. As Preventable demonstrates, planning was critical for early pandemic control, though in the long run it was not sufficient. Both approaches are needed. If the United States had added a bit more planning to the mix, many lives could have been saved during the initial outbreak.

The risks facing the United States going forward go well beyond just pandemics. Coronaviruses arent the only threat emanating from China. China poses unprecedented economic and military challenges to the United States. It is moving to a new economic model, one that combines state planning with market forces. By expanding its own economic model, the United States can respond more effectively to these new threats. Losing this competition is preventable.

See more here:

Devi Sridhar's 'Preventable' Review: The Countries That Handled COVID-19 Best - Foreign Policy

COVID-19 has affected pretty much everyone on the planet and generally overshadowed the past two-plus years of our lives.

So many of our decisions and actions over the past 26 months have been determined by the fickle nature of the virus, and shared anxieties about it have dominated our thoughts for so long.

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But, now, those widespread COVID concerns appear to be on their way out, as vaccination rates rise, the Omicron variant seems to have peaked, and countries around the world have eased or entirely dropped their international travel restrictions.

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In a recent live poll conducted by leading data and analytics company GlobalData, 57 percent of respondents said that they are not concerned or not very concerned about the spread of COVID-19. This affirms the attitude the world seems to have adopted toward the pandemic at this point, which is that we must treat the virus as endemic and learn to live with it.

The outlook for tourism in many countries is brighter than at any time in the past two years, said Hannah Free, Travel and Tourism Analyst at GlobalData. However, the turbulence and uncertainty of COVID-19 has created several challenges which are likely to further complicate recovery. Rising demand, coupled with mass layoffs and competition for talent with other sectors, has resulted in widespread labour shortages in several tourism economies, such as the UK, the Netherlands, and Spain.

With tourism now returning in earnest to many parts of the world, destinations and businesses will need to continue prioritizing hygiene and health safety measures in order to further boost travelers confidence and keep it high. GlobalData posited that coordinated health protocols designed to protect workers, communities and travelers alike, as well as support companies and their workforces, must be firmly established in order to build and maintain tourists trust.

The global travel and tourism industrys post-pandemic recovery is gaining traction as pent-up demand for international travel rekindles, Free added. According to GlobalDatas latest forecasts, on a global scale, international departures will reach 68% of pre-COVID levels in 2022. This is expected to improve to 82% in 2023, and 97% in 2024, before fully recovering by 2025 at 101% of 2019 levels. There is reason to be cautiously optimistic for the return of travel demand as growth in international travel is finally expected in 2022.

For the latest insight on travel around the world, check out this interactive guide.

For the latest travel news, updates and deals, subscribe to the daily TravelPulse newsletter here.

Read more here:

Many Tourists Around the World Now Unconcerned About COVID-19 - TravelPulse