Boris Johnson apologies to pandemic victims at COVID inquiry

The former UK leader will speak at the ongoing inquiry on Wednesday and Thursday, following criticism from colleagues and the public on how he handled the pandemic.


Disgraced former British Prime Minister Boris Johnson has apologised for the “pain and the loss and the suffering” of the victims of the COVID-19 pandemic in the United Kingdom.

Speaking at the ongoing COVID inquiry in London, he added that he “understands the feelings of these victims and their families”, repeating that he is “deeply sorry”.

Adding that he remains grateful to healthcare workers and other public servants who were on the frontline during the pandemic, Johnson explained that he hopes the inquiry will get “the answers these families are rightly asking”.

Johnson acknowledged that his government was too slow to grasp the scale of the crisis, although he skirted questions over whether any of his decisions had contributed to the country’s high death toll – one of the worst across the globe.

Testifying under oath at the inquiry, Johnson acknowledged that “we underestimated the scale and the pace of the challenge” when reports of a new virus began to emerge from China in early 2020.

The “panic level was not sufficiently high,” he admitted.

Last week, the former Health Secretary told the inquiry last week that he had tried to raise the alarm inside the government.

Matt Hancock claimed that thousands of lives could have been saved by putting the country under lockdown a few weeks earlier than the eventual date of 23 March 2020.

Britain went on to have one of Europe’s longest and strictest lockdowns. With the deaths of more than 232,000 people, it comes in at close to the top of the continent’s highest death tolls

Johnson acknowledged the government had “made mistakes” but put emphasis on apparent collective failure rather than his own errors.

He claimed that ministers, civil servants and scientific advisers had failed to sound a “loud enough klaxon of alarm” about the virus.

“If we had collectively stopped to think about the mathematical implications of some of the forecasts that were being made… we might have operated differently,” Johnson said.

Grilled by inquiry lawyer Hugo Keith, he acknowledged that he did not attend any of the government’s five Cobra crisis meetings on the new virus in February 2020. He admitted to looking only “once or twice” meeting minutes from the government’s scientific advisory group.

Johnson also claimed he had relied on “distilled” advice from his science and medicine advisers.

His testimony was interrupted as four people stood up in court as he spoke, holding signs saying: “The dead can’t hear your apologies,” before being escorted out by security staff.

Following their removal, he admitted his government had made mistakes.

“Inevitably, in the course of trying to handle a very, very difficult pandemic in which we had to balance appalling harms on either side of the decision, we may have made mistakes,” Johnson said, adding “Inevitably, we got some things wrong”.

He did assert, however, “I think we were doing our best at the time.”


The former prime minister had arrived at the inquiry venue at daybreak, several hours before he was due to take the stand, avoiding a protest by relatives of some of those who died after contracting the virus.

A group gathered outside the office building where the inquiry was set, some holding pictures of their loved ones. A banner declared: “Let the bodies pile high” – a statement attributed to Johnson by an aide. Another sign read: “Johnson partied while people died.”

Johnson agreed in late 2021 to hold a public inquiry after heavy pressure from bereaved families. The probe, led by retired Judge Heather Hallett, is expected to take three years to complete, though interim reports will be issued starting next year.

Johnson has submitted a written evidence statement to the inquiry but has not handed over some 5,000 WhatsApp messages from several key weeks between February and June 2020. They were on a phone Johnson was told to stop using when it emerged that the number had been publicly available online for years. Johnson later said he’d forgotten the password to unlock it.

At the inquiry on Wednesday, he reiterated: “Can I, for the avoidance of doubt, make it absolutely clear I haven’t removed any WhatsApps from my phone?”.


Wednesday marks the first day he’s expected to be questioned by the Inquiry. He will also face them on Thursday. 

The controversial leader, who resigned his post last June, will be grilled over his handling of the pandemic – as well as his government’s response.

The inquiry has so far heard and seen clear evidence of disarray inside Johnson’s cabinet, especially during the early weeks of the outbreak.

There has been public outcry, too, over lockdown-breaking parties in Downing Street which Johnson long denied even happened. 

Senior officials got drunk and partied during these events, while the country was in full lockdown, with some people unable to say goodbye to dying loved ones. 


Earlier this year, a Parliament committee found that he had repeatedly and deliberately lied about breaking COVID lockdown rules.

In a damning 30,000-word paper, the body said his denials were “so disingenuous that they were deliberate attempts to mislead the Committee”, also referring to the “frequency with which he closed his mind to the truth.”

As a result, he stepped down with immediate effect as an MP and Johnson, his wife Carrie and now Prime Minister – then Chancellor – Rishi Sunak among more than 100 staff fined by police.

At the COVID Inquiry, Johnson is likely to be asked to explain why he initially tried to play down the threat posed by the deadly virus. He’ll also face questions over whether he failed to chair Cobra meetings coordinating the government’s response early on in the pandemic.

The Inquiry has already heard several pieces of damning evidence against the former PM.


One particularly condemnatory example came from chief scientific adviser Patrick Vallance. In a diary entry written on 19 September 2020, he wrote: ”[Johnson] is all over the place and so completely inconsistent. You can see why it was so difficult to get agreement to lock down the first time.”

Speaking in front of the Inquiry panel in November, Vallance also claimed that Johnson had been “bamboozled” by the myriad scientific evidence about the pandemic.

Dominic Cummings, Johnson’s former chief adviser, had similar criticisms.

In written evidence presented to the inquiry, he claimed that, at the start of 2020, Johnson was distracted by “financial problems”, his divorce and pressure from his then-girlfriend Carrie wanted to “finalise the announcement of their engagement”.

Early that year, Lee Cain, Johnson’s former director of communications sent a message to Cummings asserting that the PM “doesn’t think [COVID] is a big deal and he doesn’t think anything can be done and his focus is elsewhere”.


“He thinks it’ll be like swine flu and he thinks his main danger is taking the economy into a slump,” Cain added.

Rishi Sunak is also expected to give evidence later in December.

The inquiry will not find any individual guilty of a crime. It aims to take lessons away from how the crisis was handled and how the UK could put in place preparation for a similar event in the future.

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FDA advisors recommend that new Covid vaccines target an omicron XBB variant this fall

A woman receives a booster dose of the Moderna coronavirus disease (COVID-19) vaccine at a vaccination centre in Antwerp, Belgium, February 1, 2022.

Johanna Geron | Reuters

The U.S. Food and Drug Administration‘s independent panel of advisors on Thursday recommended that updated Covid shots for the fall and winter target one of the XBB variants, which are now the dominant strains of the virus nationwide. 

The committee unanimously voted that the new jabs should be monovalent — meaning they are designed to protect against one variant of Covid — and target a member of the XBB family.

Those strains of Covid are descendants of the omicron variant, which caused cases to surge to record levels early last year. They are some of the most immune-evasive strains to date.

Advisors also generally agreed that the new shots should specifically target a variant called XBB.1.5. The panel only discussed that specific strain selection and did not vote on the matter.

XBB.1.5 accounted for nearly 40% of all Covid cases in the U.S. as of early June, according to data from the Centers for Disease Control and Prevention. That proportion is slowly declining, and cases of the related XBB.1.16 and XBB.2.3 variants are on the rise. 

Advisors noted that XBB.1.5 appears most ideal for the fall since vaccine manufacturers Pfizer, Moderna and Novavax have already started to develop jabs targeting the strain.

“The 1.5 looks good. It seems like it’s the most feasible to get across the finish line early without resulting in delays and availability,” said Dr. Melinda Wharton, a senior official at the National Center for Immunization and Respiratory Diseases. “The vaccine we can use is the vaccine that we can get. And so it feels like this would be a good choice.”

The FDA typically follows the advice of its advisory committees, but is not required to do so. It’s unclear when the agency will make a final decision on strain selection.

There is also uncertainty about which age groups the FDA and CDC will advise to receive the updated shots this fall.

But the panel’s recommendation is already a win for Pfizer, Moderna and Novavax — all of which have been conducting early trials on their respective XBB.1.5 shots ahead of the meeting.

“Novavax expects to be ready for the commercial delivery of a protein-based monovalent XBB COVID vaccine this fall in line with today’s [advisory committee] recommendation,” said John Jacobs, the company’s president and CEO.

The U.S. is expected to shift vaccine distribution to the private sector this fall. That means the vaccine makers will start selling their new Covid products directly to health-care providers and vie for commercial market share. 

The panel’s recommendation coincides with a broader shift in how the pandemic impacts the country and the world at large. 

Covid cases and deaths have dropped to new lows, governments have rolled back stringent health mandates like masking and social distancing and many people believe the pandemic is over altogether.  

But Dr. Peter Marks, head of the FDA’s vaccine division, said the agency is concerned that the U.S. will have another Covid wave “during a time when the virus has further evolved, immunity of the population has waned further and we move indoors for wintertime.”

Updated Covid vaccines that are periodically updated to target a high circulating variant will restore protective immunity against the virus, said Dr. David Kaslow, a senior official in the FDA’s vaccine division. 

It’s a similar approach to how the strains are selected for the annual flu shot. Researchers assess strains of the virus in circulation and estimate which will be the most prevalent during the upcoming fall and winter.

But it’s unclear how many Americans will roll up their sleeves to take the updated shots later this year. 

Only about 17% of the U.S. population — around 56 million people —have received Pfizer and Moderna’s boosters since they were approved in September, according to the CDC.

More than 40% of adults 65 and older have been boosted with those shots, while the rate among younger adults and children ranges between 18% and 20%.

Those boosters were bivalent, meaning they targeted the original strain of Covid and the omicron subvariants BA.4 and BA.5. 

Pfizer, Moderna and Novavax shot data

During the meeting, Pfizer, Moderna and Novavax presented preliminary data on updated versions of their shots designed to target XBB variants. 

Moderna has been evaluating shots targeting XBB.1.5 and XBB.1.16 — another transmissible omicron descendant, according to Rituparna Das, the company’s vice president of Covid vaccines. 

Preclinical trial data on mice suggests that a monovalent vaccine targeting XBB.1.5 produces a more robust immune response against the currently circulating XBB variants than the authorized bivalent shot targeting BA.4 and BA.5, according to Das. 

She added that clinical trial data on more than 100 people similarly demonstrates that the monovalent XBB.1.5 vaccine produces protective antibodies against all XBB variants. All trial participants had previously received four Covid vaccine doses.

Das said that comprehensive protection against XBB strains is likely due to the fewer unique mutations between the variants, which means their composition is similar.

There are only three unique mutations between the variants XBB.1.5 and XBB.1.16, according to Darin Edwards, Moderna’s Covid vaccine program leader. By comparison, there are 28 mutations between omicron BA.4 and BA.5.

That means the immune response an updated shot produces against XBB variants will likely be similar, regardless of which specific variant it targets, Edwards said.

Pfizer also presented early trial data indicating that a monovalent vaccine targeting an XBB variant offers improved immune responses against the XBB family. 

The company provided specific timelines for delivering an updated vaccine, depending on the strain the FDA selects. 

Pfizer will be able to deliver a monovalent shot targeting XBB.1.5 by July and a jab targeting XBB.1.16 by August, according to Kena Swanson, the company’s senior principal scientist.

Pfizer won’t be able to distribute a new shot until October if the FDA chooses a completely different strain, Swanson said.

Novavax did not provide a specific timeline for delivering a shot targeting XBB.1.5, but noted that an XBB.1.16 shot would take eight weeks longer.

Novavax unveiled preclinical trial data indicating that monovalent vaccines targeting XBB.1.5 and XBB.1.16 induce higher immune responses to XBB subvariants than bivalent vaccines do. 

Data also demonstrates that an XBB.1.5 shot produces antibodies that block XBB.2.3 from binding to and infecting human cells, according to Dr. Filip Dubovsky, Novavax’s chief medical officer.

Dubovsky said the trial results support the use of a monovalent XBB.1.5 shot in the fall.

Novavax’s jab uses protein-based technology, a decades-old method for fighting viruses used in routine vaccinations against hepatitis B and shingles.

The vaccine works differently than Pfizer’s and Moderna’s messenger RNA vaccines but achieves the same outcome: teaching your body how to fight Covid.

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Could the COVID pandemic have been avoided if China were a democracy?

By Oliver St. John, Founder and Public Affairs Manager, IAD

Not only could China have potentially prevented the global coronavirus pandemic — its authoritarian regime is now also impeding our ability to learn from it, thereby increasing the risk of future pandemics, Oliver St. John writes.

Several weeks ago, the Director General of the World Health Organisation, Tedros Ghebreyesus, declared “an end to COVID-19 as a public health emergency”. 

It is now more than three and a half years since the first case of COVID-19 was reported in China, and it is still unclear how the pandemic started. 

It is imperative that we now redouble efforts to determine how the pandemic started and how it could have been avoided, so we can prevent future pandemics. 

One important aspect that has not been given consideration is whether the nature of authoritarian regimes fosters public health emergencies such as COVID-19.

China’s authoritarian regime severely curtails many of the fundamental freedoms which citizens in democracies take for granted. 

The suppression of freedom of expression, in particular, hinders independent research, information sharing and freedom of the press. 

If China were a democracy, a political system in which freedom of expression and freedom of the press is indispensable, could it have been possible to contain the COVID-19 outbreak at an early stage, thus potentially avoiding the devastating global pandemic we experienced?

China’s freedom of speech crackdown didn’t help limit the spread

The pandemic has had an unprecedented negative impact on the lives of billions around the world and continues to affect us to this day. 

According to the WHO, there have been almost 7 million deaths due to COVID-19. 

And let us remember, these are only official numbers presented; authoritarian regimes such as China have not been transparent in their reporting. 

And this is not the first time that Beijing’s suppression of freedom of speech has fostered the spread of a coronavirus and sparked an international health crisis, as seen in the case of Dr Jiang Yanyong during the 2003 SARS epidemic.

It is, therefore, vital to understand whether China’s authoritarian system provides optimal conditions for deadly diseases to spread.

Arrests, detentions, and reprimands

The earliest case of COVID-19 is reported to have been detected on 17 November 2019, weeks before Chinese authorities acknowledged the virus. 

On 30 December 2019, a Chinese doctor, Li Wenliang, informed colleagues in a chat group about a novel virus, which resulted in Li being detained by police. 

Li, unfortunately, died of COVID-19 in February 2020. 

His death sparked demands on social media for freedom of speech in China; these demands were unsurprisingly censored by China’s repressive authorities.

Li was not an exception; it is thought that eight people were detained by police for sharing information about the COVID-19 outbreak.

Ai Fen is another doctor in Wuhan who was reprimanded for raising the alarm of a new virus in December 2019. 

Staff at Ai’s hospital were explicitly forbidden from sharing information relating to the virus.

Expert advice was ignored, too

Chinese officials initially ignored advice from experts and refused to acknowledge human-to-human transmission of the virus, allowing the virus to spread quickly. 

It took until 20 January 2020 for Chinese officials to finally acknowledge transmission between humans and until 23 January 2020 for a travel ban and quarantine to be imposed on Wuhan. 

That amounts to over two months between the detection of the virus and the implementation of measures.

The period between 17 November 2019 and 23 January 2020 was crucial. If experts in China had been free to voice their professional opinions and share their data and findings, and if the media had been allowed to report freely on these findings, appropriate action could have been taken earlier to contain the outbreak, which was initially limited to a small area. 

“We watched more and more patients come in as the radius of the spread of infection became larger,” Ai stated. 

In the lead-up to the Chinese Lunar New Year holiday, before the travel ban was finally implemented, around 5 million people are estimated to have travelled from Wuhan, the epicentre of the COVID-19 outbreak, thus allowing the virus to spread across China and ultimately, the globe.

We still don’t know how the pandemic started

The absence of independent research and information sharing under China’s authoritarian regime continues to affect us today. 

In the aftermath of a global pandemic that has claimed the lives of millions and affected billions, it is crucial to understand its origins, so we can prevent it from happening again. 

However, China’s authoritarian regime strikes again. 

More than three years after the outbreak of COVID-19, it is still unclear how the pandemic started. In April this year, a senior WHO official denounced China’s “lack of data disclosure” as “simply inexcusable”. 

Not only could China have potentially prevented the global COVID-19 pandemic — its authoritarian regime is now also impeding our ability to learn from it, thereby increasing the risk of future pandemics.

Things would have been different under a democratic regime

If China were a democracy, medical professionals and scientists would have been free to share information about the outbreak of COVID-19 without fear of repercussions. 

Journalists in China would have been free to report on the outbreak. Experts could have advised the government about how to stop the spread of the deadly virus.

Under these circumstances, the Chinese government would have had no other choice but to take action earlier. 

This could have prevented the virus from spreading outside of Wuhan. 

At least 7 million deaths could have been avoided and immeasurable suffering prevented if only the Chinese government weren’t afraid of the voices of its own citizens.

Oliver St. John is the Founder and Public Affairs Manager at the International Association for Democracy (IAD). At IAD, he leads the work on raising awareness about the challenges facing democracy around the world and on lobbying politicians to do more to promote and defend democracy.

At Euronews, we believe all views matter. Contact us at [email protected] to send pitches or submissions and be part of the conversation.

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RFK Jr. And Elon Musk: Two Great Dicks That Taste Like Sh*t!

Robert F. Kennedy Jr. sure has come a long way from 2014, when he angered fossil fuel lobbyists by saying that climate change deniers should be jailed. Or maybe not such a long way; by 2005 he was already spreading the anti-vax gospel and falsely claiming that childhood vaccines cause autism. And now he’s running for president and everyone is reminding you what a complete freakass whackaloon he is.

We’ll do our part. Hey, remember that long-ago time in 2022 when he said, of COVID vaccine mandates, that at least in Nazi Germany “you could cross the Alps into Switzerland, you could hide in an attic like Anne Frank did.”

Kennedy did his part to help out that educational endeavor Monday night by sitting down with chief Twitter troll Elon Musk, who seems to love conspiratorial bullshit nearly as much as Kennedy does. He started out by thanking Musk for ending all the terrible “censorship” on the platform — by making it a free-for all for COVID and vaccine disinformation, not to mention for Nazis, far-Right conspiracy theories, and rampant hatred of transgender people, but also by actually censoring people on behalf of authoritarian governments. Kennedy also explained that in 2021, “the government pressured Mark Zuckerberg” to ban him from Instagram, although now his account has been restored because he’s running for president. Talk about ineffective censorship!

Rolling Stone reports that for the first 40 minutes of the Twitter Spaces chat, Kennedy barely talked about his candidacy, because he and Musk were too busy telling each other how much they admired each other for being courageous and shit, which is honestly what free speech is for.

At one point, Kennedy asked where Musk got the courage to be like one of America’s Founders by being “willing to take this huge, massive, unspeakable economic hit on behalf of a principle for a country in which you weren’t even born?” Musk, who does kind of have US citizenship after all, replied, “I should say I do very much consider myself an American.” Musk also acknowledged that advertisers had deserted the platform because he was so very committed to democracy, at least for people who think he’s cool, so it’s been “frankly a struggle to break even” (he is not breaking even) and then everyone with an $8 blue checkmark felt very warm that they had done their part to save America and/or Twitter.

After they both agreed that free speech is the very best, and that they both really love free speech the most, Kennedy bemoaned the sad fact that “we’re no longer living in a democratic system,” because Big Pharma controls the government and silences brave advocates of medical disinformation, which would explain why we only hear from anti-vaxxers everywhere on social media but not yet in (most) doctors’ offices.

Among other great trolls, Musk and Kennedy were joined by Tulsi Gabbard and Michael Shellenberger, author of books about how environmentalism is bad for everyone and global warming is happening but is honestly no big deal, yeesh, calm down. UPDATE/CORRECTION: I initially had a brain fart and confused Shellenberger with a different “contrarian” dipshit, Alex Berenson, formerly of the New York Times. Wonkette regrets the error.

Kennedy and Musk agreed that America shouldn’t be supporting the Ukrainian government, since as Kennedy put it, the Ukrainian people are “almost equally” victimized by America as by Russians. Musk added that the war was kind of our fault anyway, since “We are sending the flower of Ukrainian youth and Russian youth to die in the trenches, and it’s morally reprehensible,” and when you think about it, we probably shouldn’t be ordering Russia’s youth flowers around like that, how would we like it huh?

The conversation got even more sane when Gabbard added that

the U.S. had turned Ukraine into a “slaughterhouse” and blamed the conflict on an “elitist cabal of war-mongers” who had seized control of the Democratic Party.

Those war-mongers, Kennedy warned, hadn’t just taken control of the Democratic party: They were in control of the Deep State as well.

He recalled being told by Donald Trump’s former CIA Director Mike Pompeo that the “top layer of that agency is made up almost entirely of people who do not believe in the American institutions of democracy,” which is pretty rich coming from a top guy in the Trump administration.

Kennedy also said he opposed an assault weapons ban, because the Second Amendment is pretty awesome, and anyway, the problem isn’t guns, it’s antidepressant meds, which turn people into mass shooters, explaining that

“prior to the introduction of Prozac, we had almost none of these events in our country. […] The one thing that we have, it’s different than anybody in the world, is the amount of psychiatric drugs our children are taking.” He then alleged that the National Institutes of Health won’t research the supposed link between these drugs and shootings “because they’re working with the pharmaceutical industry.”

It’s pretty convincing until you remember that antidepressants are prescribed worldwide, but in countries where there aren’t more guns than people, there aren’t a bunch of school shootings. Also, maybe someone could have pointed out that only about a quarter of mass shooters use antidepressants, while 100 percent of them use firearms, albeit not usually with a doctor’s prescription.

Along the way, Kennedy also insisted that COVID was a “bioweapon,” lied that after the passage of the Affordable Care Act the “Democrats were getting more money from pharma than Republicans” (it’s the other way around, according to STAT News, but then STAT News believes vaccines work), and promised to go to the US-Mexico border to “try to formulate policies that will seal the border permanently,” so he really sounds like the mainstream Democrat that everyone on the far Right has been looking for, the end and OPEN THREAD.

[Rolling Stone / Insider / NYT]

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Morning Digest: May 6, 2023

Army and Assam Rifles personnel during a flag march in violence-hit areas amid tribal groups’ protest over court order on Scheduled Tribe status, in Imphal, on May 5, 2023.
| Photo Credit: PTI

Central security forces flood crisis-hit Manipur

The Centre has “taken over” control of security in violence-hit Manipur on Friday by deploying 12 companies, comprising around 1,000 personnel, of the Border Security Force (BSF) and airlifting anti-riot vehicles to the northeastern State, even as stray incidents of violence and looting were reported from parts of the State. However, the Ministry of Home Affairs has denied promulgating Article 355.

Pakistan Foreign Minister a promoter, spokesperson of terror industry: Jaishankar

Calling Pakistan Foreign Minister Bilawal Bhutto Zardari a “promoter, justifier and spokesperson” of terrorism, External Affairs Minister S. Jaishankar on Friday hit out at Islamabad for its continued support to terror groups. Speaking at the end of the Shanghai Cooperation Organisation’s Council For Foreign Ministers (SCO-CFM) that he had chaired, Mr. Jaishankar said Indians felt “outrage” over a incident on Friday, referring to the firing in Rajouri in which five Indian soldiers were killed. The bilateral spat between both countries came even as the SCO Foreign Ministers’ meeting agreed to strengthen cooperation in a number of areas, including economic and technological spheres.

Sudan’s warring sides send envoys for talks in Saudi Arabia

Sudan’s two warring generals sent their envoys on May 5 to Saudi Arabia for talks aimed at firming up a shaky cease-fire after three weeks of fierce fighting that has killed hundreds and pushed the African country to the brink of collapse, three Sudanese officials said. According to the three — two senior military officials and one from their paramilitary rival — the talks will begin in the Saudi coastal city of Jeddah on Saturday.

Fresh firefight takes place at Rajouri encounter site in Jammu: Army

A fresh firefight between the security forces and hiding militants took place in the Kandi Forest area in Jammu division’s Rajouri on May 6. The Army said the security forces engaged the hiding militants in a firefight in the Kandi Forest area in Jammu’s Rajouri around 1:15 a.m. On Friday morning, the hiding militants detonated explosives and killed five soldiers immediately after contact was established with them during the combing operation.

Operation Kaveri wraps up with 3,862 Indians now home from Sudan

India on Friday wrapped up ‘Operation Kaveri’, launched to rescue its nationals stranded in crisis-hit Sudan, with the transport aircraft of the Indian Air Force making its final flight to bring 47 passengers home. India launched Operation Kaveri on April 24 to evacuate its nationals from Sudan, which has witnessed deadly fighting between the country’s army and a paramilitary group.

Border situation is ‘stable’, China’s Foreign Minister tells EAM Jaishankar

The situation along the India-China border is “generally stable” and both sides should “draw lessons from history”, visiting Chinese Foreign Minister Qin Gang told External Affairs Minister S. Jaishankar in talks on Thursday. Mr. Qin and other Chinese officials have described the border situation as being “stable” and moving to what they have called normalised management, and asked India to place the issue in an “appropriate” position in the relationship.

India at vanguard of digital revolution, its financial inclusion journey can be example for others: United Nations officials

India is at the vanguard of the digital revolution and its financial inclusion journey can be an example for other developing countries to look at, senior United Nations (UN) officials and economists have said. The discussion, organised by the Permanent Mission of India to the UN, aimed at bringing to centre stage the role of financial inclusion in achieving the Sustainable Development Goals.

All demands of wrestlers met, let police finish its probe: Sports Minister Anurag Thakur

Union Sports Minister Anurag Thakur on May 5 said that all demands of the wrestlers sitting on dharna in Delhi have been met and that they should let an unbiased probe be completed by Delhi Police. “It is my request to all the sportspersons who are agitating there that whatever their demands were, they were met. Court has also given its directions and they should let an unbiased probe be completed,” Mr. Thakur told reporters in New Delhi.

COVID-19 no longer a global emergency, says WHO

The World Health Organization said on May 5 that COVID-19 no longer qualifies as a global emergency, marking a symbolic end to the devastating coronavirus pandemic that triggered once-unthinkable lockdowns, upended economies worldwide and killed at least 7 million people worldwide. “It’s with great hope that I declare COVID-19 over as a global health emergency,” WHO Director-General Tedros Adhanom Ghebreyesus said. “That does not mean COVID-19 is over as a global health threat.”

PM Modi accepts French invite for Bastille Day celebration in Paris

Prime Minister Narendra Modi has accepted the invite from French President Emmanuel Macron to be the Guest of Honour at the Bastille Day Parade in Paris on July 14, in Paris, the Ministry of External Affairs announced on Friday. Mr. Modi’s presence in Paris is being described as a gesture of special significance as India and France are celebrating the 25 th anniversary of the strategic partnership, launched in 1998.

As Ukrainian attacks pick up inside Russia, the war is coming home for Putin

For months after the Ukraine war began, which Russia still calls a “special military operation”, many ordinary Russians, particularly those whose families were spared from the mobilisation, saw the conflict as something that’s happening far away from home. Not any more: with drones attacking the Kremlin, the seat of power in the Russian capital, just a few days before the Second World War Victory Day celebrations, the war is coming home for Russians.

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Morning Digest: May 5, 2023

External Affairs Minister S Jaishankar meets State Councillor and FM Qin Gang of China on the sidelines of the SCO Foreign Ministers’ Meeting, in Panaji, on May 4, 2023.
| Photo Credit: PTI

Jaishankar discusses LAC with Qin; holds talks with Lavrov, no talks with Bilawal Bhutto

The unresolved three-year old military stand-off at the Line of Actual Control (LAC) remained the “focus” of India-China talks as External Affairs Minister S. Jaishankar met with Chinese Foreign Minister Qin Gang here on May 4, and held a “detailed” discussion on bilateral ties. This is the second time the two Ministers have held talks this year, as Mr. Qin had previously attended the G-20 Foreign Ministers Meeting in Delhi in March. 

DRDO scientist arrested in Pune for providing secret information to Pakistani intelligence operative

A scientist working for the Defence Research and Development Organisation (DRDO) here has been arrested by the Maharashtra Anti-Terrorism Squad (ATS) for providing confidential information to a Pakistani agent, officials said. An offense under relevant sections of the Official Secrets Act has been registered with Kalachowki unit of the ATS in Mumbai and further probe is on, he added.

Many killed in Manipur riots; State government issues shoot-at-sight order

The Manipur government on May 4 issued a shoot-at-sight order in “extreme cases”, as escalating ethnic violence following a tribal solidarity march displaced more than 9,000 people in the State. There was no official confirmation of the number of people killed or injured in the violence, but Chief Minister Nongthombam Biren Singh admitted that “some precious lives were lost”.

Kamala Harris meets with tech CEOs about artificial intelligence risks

Vice President Kamala Harris met on May 4 with the heads of Google, Microsoft and two other companies developing artificial intelligence as the Biden administration rolls out initiatives meant to ensure the rapidly evolving technology improves lives without putting people’s rights and safety at risk.

After Dantewada attack, roads being combed for IEDs in Chhattisgarh

A week after ten security personnel were killed in Chhattisgarh’s Dantewada, a massive exercise is being undertaken to comb newly constructed roads for the presence of Improvised Explosive Devices (IEDs), a senior government official said. The April 26 incident on the Aranpur road in Dantewada, where ten District Reserve Guard (DRG) personnel of the Chhattisgarh police were killed, was the first of its kind in the region in the past five years.

Biden issues order setting path for sanctions in Sudan

President Joe Biden signed an executive order on May 4 setting the path to sanction individuals involved in the recent violence in Sudan that’s left hundreds dead and thrown the African nation into chaos. Sudan’s fighting broke out April 15 between two commanders who just 18 months earlier jointly orchestrated a military coup to derail the nation’s transition to democracy.

Delhi witnesses rare fog in the hottest month of the year, 3rd coldest May morning since 1901

Delhi saw an unusual episode of shallow fog on May 4 morning much to the bemusement of its residents, who are used to a less-happening, sultry weather this time of the year. Delhi is experiencing an unexpected pattern with cloudy skies, sporadic rain, and cool weather, which officials attribute to back-to-back western disturbances affecting northwest India.

The SARS-CoV-2 virus is here to stay, and countries need to manage it alongside other infectious diseases: WHO

The SARS-CoV-2 virus is here to stay, and countries need to manage it alongside other infectious diseases, said the World Health Organisation (WHO) issuing an updated ‘COVID-19 Global Strategic Preparedness, Readiness and Response Plan (SPRP) 2023-2025’ earlier this week. The latest update is WHO’s fourth strategic plan for COVID-19. The document is a guide for countries on how to manage COVID-19 over the next two years in the transition from an emergency phase to a longer-term, sustained response.

Calcutta High Court stays move to take part of Amartya Sen’s Shantiniketan land

Calcutta High Court on May 4 gave an interim stay against a move by Visva Bharati to take away a part of Nobel laureate Amartya Sen’s property — Pratichi — at Shantiniketan. Nobel laureate Amartya Sen moved the Calcutta High Court, seeking relief as the university had passed an order directing the petitioner to vacate 0.13 acres (5,500 sq ft) of land at his ancestral Santiniketan residence by May 6, even as an appeal for a stay on possible eviction was fixed for hearing on May 15, 2023 at a court in Suri in Birbhum district of West Bengal.

Russia says U.S. masterminded drone attack on Kremlin

Russia on Thursday accused the U.S. of masterminding a drone attack on the Kremlin and said sabotage attacks by Ukraine behind Russian lines had reached “unprecedented momentum”. The Kremlin has said Ukraine carried out the attack with two drones aiming to kill President Vladimir Putin — a charge which Kyiv has denied. “Decisions on such attacks are not made in Kyiv, but in Washington,” Kremlin spokesman Dmitry Peskov said.

President Droupadi Murmu rejects mercy petition of man convicted for raping, killing 4-year-old girl

President Droupadi Murmu has rejected the mercy petition of a man convicted for raping and stoning to death a four-year-old girl in Maharashtra in 2008, according to the Rashtrapati Bhavan. While upholding the death penalty awarded to the convict, the top court had said that the rape of a minor girl was “a monstrous burial of her dignity in darkness.” The court had referred to the sequence of events in the case and said that the convict, who was a neighbour, lured the girl, raped her and then battered her to death using two heavy stones.

Go First cancels all flights till May 9; suspends bookings till May 15

Budget airline Go First on Thursday extended flight cancellations until May 9 and informed the DGCA that it would not be taking any further bookings till May 15 on a day the National Company Law Tribunal (NCLT) reserved its judgment on the airline’s plea for insolvency proceedings and an interim moratorium on lessors re-possessing its planes. The airline’s CEO, Kaushik Khona, who was present at the NCLT hearing in Delhi told The Hindu that the total refunds for tickets booked directly through the airline amounted to “₹30-40 lakh”, in addition to which there were refunds for tickets bought through travel agents and web portals.

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As COVID Tracking Wanes, Are We Letting Our Guard Down Too Soon?

April 11, 2023 – The 30-second commercial, part of the government’s We Can Do This campaign, shows everyday people going about their lives, then reminds them that, “Because COVID is still out there and so are you,” it might be time to update your vaccine.

But in real life, the message that COVID-19 is still a major concern is muffled if not absent for many. Many data tracking sources, both federal and others, are no longer reporting, as often, the number of COVID cases, hospitalizations, and deaths. 

The U.S. Department of Health and Human Services (HHS) in February stopped updating its public COVID data site, instead directing all queries to the CDC, which itself has been updating only weekly instead of daily since last year

Nongovernmental sources, such as John Hopkins University, stopped reporting pandemic data in March, The New York Times also ended its COVID data-gathering project last month, stating that “the comprehensive real-time reporting that The Times has prioritized is no longer possible.” It will rely on reporting weekly CDC data moving forward. 

Along with the tracking sites, masking and social distancing mandates have mostly disappeared. President Joe Biden signed a bipartisan bill on Monday that ended the national emergency for COVID. While some programs will stay in place for now, such as free vaccines, treatments, and tests, that too will go away when the federal public health emergency  expires on May 11. The HHS already has issued its transition roadmap. 

Many Americans, meanwhile, are still on the fence about the pandemic. A Gallup poll from March shows that about half of the American public says it’s over, and about half disagree. 

Are we closing up shop on COVID-19 too soon, or is it time? Not surprisingly, experts don’t agree. Some say the pandemic is now endemic – which broadly means the virus and its patterns are predictable and steady in designated regions – and that it’s critical to catch up on health needs neglected during the pandemic, such as screenings and other vaccinations

But others don’t think it’s reached that stage yet, saying that we are letting our guard down too soon and we can’t be blind to the possibility of another strong variant – or pandemic – emerging. Surveillance must continue, not decline, and be improved.

Time to Move On?

In its transition roadmap released in February, the HHS notes that daily COVID reported cases are down over 90%, compared to the peak of the Omicron surge at the end of January 2022; deaths have declined by over 80%; and new hospitalizations due to COVID have dropped by nearly 80%.

It is time to move on, said Ali Mokdad, PhD, a professor and chief strategy officer of population health at the Institute for Health Metrics and Evaluation at the University of Washington. 

“Many people were delaying a lot of medical care, because they were afraid” during COVID’s height, he said, explaining that elective surgeries were postponed, prenatal care went down, as did screenings for blood pressure and diabetes.

His institute was tracking COVID projections every week but stopped in December.

As for emerging variants, “we haven’t seen a variant that scares us since Omicron” in November 2021, said Mokdad, who agrees that COVID is endemic now. The subvariants that followed it are very similar, and the current vaccines are working. 

“We can move on, but we cannot drop the ball on keeping an eye on the genetic sequencing of the virus,” he said. That will enable quick identification of new variants.

If a worrisome new variant does surface, Mokdad said, certain locations and resources will be able to gear up quickly, while others won’t be as fast, but overall the U.S. is in a much better position now. 

Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore, also believes the pandemic phase is behind us

“This can’t be an emergency in perpetuity,” he said “Just because something is not a pandemic [anymore] does not mean that all activities related to it cease.”

COVID is highly unlikely to overwhelm hospitals again, and that was the main reason for the emergency declaration, he said. 

“It’s not all or none — collapsing COVID-related [monitoring] activities into the routine monitoring that is done for other infectious disease should be seen as an achievement in taming the virus,” he said.

Not Endemic Yet

Closing up shop too early could mean we are blindsided, said Rajendram Rajnarayanan, PhD, an assistant dean of research and associate professor at the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University in Jonesboro. 

Already, he said, large labs have closed or scaled down as testing demand has declined, and many centers that offered community testing have also closed. Plus, home test results are often not reported.

Continued monitoring is key, he said. “You have to maintain a base level of sequencing for new variants,” he said. “Right now, the variant that is ‘top dog’ in the world is XBB.1.16.” 

That’s an Omicron subvariant that the World Health Organization is currently keeping its eye on, according to a media briefing on March 29. There are about 800 sequences of it from 22 countries, mostly India, and it’s been in circulation a few months. 

Rajnarayanan said he’s not overly worried about this variant, but surveillance must continue. His own breakdown of XBB.1.16 found the subvariant in 27 countries, including the U.S., as of April 10.   

Ideally, Rajnarayanan would suggest four areas to keep focusing on, moving forward:

  • Active, random surveillance for new variants, especially in hot spots
  • Hospital surveillance and surveillance of long-term care, especially in congregate settings where people can more easily spread the virus
  • Travelers’ surveillance, now at seven U.S. airports, according to the CDC
  • Surveillance of animals such as mink and deer, because these animals can not only pick up the virus, but the virus can mutate in the animals, which could then transmit it back to people 

With less testing, baseline surveillance for new variants has declined. The other three surveillance areas need improvement, too, he said, as the reporting is often delayed. 

Continued surveillance is crucial, agreed Katelyn Jetelina, PhD, an epidemiologist and data scientist who publishes a newsletter, Your Local Epidemiologist, updating developments in COVID and other pressing health issues. 

“It’s a bit ironic to have a date for the end of a public health emergency; viruses don’t care about calendars,” said Jetelina, who is also director of population health analytics for the Meadows Mental Health Policy Institute“COVID-19 is still going to be here, it’s still going to mutate,” she said, and still cause grief for those affected. “I’m most concerned about our ability to track the virus. It’s not clear what surveillance we will still have in the states and around the globe.” 

For surveillance, she calls wastewater monitoring “the lowest-hanging fruit.” That’s because it “is not based on bias testing and has the potential to help with other outbreaks, too.” Hospitalization data is also essential, she said, as that information is the basis for public health decisions on updated vaccines and other protective measures.

While Jetelina is hopeful that COVID will someday be universally viewed as endemic, with predictable seasonal patterns, “I don’t think we are there yet. We still need to approach this virus with humility; that’s at least what I will continue to do.”

Rajnarayanan agreed that the pandemic has not yet reached endemic phase, though the situation is much improved.  “Our vaccines are still protecting us from severe disease and hospitalization, and [the antiviral drug] Paxlovid is a great tool that works.”

Keeping Tabs

While some data tracking has been eliminated, not all has, or will be. The CDC, as mentioned, continues to post cases, deaths, and a daily average of new hospital admissions weekly. The World Health Organization’s dashboard tracks deaths, cases, and vaccine doses globally. 

In March, the WHO updated its working definitions and tracking system for SARS-CoV-2 variants of concern and variants of interest, with goals of evaluating the sublineages independently and to classify new variants more clearly when that’s needed. 

Still, WHO is considering ending its declaration of COVID as a public health emergency of international concern sometime this year.

Some public companies are staying vigilant. The drugstore chain Walgreens said it plans to maintain its COVID-19 Index, which launched in January 2022. 

“Data regarding spread of variants is important to our understanding of viral transmission and, as new variants emerge, it will be critical to continue to track this information quickly to predict which communities are most at risk,” Anita Patel, PharmD, vice president of pharmacy services development for Walgreens, said in a statement.   

The data also reinforces the importance of vaccinations and testing in helping to stop the spread of COVID-19, she said.

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Doctor’s Checklist for Treating Long COVID Patients

April 4, 2023 – Lisa McCorkell had a mild bout of COVID-19 in March 2020. Young and healthy, she assumed that she would bounce back quickly. But when her fatigue, shortness of breath, and brain fog persisted, she realized that she most likely had long COVID. 

“Back then, we as patients basically coined the term,” she said. While her first primary care provider was sympathetic, they were unsure how to treat her. After her insurance changed, she ended up with a second primary care provider who didn’t take her symptoms seriously. “They dismissed my complaints and told me they were all in my head. I didn’t seek care for a while after that.”

McCorkell’s symptoms improved after her first COVID vaccine in the spring of 2021. She also finally found a new primary care doctor she could trust. But as one of the founders of the Patient-Led Research Collaborative, a group of researchers who study long COVID, she says many doctors still don’t know the hallmark symptoms of the condition or how to treat it. 

“There’s still a lack of education on what long COVID is, and the symptoms associated with it,” she said. “Many of the symptoms that occur in long COVID are symptoms of other chronic conditions, such as myalgic encephalomyelitis / chronic fatigue syndrome, that are often dismissed. And even if providers believe patients and send them for a workup, many of the routine blood and imaging tests come back normal.

The term “long COVID” emerged in May 2020. And though the condition was recognized within a few months of the start of the pandemic, doctors weren’t sure how to screen or treat it. 

While knowledge has developed since then, primary care doctors are still in a tough spot. They’re often the first providers that patients turn to when they have symptoms of long COVID. But with no standard diagnostic tests, treatment guidelines, standard care recommendations, and a large range of symptoms the condition can produce, doctors may not know what to look for, nor how to help patients.

“There’s no clear algorithm to pick up long COVID – there are no definite blood tests or biomarkers, or specific things to look for on a physical exam,” said Lawrence Purpura, MD, an infectious disease specialist and director of the long COVID clinic at Columbia University Medical Center in New York City. “It’s a complicated disease that can impact every organ system of the body.”

Even so, emerging research has identified a checklist of sorts that doctors should consider when a patient seeks care for what appears to be long COVID. Among them:

  • The key systems and organs impacted by the disease
  • The most common symptoms
  • Useful therapeutic options for symptom management that have been found to help people with long COVID
  • The best heathy lifestyle choices that doctors can recommend to help their patients 

Here’s a closer look at each of these aspects, based on research and interviews with experts, patients, and doctors. 

Key Systems, Organs Impacted                                                                                                 

At least 10% of people who are infected with COVID-19 go on to have long COVID, according to a recent study that McCorkell helped co-author. But more than 3 years into the pandemic, much about the condition is still a mystery. 

COVID is a unique virus because it can spread far and wide in a patient’s body. A December 2022 study, published in the journal Nature, autopsied 44 people who died of COVID and found that the virus could spread throughout the body and persist, in one case as long as 230 days after symptoms started

“We know that there are dozens of symptoms across multiple organ systems,” said McCorkell. “That makes it harder for a primary care physician to connect the dots and associate it with COVID.”

A paper published last December in Nature Medicine proposed one way to help guide diagnosis. It divided symptoms into four groups: 

  • Cardiac and renal issues such as heart palpitations, chest pain, and kidney damage
  • Sleep and anxiety problems like insomnia, waking up in the middle of the night, and anxiety
  • In the musculoskeletal and nervous systems: musculoskeletal pain, osteoarthritis, and problems with mental skills
  • In the digestive and respiratory systems: trouble breathing, asthma, stomach pain, nausea, and vomiting

There were also specific patterns in these groups. People in the first group were more likely to be older, male, have other conditions and to have been infected during the first wave of the COVID pandemic. People in the second group were over 60% female, and were more likely to have had previous allergies or asthma. The third group was also about 60% female, and many of them already had autoimmune conditions such as rheumatoid arthritis. Members of the fourth group – also 60% female – were the least likely of all the groups to have another condition.

This research is helpful, because it gives doctors a better sense of what conditions might make a patient more likely to get long COVID, as well as specific symptoms to look out for, said Steven Flanagan, MD, a physical medicine and rehabilitation specialist at NYU Langone Medical Center who also specializes in treating patients with long COVID. 

But the “challenge there, though, for health care providers is that not everyone will fall neatly into one of these categories,” he stressed.

Checklist of Symptoms 

Although long COVID can be confusing, doctors say there are several symptoms that appear consistently that primary care providers should look out for, that could flag long COVID. They include:

Post-exertional malaise (PEM). This is different from simply feeling tired. “This term is often conflated with fatigue, but it’s very different,” said David Putrino, PhD, director of rehabilitation innovation at the Mount Sinai Health System in New York City, who says that he sees it in about 90% of patients who come to his long COVID clinic. 

PEM is the worsening of symptoms after physical or mental exertion. This usually occurs a day or two after the activity, but it can last for days, and sometimes weeks. 

“It’s very different from fatigue, which is just a generalized tiredness, and exercise intolerance, where someone complains of not being able to do their usual workout on the treadmill,” he noted. “People with PEM are able to push through and do what they need to do, and then are hit with symptoms anywhere from 12 to 72 hours later.”

Dysautonomia. This is an umbrella term used to describe a dysfunction of the autonomic nervous system, which regulates bodily functions that you can’t control, like your blood pressure, heart rate, and breathing. This can cause symptoms such as heart palpitations, along with orthostatic intolerance, which means you can’t stand up for long without feeling faint or dizzy. 

“In my practice, about 80% of patients meet criteria for dysautonomia,” said Putrino. Other research has found that it’s present in about two-thirds of long COVID patients.

One relatively easy way primary care providers can diagnose dysautonomia is to do the tilt table test. This helps check for postural orthostatic tachycardia syndrome (POTS), one of the most common forms of dysautonomia. During this exam, the patient lies flat on a table. As the head of the table is raised to an almost upright position, their heart rate and blood pressure are measured. Signs of POTS include an abnormal heart rate when you’re upright, as well as a worsening of symptoms.

Exercise intolerance. A 2022 review published in the journal JAMA Network Open analyzed 38 studies on long COVID and exercise and found that patients with the condition had a much harder time doing physical activity. Exercise capacity was reduced to levels that would be expected about a decade later in life, according to study authors

“This is especially important because it can’t be explained just by deconditioning,” said Purpura. “Sometimes these patients are encouraged to ramp up exercise as a way to help with symptoms, but in these cases, encouraging them to push through can cause post-exertional malaise, which sets patients back and delays recovery.”

While long COVID can cause dozens of symptoms, a paper McCorkell co-authored zeroed in on some of the most common ones:

  • Chest pain
  • Heart palpitations
  • Coughing
  • Shortness of breath
  • Belly pain
  • Nausea
  • Problems with mental skills
  • Fatigue
  • Disordered sleep
  • Memory loss
  • Ringing in the ears (tinnitus)
  • Erectile dysfunction
  • Irregular menstruation
  • Worsened premenstrual syndrome

While most primary care providers are familiar with some of these long COVID symptoms, they may not be aware of others. 

“COVID itself seems to cause hormonal changes that can lead to erection and menstrual cycle problems,” explained Putrino. “But these may not be picked up in a visit if the patient is complaining of other signs of long COVID.” 

It’s not just what symptoms are, but when they began to occur, he added. 

“Usually, these symptoms either start with the initial COVID infection, or begin sometime within 3 months after the acute COVID infection. That’s why it’s important for people with COVID to take notice of anything unusual that crops up within a month or two after getting sick.”

Can You Prevent Long COVID?

You can reduce your risk by taking preventive measures such as wearing a mask, keeping your distance from others in crowded indoor settings, and getting vaccinated. Getting at least one dose of a COVID vaccine before you test positive for COVID lowers your risk of long COVID by about 35% according to a 2022 study published in Antimicrobial Stewardship & Healthcare Epidemiology. Unvaccinated people who recovered from COVID, and then got a vaccine, lowered their own long COVID risk by 27%

In addition, a February study published in JAMA Internal Medicine found that women who were infected with COVID were less likely to go on to get long COVID and/or have less debilitating symptoms if they had a healthy lifestyle, which included the following: 

  • Healthy weight (a BMI between 18.5 and 24.7)
  • Never smoker
  • Moderate alcohol consumption
  • A high-quality diet
  • Seven to 9 hours of sleep a night
  • At least 150 minutes per week of physical activity

But McCorkell noted that she herself had a healthy pre-infection lifestyle but got long COVID anyway, suggesting these approaches don’t work for everyone.

“I think one reason my symptoms weren’t addressed by primary care physicians for so long is because they looked at me and saw that I was young and healthy, so they dismissed my reports as being all in my head,” she explained. “But we know now anyone can get long COVID, regardless of age, health status, or disease severity. That’s why it’s so important that primary care physicians be able to recognize symptoms.”

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Bias, Lack of Access Make Long COVID Worse for Patients of Color

March 28, 2023 – Over and over, Mesha Liely was told that it was all in her head. That she was just a woman prone to exaggeration. That she had anxiety. That she simply needed to get more rest and take better care of herself. 

The first time an ambulance rushed her to the emergency room in October 2021, she was certain something was seriously wrong. Her heart raced, her chest ached, she felt flushed, and she had numbness and tingling in her arms and legs. And she had recently had COVID-19. But after a 4-day hospital stay and a battery of tests, she was sent home with no diagnosis and told to see a cardiologist. 

More than a dozen trips to the emergency room followed over the next several months. Liely saw a cardiologist and several other specialists: a gastroenterologist; an ear, nose, and throat doctor; a vascular doctor; and a neurologist. She got every test imaginable. But she still didn’t get a diagnosis. 

“I believe more times than not, I was dismissed,” said Liely, 32, who is Black. “I am female. I am young. I am a minority. The odds are up against me.”

By the time she finally got a diagnosis in May 2022, she felt like a bobble-head with weakness in her arms and legs, rashes and white patches of skin along the right side of her body, distorted vision, swelling and discomfort in her chest, and such a hard time with balance and coordination that she often struggled to walk or even stand up.

“I was in a wheelchair when the doctor at Hopkins told me I had long COVID,” Liely said. “I just broke down and cried. The validation was the biggest thing for me.”

Stark racial and ethnic disparities in who gets sick and who receives treatment have been clear since the early days of the pandemic. Black and Hispanic patients were more likely to get COVID than white people, and, when they did get sick, they were more likely to be hospitalized and more apt to die.

Now, an emerging body of evidence also suggests that Black and Hispanic patients are also more likely to have long COVID – and more likely to get a broader range of symptoms and serious complications when they do. 

One study recently published this year in the Journal of General Internal Medicine followed more than 62,000 adults in New York City who had COVID between March 2020 and October 2021. Researchers tracked their health for up to 6 months, comparing them to almost 250,000 people who never had COVID. 

Among the roughly 13,000 people hospitalized with severe COVID, 1 in 4 were Black and 1 in 4 were Hispanic, while only 1 in 7 were white, this study found. After these patients left the hospital, Black adults were much more likely than white people to have headaches, chest pain, and joint pain. And Hispanic patients were more apt to have headaches, shortness of breath, joint pain, and chest pain.

There were also racial and ethnic disparities among patients with milder COVID cases. Among people who weren’t hospitalized, Black adults were more likely to have blood clots in their lungs, chest pain, joint pain, anemia, or be malnourished. Hispanic adults were more likely than white adults to have dementia, headaches, anemia, chest pain, and diabetes. 

Yet research also suggests that white people are more likely to get diagnosed and treated for long COVID. A separate study published this year in the journal BMC Medicine offers a profile of a typical long COVID patient receiving care at 34 medical centers across the country. And these patients are predominantly white, affluent, well-educated, female, and living in communities with great access to health care. 

While more Black and Hispanic patients may get long COVID, “having symptoms of long COVID may not be the same as being able to get treatment.,” said Dhruv Khullar, MD, lead author of the New York City study and a doctor and assistant professor of health policy and economics at Weill Cornell Medical College in New York City.

Many of the same issues that made many Black and Hispanic patients more vulnerable to infection during the pandemic may now be adding to their limited access to care for long COVID, Khullar said. 

Nonwhite patients were more apt to have hourly jobs or be essential workers without any ability to telecommute to avoid COVID during the height of the pandemic, Khullar said. They’re also more likely to live in close quarters with family members or roommates and face long commutes on public transit, limiting their options for social distancing. 

“If people that are going out of the home that are working in the subways or grocery stores or pharmacies or jobs deemed essential were disproportionately Black or Hispanic, they would have a much higher level of exposure to COVID than people who could work from home and have everything they needed delivered,” Khullar said. 

Many of these hourly and low-wages workers are also uninsured or underinsured, lack paid sick time, struggle with issues like child care and transportation when they need checkups, and have less disposable income to cover copays and other out-of-pocket fees, Khullar said. “They can get access to acute urgent medical care, but it’s very hard for a lot of people to access routine care like you would need for long COVID,” Khullar says.

These longstanding barriers to care are now contributing to more long COVID cases – and worse symptoms – among Black and Hispanic patients, said Alba Miranda Azola, MD, co-director of the Post-Acute COVID-19 Team at Johns Hopkins University School of Medicine in Baltimore. 

“They basically push through their symptoms for too long without getting care either because they don’t see a doctor at all or because the doctor they do see doesn’t do anything to help” said Azola, who diagnosed Mesha Liely with long COVID. “By the time they get to me, their symptoms are much worse than they needed to be.”

In many ways, Liely’s case is typical of the Black and Hispanic patients Azola sees with long COVID. “It’s not unusual for patients have 10 or even 15 visits to the emergency room without getting any help before they get to me,” Azola said. “Long COVID is poorly understood and underdiagnosed and they just feel gaslit.”

What sets Liely apart is that her job as 911 operator comes with good health benefits and easy access to care. 

“I started to notice a pattern where when I go to the ER and my co-workers are there or I am in my law enforcement uniform, and everyone is so concerned and takes me right back,” she recalled. “But when I would go dressed in my regular clothing, I would be waiting 8 to 10 hours and nobody would acknowledge me, or they would ask if I was just here to get pain medicines.”

Liely can easily see how other long COVID patients who look like her might never get diagnosed at all. “It makes me mad but doesn’t surprise me,” she says. 

After months of long COVID treatment, including medications for heart issues and muscle weakness as well as home health care, occupational therapy, and physical therapy, Liely went back to work in December. Now, she has good days and bad days. 

“On the days I wake up and feel like I’m dying because I feel so bad, that’s when I really think it didn’t need to be like this if only I had been able to get somebody to listen to me sooner,” she said.

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‘We’re Struggling’: Long COVID Mystery Has Doctors in the Dark

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

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

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

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

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

he lay press and turned into clickbait. 

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

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

Long COVID: What Is It?   

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

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

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

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

How to Distinguish Long COVID From Other Conditions

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

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

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

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

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

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

Control Groups in Studies Are Key

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

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

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

Identifying Risk Factors

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

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

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

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

Role of Antivirals and Vaccines 

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

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

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

 Long COVID and Other Infectious Diseases 

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

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

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

Where to Go From Here: A Research Agenda

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

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

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

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

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

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