Amala Akkineni: Cinema is no longer about one person producing a masterpiece

Amala Akkineni: Cinema is no longer about one person producing a masterpiece

Post By Entertainment Akkineni Nageswara Rao, Amala Akkineni, Annapurna College of Film and Media, Annapurna Studio, film school, Kanam, Oke Oka Jeevitham, pandemic, screenwriting, Virtual Production Stage

Amala Akkineni
| Photo Credit:
Special Arrangement

It’s been eight years since Amala Akkineni took over as director of Annapurna College of Film and Media (ACFM), Hyderabad. She has been privy to changes in the entertainment sector with the scope to make shorts, feature films, web series and documentaries for theatrical release as well as streaming platforms. The film school is working towards getting its students to work with AI (artificial intelligence) and the virtual production stage. In an interview (video at www.thehindu.com) at her office, she takes stock of what these changes mean for aspiring filmmakers and what needs to change.

In 2015, Amala had observed that film education was a niche category as parents were hesitant to send their children to a film school, citing the unpredictable nature of work. That mindset has not changed drastically, she admits; medicine and engineering remain the preferred courses. However, she has observed more enthusiasm among second and third-generation film families to seek formal training. “They take to the curriculum like fish to water,” Amala says, mentioning how sons and daughters of cinematographers, sound engineers and other technical departments enrol for ACFM courses.

Amala cites a report (‘South India: Setting Benchmarks for the Nation in Media and Entertainment’ by Team MCube Insights) presented at the recent Confederation of Indian Industry Dakshin conference that reveals the South Indian entertainment and media sector has grown by 33% in 2022. “There is a need for trained film professionals now more than ever before since the corporates are stepping in. The corporate sector is particular about where you train, who are your mentors, whether you can work within a budget, and so on. All this comes with learning the basics.”

ANR Virtual Production Stage

Annapurna Studios recently announced the setting up of the ANR (Akkineni Nageswara Rao) Virtual Production Stage in association with Qube Cinema.

A virtual production stage combines physical and virtual productions and eliminates the green screen, which is now used by film units to shoot sequences that require visual effects to be added in the post production stage.

Imagine a filmmaker who wants to shoot a cyclone or a mountain range sequence. A 3D virtual projection of the required images (generated with the help of software) appears on the LED screen (curved, 20 feet tall and 60 feet wide) in the background while the actors are in the foreground. The resulting footage makes it appear as though the actors are in the environment.

Soon after the first lockdown, there was a surge in demand in the Telugu entertainment space for equipment and technicians to shoot feature films, web series and television shows, given the increased appetite of the audience for the content. Amala says it was a wake-up call. “The world had larger issues to deal with. Those in the entertainment industry were grateful for the opportunity to return to work. Everyone learnt to work with smaller crews, budgets and complete filming within a stipulated time. The OTT platforms that had begun to make inroads 10 years ago further established their markets. Filmmakers and technicians reinvented and re-organised themselves.” As for the film school, she mentions how at least 50 industry practitioners who were busy earlier were available to conduct online sessions. “Once the studios reopened, the students could apply theory into practice.”

Shree Karthick and Amala Akkineni on the sets of ‘Kanam’/’Oke Oka Jeevitham’
| Photo Credit:
Special Arrangement

While technical departments such as cinematography, sound design, visual effects, animation and editing are considered areas that require formal training, some aspirants feel that screenwriting and direction can be learnt intuitively, on the job. Drawing from her experience of having worked with generations of writers in different languages, Amala says, “It is the writer’s mind that produces the story. Good training imparts not just the process but also mentors young minds to write with depth rather than recreate ideas that they have observed in other movies. It is no longer about one writer or director producing a masterpiece; writers’ groups have taken over where each writer analyses a story from different angles. Representation is also brought in where necessary. If a character is that of a mature woman, a woman of that age group is consulted to help the writing be more authentic.”

She adds that students enter an institute at the age of 17 or 18 when they are still too young to be able to write or direct with maturity. She recalls a few filmmakers confiding in her how they felt lost on a film set, unfamiliar with the terms and way of work. After a formal course, they returned to the sets more confident.

A glimpse of the possibilities using ANR Virtual Production Stage
| Photo Credit:
Annapurna Studios

She explains that each year, the curriculum goes through changes with the inputs of the in-house academic council and the JNAFAU (Jawaharlal Nehru Architecture and Fine Arts University)’s advisory board. For instance, the board and the faculty observed that students who have grown up in an urban atmosphere have less exposure to rural culture and issues. Students had become familiar with filming in controlled environments but were less prepared for outdoor filming that comes with several challenges. Hence there has been more emphasis on filming in real-life outdoor situations and rural pockets.

Before she took up the responsibility at the film school, Amala had more or less stepped back from acting after director Sekhar Kammula’s Life is Beautiful (2012), barring a fleeting cameo in Manam (2014). Her later projects — Karwaan (Hindi), Kanam/Oke Oka Jeevitham (Tamil-Telugu bilingual), High Priestess (Telugu web series) and C/O Saira Banu (Malayalam) — gave her a ringside view of how the younger filmmakers worked. About her last film Kanam/Oke Oka Jeevitham, she says, “Shree Karthick was an ad filmmaker who was making his first film and the story (of the lead actor stepping into a time machine to revisit his mother) touched me. I was curious how a first-time director will pull this off. He was precise and meticulous in his preparation. On the sets, he would play specific ragas to get us into the mood of the scene that was to be filmed.”

Amala Akkineni
| Photo Credit:
Thulasi Kakkat

Similarly, theatre personality Akarsh Khurana was stepping into a new zone with the film Karwaan, and Pushpa Ignatius was taking on a web series for the first time. Amala says she uses these occasional acting assignments to observe new-gen filmmakers and impart those learnings at the film school. “All these films were small budget ventures. When a film graduate completes studies, he or she is more likely to work with smaller budgets and has to be quick and efficient, with bound scripts. There is no time to second guess on a set. The filmmaker and technicians need to be efficient. I was observing all this in front of me.”

Reflecting on her acting career, since the time she debuted in 1986 with the Tamil film Mythili Ennai Kadhali, as an untrained actor, she says Bharatanatyam inculcated in her the discipline to show up and work on cue every single day. “Dance expressions tend to be exaggerated as opposed to acting for cinema. My directors, including my first director T. Rajender, told me that they would teach me. And they did.” In the first few films, all she could hear was the whirring sound of the camera and other equipment, the bright lights and a motley crew staring at her. This was starkly different from being on stage and performing in front of a bigger audience. “My dance training taught me to take up a task, break it into small steps and complete them one by one. By the time I worked in Pushpak, I had gotten over my anxiety and fear of the camera.”

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#Amala #Akkineni #Cinema #longer #person #producing #masterpiece

Supreme Court: You Owe Your Soul To The Student Debt Store

Post By Politics alexander taylor, dissent, education department, elena kagan, EPA, heroes act, idr account adjustment, income driven repayment, Joe Biden, john roberts, kagan dissent, Ketanji Brown Jackson, missouri, missouri higher education loan authority, mohela, myra brown, Nebraska, pandemic, secretary of education, sonia sotomayor, standing, state of emergency, student debt, student loan defaults, student loan forgiveness, supreme court, supreme court cancels student debt relief, waivers and modifications

The US Supreme Court today tossed out President Joe Biden’s student loan forgiveness plan (Washington Post gift link), ruling in a 6-3 decision that Biden lacked the authority to order the debt forgiveness plan without an explicit bill from Congress.

As you’ll recall, Biden announced last August a plan for the Education Department to forgive up to $10,000 for millions of borrowers in federal student loan programs, or up to $20,000 for folks who’d received Pell grants while in college. As many as 40 million Americans would have benefited from the plan. The loan forgiveness program was limited to people with incomes under $125,000 a year for an individual or $250K for a married couple, although relatively few borrowers met that upper limit anyway. The administration estimated that 90 percent of the loan forgiveness would go to borrowers making less than $75,000 a year.

Previously!

Supreme Court ‘Skeptical’ Of Student Debt Relief, If You Can Believe That!

What Good Arguments Will Supreme Court Ignore In Student Debt Relief Case?

Look At These Twerps Who Ruined Student Loan Forgiveness For Everybody

Joe Biden CANCEL CULTURES Student Debt! So How Do You Get You Some Of That?

Here’s Joe Biden To Tell You How He’ll Cancel Assloads Of Student Debt!

Almost as soon as Biden stepped away from the podium and the TV cameras switched off, rightwing groups started filing lawsuits to overturn the debt relief plan. Quite a few fizzled out as federal courts decided the plaintiffs lacked standing, because even if plaintiffs resented someone else having some of their debt forgiven, that’s hardly proof that they were harmed themselves. The Court actually decided two cases on the debt forgiveness program today, throwing out one for lack of standing but deciding in the other that Biden didn’t have the authority to forgive loans under the 2003 HEROES Act, which enables the Education Department to waive student debt obligations during times of national emergency.

Standing: You’re Grounded!

One set of plaintiffs in the case, Alexander Taylor and Myra Brown, claimed that they had been harmed because their loans didn’t qualify for debt relief — in Taylor’s case, because he didn’t qualify for the upper limit of the debt forgiveness and in Brown’s because her loans were privately held. They argued the Education Department didn’t follow proper procedures in setting up the debt forgiveness program, but the Court held today that they lacked standing, so tough nuggets, kids, and welcome to the dubious fame of being a judicial footnote.

Surprisingly, though, the Supremes agreed that the other plaintiffs, a group of six states led by Nebraska, did have standing, however sloppy the argument was. One or the six, Missouri, argued that its nonprofit state agency that services student loans nationwide, the “Missouri Higher Education Loan Authority,” aka MOHELA, would surely lose revenue because of the debt forgiveness. It’s a weird argument, because as was pointed out in oral arguments, MOHELA is a legally separate entity from the state of Missouri, and MOHELA did not join the lawsuit.

In his decision in Biden et al. v. Nebraska et al., Chief Justice John Roberts et all Missouri’s arguments, including the claim that MOHELA would lose out on $44 million a year in fees on the cancelled debt. Mind you, that’s a bit of a fiction too, since it assumes all those borrowers will pay their outstanding loans, when many will just say the hell with it and default. Roberts brushed right past the claim that MOHELA is a separate entity, citing a couple precedents that we aren’t going to chase down, and insisting that

where a State has been harmed in carrying out its responsibilities, the fact that it chose to exercise its authority through a public corporation it created and controls does not bar the State from suing to remedy that harm itself.

You don’t often see a Supreme Court decision argue that an issue of standing is literally close enough enough for government work, but at least Roberts didn’t cite any 17th century witchfinders, so let’s get on to the merits of the case.

We shouldn’t be too surprised since the Court keeps taking cases simply for the sake of throwing its weight around, as we saw last year when the Court struck down an EPA regulation that never went into effect, and today, when they protected a hypothetical Christian website designer from being sued by hypothetical gay people. (We have a separate post on that one right here.)

We Don’t Need Another HEROES Act. Or Maybe We Do.

The administration argued that it had the authority to waive student debt during the pandemic emergency, because the 2003 HEROES Act allows the Department of Education to issue “waivers and modifications” to change student debt payments during times of national emergency.

Roberts noted that sure, the law says the secretary of Education can do that, but not to the tune of an estimated $430 billion in student loan principal, because well, just because, you see. Here’s his explanation, minus the internal citations:

The text of the HEROES Act does not authorize the Secretary’s loan forgiveness program. The Secretary’s power under the Act to “modify” does not permit “basic and fundamental changes in the scheme” designed by Congress.[…] Instead, “modify” carries “a connotation of increment or limitation,” and must be read to mean “to change moderately or in minor fashion.” That is how the word is ordinarily used and defined, and the legal definition is no different.

The authority to “modify” statutes and regulations allows the Secretary to make modest adjustments and additions to existing provisions, not transform them. Prior to the COVID–19 pandemic, “modifications” issued under the Act were minor and had limited effect. But the “modifications” challenged here create a novel and fundamentally different loan forgiveness program. While Congress specified in the Education
Act a few narrowly delineated situations that could qualify a borrower
for loan discharge, the Secretary has extended such discharge to nearly
every borrower in the country.

In short, Roberts says, the Education Department did some modifications and waivers under the law, but they were TOO BIG and so the entire thing exceeded the administration’s authority, so knock it off.

In a dissent that she summarized from the bench, Justice Elena Kagan said that the case never should have been taken up by the Court to start with, because the states lacked standing in the first place. The dissent (page 48 of the decision PDF), joined by Justices Sonia Sotomayor and Ketanji Brown Jackson, points out that the HEROES Act contains none of the supposed limits Roberts invented, and that the law’s only internal limit is that the Education secretary

could do only what was “necessary” to alleviate the emergency’s impact on affected borrowers’ ability to repay their student loans. […] But within that bounded area, Congress gave discretion to the Secretary. He could “waive or modify any statutory or regulatory provision” applying to federal student-loan programs, including provisions relating to loan repayment and forgiveness. And in so doing, he could replace the old provisions with new “terms and conditions.” […] The Secretary, that is, could give the relief that was
needed, in the form he deemed most appropriate, to counteract the effects of a national emergency on borrowers’ capacity to repay. That may have been a good idea, or it may
have been a bad idea. Either way, it was what Congress
said.

Gee, sure looks like Kagan is looking at the law’s text and original intent there, huh?

The real problem, though, Kagan wrote, is that the Court had itself overstepped its own authority by taking a case where the plaintiffs lacked standing:

Under Article III of the Constitution, a plaintiff must have standing to challenge a government action. And that requires a personal stake—an injury in fact. We do not allow plaintiffs to bring suit just because they oppose a policy. Neither do we allow plaintiffs to rely on injuries suffered by others.

Such limits on judicial meddling are vital, but were ignored in this case, she argued:

The plaintiffs in this case are six States that have no personal stake in the Secretary’s loan forgiveness plan. They are classic ideological plaintiffs: They think the plan a very bad idea, but they are no worse off because the Secretary differs. In giving those States a forum—in adjudicating their complaint— the Court forgets its proper role. The Court acts as though it is an arbiter of political and policy disputes, rather than of cases and controversies.

Kagan went on to note that this is a pretty disturbing habit with the current court, citing last year’s case against the EPA, which was another case where Congress delegated broad regulatory authority to a government agency, only for the Court to impose arbitrary new rules to claim that Congress needed to be more specific in giving direction to the Executive branch.

Ultimately, said Kagan, the Court substituted its own ideological preferences for the will of Congress, and that is not good for America, nor good for the Court:

The Court refuses to acknowledge the plain words of the HEROES Act. It declines to respect Congress’s decision to give broad emergency powers to the Secretary. It strikes down his lawful use of that authority to provide student-loan assistance. It does not let the political system, with its mechanisms of accountability, operate as normal. It makes itself the decisionmaker on, of all things, federal student-loan policy. And then, perchance, it wonders why it has only compounded the “sharp debates” in the country?

Gosh, she’s so divisive!

Unfortunately, she’s also outnumbered, so Biden’s loan relief program is toast. But here’s where we have some good news for people struggling with student loans: Many of us can still get some relief — including, for many, complete cancellation of debt — through existing parts of the loan system that aren’t at all affected by this rotten decision. Here are the two pieces where we’ve covered this so far, and we’ll follow them up with a concise guide tomorrow, and when that’s up we’ll link it here, too)

Also Too!

I Got My Student Loans Ready For Joe Biden’s Big Income-Based Forgive-A-Thon And You Should Too

Did Joe Biden Just Fix Student Loan Debt Going Forward? Mayyyyybe!

UPDATE: Join us right here at 3:30 EDT for our WonkTV livestream of Joe Biden’s remarks on the student debt decision.

[WaPo (gift link) / Biden V. Nebraska decision]

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#Supreme #Court #Owe #Soul #Student #Debt #Store

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

Post By World China, Chinese politics, covid-19, EU-China, pandemic

By Oliver St. John, Founder and Public Affairs Manager, IAD • Updated: 14/06/2023
– 13:21

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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#COVID #pandemic #avoided #China #democracy

Look At These Butt-Heads Voting To Roll Back Student Debt Relief! What A Bunch Of Butt-Heads!

Post By Politics Congress, Congressional Review Act, debt ceiling bill, idr, idr account adjustment, income driven repayment, Joe Biden, joe manchin, john tester, kyrsten sinema, loan servicers, pandemic, pell grants, pslf, public service loan forgiveness program, student debt, student loan consolidation, student loan forgiveness, student loan pause, Student loans, supreme court, us senate

A Republican-led bill to undo President Joe Biden’s Student Loan forgiveness plan — already on hold until the Supreme Court ~~kills it~~carefully considers its merits and rules to kill it later this month — passed in the Senate yesterday, although Biden has already promised to veto it. Senate Republicans were joined in the 52-46 vote by two right-leaning Democrats — Joe Manchin (D??- Gob Coal) and Jon Tester (D-Montana) — as well as right-leaning former Democrat Kyrsten Sinema (I-Arizona).

A very unhappy former constituent of Sen. Tester tweeted thusly on hearing the news:

u201chey @jontester how about you either a) stop voting against student debt relief (while ALSO voting against raising taxes on dead millionaires) or b) stop texting me asking for money. nnYou’ve texted me like five times in the past two days. Pick a lane.u201d

— Rebecca Schoenkopf, Wonkette. (@Rebecca Schoenkopf, Wonkette.)
1685715186

Previously!

What Good Arguments Will Supreme Court Ignore In Student Debt Relief Case?

In addition to killing off Biden’s debt-relief plan, which would forgive up to $20,000 in federal student loans for folks who received Pell grants while in college, or up to $10,000 for borrowers who didn’t, the bill would have immediately ended the pandemic pause on repayment and interest for most federal student loans. The latter provision was somewhat redundant anyway, since the loan repayment pause will end on August 30 as part of the debt limit bill that Biden will sign today. Even without legislation, the pause was inevitably going to end because the pandemic state of emergency as ended; the debt ceiling bill just makes good and sure that the Education Department stops being nice to borrowers ASAP.

Manchin, always on the lookout to pander to the Right, called the debt relief plan “reckless” because it would add to the deficit in very bad ways that aircraft carriers and oil subsidies do not. In a statement, Manchin said that giving any relief to folks burdened with student debt would force “hard-working taxpayers who already paid off their loans or did not go to college to shoulder the cost.” Considering that without the debt relief, many borrowers will default anyway, it’s not exactly the most logical stance, but again, it plays well to class resentment against educated snobs who used a student loan to get vocational training. But you know how it is with “education” — they probably sneak some Marxism in there while training people to be dental technicians.

The bill was able to pass in the Senate with a simple majority because it was introduced under the Congressional Review Act, which empowers Congress to overturn executive branch rules and regulations it doesn’t like. The CRA was also why the bill could go to a vote without being brought up by Majority Leader Chuck Schumer.

In a statement last month, the White House made clear that if the bill passed, Biden would veto it. The statement said the bill was “an unprecedented attempt to undercut our historic economic recovery and would deprive more than 40 million hard-working Americans of much-needed student debt relief, ” adding that it would “weaken America’s middle class.”

Nearly 90 percent of the relief provided by the Department of Education would go to Americans earning less than $75,000 per year, and no relief would go to any individual or household in the top 5 percent of incomes. Americans should be able to have a little more breathing room as they recover from the economic strains associated with the COVID-19 pandemic.

Reiterating the argument the administration made before the Supreme Court in February, the White House noted that Congress gave the Education Department the authority to forgive loans during a national emergency, and that previous administrations have done exactly that, so get outta here.

Now, we just have to wait and see what the Supreme Court decides. Given the Court’s tendency to do whatever it damn well pleases regardless of precedent, we’re not getting our hopes up too much, damn it. But hey, the Supremes have surprised us before.

As Yoda Said, There is Another

Also Previously!

I Got My Student Loans Ready For Joe Biden’s Big Income-Based Forgive-A-Thon And You Should Too

Finally, we’ll add that the text of the bill Biden plans to veto, and the upcoming Supreme Court decision, only concern the one-time debt forgiveness program Biden announced last August.

That’s kind of a big deal, because as we mentioned a few months back, there’s also a separate, long-extant loan forgiveness program for folks enrolled in income-driven repayment plans (IDR), under which borrowers can have the balance of their loans forgiven after making payments for 20 years for undergraduate loans, or 25 years for grad school loans. That program is unaffected by the upcoming Court ruling because it was created by Congress and predates the Biden administration.

There’s also the better-publicized Public Service Loan Forgiveness (PSLF) program, which forgives student debt for teachers and other government workers after they’ve made payments for 10 years. (Although not in practice.)

Even better, the Education Department has improved the terms of those programs to make up for some longtime shady behavior by private loan servicers, who would often talk people into deferring their loans (which continued to accrue interest) instead of letting them know about income driven repayment plans. You can find more details in our earlier article or straight from the studentaid.gov website. The upshot is that the Ed Department will be reviewing millions of accounts and adjusting the time necessary to qualify for forgiveness of loans. More than 3.6 million borrowers will get at least three years of credit toward fulfilling their obligation, and many will have their loan balances wiped out by the adjustment. The adjustments will also apply to those PSLF loans, too, and to a lot of loans taken out by parents for students.

To qualify, you may need to consolidate your existing loans into an IDR plan, and here too there’s some terrific news: The initial deadline to qualify had been May 1, but the Education Department has extended that to the end of 2023.

For more information, and to start the process, check thestudentaid.gov website here. And if you’re completely at sea, the folks at the Education Department’s Student Aid help desk (1-800-433-3243) are astonishingly smart and helpful.

[NBC News / Politico / StudentAid.gov]

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#ButtHeads #Voting #Roll #Student #Debt #Relief #Bunch #ButtHeads

#TuckerTwitterFiles: Tucker Carlson censored for complaining about big tech censorship

Post By Politics censorship, covid, pandemic, Tucker Carlon, twitter files, vaccines, WHO, World Health Organization

About a year ago, Tucker Carlson wrote an opinion piece on the Fox News website complaining about big tech censorship:

To quote from his piece:

[T]he WHO’s latest finding — that the vaccine is not safe for children — threatens everything that reckless creeps like Zeke Emanuel and the pharmaceutical industry have been working for….

Facebook has just censored a woman called Michelle Coriaty-Herbst for sharing the WHO’s bulletin on vaccines word-for-word. She just posted it. Facebook deleted it. ‘Your comment goes against our community standards on spam,’ Facebook wrote. So, this is Silicon Valley’s new policy: everything about vaccines is good. Period. You are not allowed to suggest otherwise. No matter what data you might have. No matter what data you might have, no matter what a health organization might tell you.

You got that? The WHO cast doubt on vaccines for children but if someone dares to quote them … Facebook was deleting the post.

And if, like Mr. Carlson, you quote the WHO, while complaining about how big tech censored a person just for quoting the WHO, well … that is double plus ungood. For that, Tucker was put on double-secret probation by Twitter, as Paul D. Thacker just revealed:

1. Why did Twitter censor Tucker Carlson? Better yet, who helped Twitter do that? #TuckerTwitterFiles pic.twitter.com/b5WGinZA4V

— Paul D. Thacker (@thackerpd) April 27, 2023

2. While reading an endless sea of #TwitterFiles, one request to censor alleged “Covid misinformation” stood out: Tucker Carlson.

Tucker is now in the news after Fox announced his departure.

— Paul D. Thacker (@thackerpd) April 27, 2023

3. A Twitter employee emailed colleagues in June 2021 to inquire if a Tucker Carlson op-ed for @FoxNewsOpinion should be flagged for COVID-19 “misinformation.” pic.twitter.com/2mBIBSA5bJ

— Paul D. Thacker (@thackerpd) April 27, 2023

4. Twitter then punished Tucker Carlson for this op-ed.
Tucker actually cited the World Health Organisation’s own website which stated that the WHO was NOT recommending children get the COVID vax. pic.twitter.com/BKnMnyqbPV

— Paul D. Thacker (@thackerpd) April 27, 2023

5. When I looked back at the WHO website, I found they stealth edited their page to remove this passage stating they did not recommend kids get vaccinated. pic.twitter.com/hyf7X0gcRc

— Paul D. Thacker (@thackerpd) April 27, 2023

He understates this. Not only was the WHO website stealth edited, but according to the substack linked at the end of this thread, it was immediately stealth-edited after Mr. Carlson cited them in his piece, which might have contributed to calls to suppress his column. After all, by citing what the WHO had said the day before, they were contradicting what the WHO was saying the day after. From the substack post:

When Tucker’s June 2021 report on the WHO’s vaccine recommendations hit Twitter, the WHO stealth edited their COVID vaccine page to remove language Tucker cited in his op-ed. The following day, Twitter officials began discussing Tucker’s essay and how to limit its impact without calling attention to Tucker and creating ‘political risks’ for Twitter by directly censoring Fox News.

Back to Mr. Thacker’s thread:

6. After Twitter began reviewing Tucker’s op-ed for alleged COVID-19 misinformation, an employee emailed that they would take action by “labelling any tweets linking the article.” #TwitterFiles pic.twitter.com/SXMkvnqjjq

— Paul D. Thacker (@thackerpd) April 27, 2023

7. Twitter officials also discussed looping in top Twitter execs, such as the general counsel, due to the “political risks” associated with such actions.

Yoel Roth agreed with this approach to “escalate.” pic.twitter.com/wIbE32k3xo

— Paul D. Thacker (@thackerpd) April 27, 2023

8. One employee chimed in to explain various options Twitter could take that would affect the op-eds reach, without directly censoring Fox. There were various choices. pic.twitter.com/N1onXc1ylE

— Paul D. Thacker (@thackerpd) April 27, 2023

9. Tucker Carlson would have never known this happened, but when Twitter held a meet and greet months, later, they wrote of Tucker’s producer, “[I]t was pretty apparent from the get-go we understood the very different goals we have at work.” pic.twitter.com/Uop2l8T66G

— Paul D. Thacker (@thackerpd) April 27, 2023

10. BTW, the Twitter official who first brought Tucker’s article to attention came to Twitter from the office of Senator Chuck Schumer, a frequent Tucker critic. pic.twitter.com/A6SEJ8L6j0

— Paul D. Thacker (@thackerpd) April 27, 2023

11. Much thanks to @TexasLindsay_ who helped collect and organise #TwitterFiles. I love San Francisco, but we read and read, until our eyes bled.

More #TwitterFiles to come! pic.twitter.com/KaeGBIDDcu

— Paul D. Thacker (@thackerpd) April 27, 2023

12. Read more on Twitter’s censoring of Tucker Carlson at @DisInfoChron: “WHO Censored Itself on Vaccines to Help Twitter Censor Tucker Carlson” https://t.co/YMhhEa2Pba Bird factory secretly clipped Tucker’s wings pic.twitter.com/cebTyjfRg9

— Paul D. Thacker (@thackerpd) April 27, 2023

To review, a platform (Twitter) with an advertising deal with a vaccine manufacturer, did their best to suppress a story that, if enough people were persuaded by it, would reduce the sales of vaccines. But they also did their best to keep Mr. Carlson from finding out what they were doing, to prevent them from being called out for this corrupt behavior.

In the long arc of history, the people who try to silence critics are almost never the good guys.

Mr. Carlson, for his part, does not seem to be down about his dismissal from Fox News. Here he is laughing at someone in the media for filming him and his wife:

Tucker Carlson spotted in Florida riding around in a golf car laughing his head offpic.twitter.com/pTOkQCMTsD

— Citizen Free Press (@CitizenFreePres) April 26, 2023

When he gets back ‘on the air’—and he might have a non-compete agreement that prevents him from doing that for a while—we suspect he will say some very interesting things. It might not be that he has been deplatformed, so much as unleashed.

***

Editor’s Note: Do you enjoy Twitchy’s conservative reporting taking on the radical left and woke media? Support our work so that we can continue to bring you the truth. Join Twitchy VIP and use the promo code SAVEAMERICA to get 40% off your VIP membership!

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

Post By Health cases, coronavirus, covid-19, deaths, hospitalizations, pandemic, Public health, tracking, vaccines

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

Post By Health black health, black patients, coronavirus, covid-19, hispanic health, hispanic patients, long covid, minority health, pandemic

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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#Bias #Lack #Access #Long #COVID #Worse #Patients #Color

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

Post By Health coronavirus, covid, covid-19, long covid, long covid symptoms, pandemic

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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It’s (Finally) Time to Stop Calling It a Pandemic: Experts

Post By Health coronavirus, covid-19, COVID-19 pandemic, endemic, pandemic, Public health

March 17, 2023 — It’s been 3 years since the World Health Organization officially declared the COVID-19 emergency a pandemic. Now, with health systems no longer overwhelmed and more than a year of no surprise variants, many infectious disease experts are declaring a shift in the crisis from pandemic to endemic.

Endemic, broadly, means the virus and its patterns are predictable and steady in designated regions. But not all experts agree that we’re there yet.

Eric Topol, MD, founder and director of the Scripps Research Translational Institute in La Jolla, CA, and editor in chief of Medscape, WebMD’s sister site for health professionals, said it’s time to call COVID endemic.

He wrote in his Substack, Ground Truth, that all indications — from genomic surveillance of the virus to wastewater to clinical outcomes that are still being tracked — point to a new reality: “[W]e’ve (finally) entered an endemic phase. “

No new SARS-CoV-2 variants have yet emerged with a growth advantage over XBB.1.5, which is dominant throughout much of the world, or XBB.1.9.1, wrote Topol.

But he has two concerns. One is the number of daily hospitalizations and deaths – hovering at near 26,000 and 350, respectively, according to The New York Times COVID tracker. That’s far more than the daily number of deaths in a severe flu season.

“This is far beyond (double) where we were in June 2021,” he wrote.

Topol’s second concern is the chance that a new family of virus might evolve that is even more infectious or lethal – or both – than the recent Omicron variants.

Three Reasons to Call It Endemic

William Schaffner, MD, infectious disease expert at Vanderbilt University Medical Center in Nashville, is in the endemic camp as well for three reasons.

First, he said, “We have very high population immunity. We’re no longer seeing huge surges, but we’re seeing ongoing smoldering transmission.”

Also, though noting the concerning numbers of daily deaths and hospitalizations, Schaffner said, “it’s no longer causing crises in health care or, beyond that, into the community economically and socially anymore.”

“Number three, the variants causing illness are Omicron and its progeny, the Omicron subvariants. And whether because of population immunity or because they are inherently less virulent, they are causing milder disease,” Schaffner said.

Changing societal norms are also a sign the U.S. is moving on, he said. “Look around. People are behaving endemically.”

They’re shedding masks, gathering in crowded spaces, and shrugging off additional vaccines, “which implies a certain tolerance of this infection. We tolerate the flu,” he noted.

Schaffner said he would limit his scope of where COVID is endemic or close to endemic to the developed world.

“I’m more cautious about the developing world because our surveillance system there isn’t as good,” he said.

He added a caveat to his endemic enthusiasm, conceding that a highly virulent new variant that can resist current vaccines could torpedo endemic status.

No Huge Peaks

“I’m going to go with we’re endemic,” said Dennis Cunningham, MD, system medical director of infection prevention of the Henry Ford Health System in Detroit.

“I’m using the definition that we know there’s disease in the population. It occurs regularly at a consistent rate. In Michigan, we’re no longer having those huge peaks of cases,” he said.

Cunningham said though the deaths from COVID are disturbing, “I would call cardiovascular disease endemic in this country and we have far more than a few hundred deaths a day from that.”

He also noted that vaccines have resulted in high levels of control of the disease in terms of reducing hospitalizations and deaths.

The discussion really becomes an academic argument, Cunningham said.

“Even if we call it endemic, it’s still a serious virus that’s really putting a lot of a strain on our health care system.”

Not So Fast

But not everyone is ready to go all-in with “endemic.”

Stuart Ray, MD, professor of medicine in the Division of Infectious Diseases at Johns Hopkins School of Medicine in Baltimore, said any endemic designation would be specific to a certain area.

“We don’t have much information about what’s happening in China, so I don’t know that we can say what state they’re in, for example,” he said.

Information in the U.S. is incomplete as well, Ray said, noting that while home testing in the U.S. has been a great tool, it has made true case counts difficult.

“Our visibility on the number of infections in the United States has, understandably, been degraded by home testing. We have to use other means to glean what’s happening with COVID,” he said.

“There are people with infections we don’t know about and something from that dynamic could surprise us,” he said.

There are also a growing number of young people who have not yet had COVID, and with low vaccination rates among young people, “we might see spikes in infections again,” Ray said.

Why No Official Endemic Declaration?

Some question why endemic hasn’t been declared by the WHO or CDC.

Ray said health authorities tend to declare emergencies, but are slower to make pronouncements that an emergency has ended if they make one at all.

President Joe Biden set May 11 as the end of the COVID emergency declaration in the U.S. after extending the deadline several times. The emergency status allowed millions to receive free tests, vaccines, and treatments.

Ray said we will only truly know when the endemic started retrospectively.

“Just like I think we’ll look back at March 9 and say that Baltimore is out of winter. But there may be a storm that will surprise me,” he aid.

Not Enough Time to Know

Epidemiologist Katelyn Jetelina, PhD, MPH, director of population health analytics at the Meadows Mental Health Policy Institute in Dallas, and a senior scientific consultant to the CDC, said we haven’t had enough time with COVID to call it endemic.

For influenza, she said, which is endemic, “It’s predictable and we know when we’ll have waves.”

But COVID has too many unknowns, she said.

What we do know is that moving to endemic does not mean an end to the suffering, said Jetelina, who also publishes a Substack called Your Local Epidemiologist.

“We see that with malaria and [tuberculosis] and flu. There’s going to be suffering,” she said.

Public expectations for tolerating illness and death with COVID are still widely debated.

“We don’t have a metric for what is an acceptable level of mortality for an endemic. It’s defined more by our culture and our values and what we do end up accepting,” she said. “That’s why we’re seeing this tug of war between urgency and normalcy. We’re deciding where we place SARS-CoV-2 in our repertoire of threats.”

She said in the U.S., people don’t know what these waves are going to look like — whether they will be seasonal or whether people can expect a summer wave in the South again or whether another variant of concern will come out of nowhere.

“I can see a future where (COVID) is not a big deal in certain countries that have such high immunity through vaccinations and other places where it remains a crisis.

“We all hope we’re inching toward the endemic phase, but who knows? SARS-CoV-2 has taught me to approach it with humility,” Jetelina said. “We don’t ultimately know what’s going to happen.”

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Q&A: The Future of COVID-19

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Senior writer Kara Grant co-authored this report.

March 15, 2023 – As we approach the third anniversary of the COVID-19 pandemic, experts and everyday Americans wonder if we are finally at the end of what has been a painful and exhausting ordeal that’s lasted 3 years. With vaccine and booster fatigue, COVID-19 cases leveling out, and a growing body of research that has helped us understand the virus more clearly, many are still asking: How concerned should I be?

In February, the Biden administration announced that it was the end of the road for the COVID-19 emergency orders, which had been in place since January 2020. That came after a year still fraught with ups and downs, with the U.S. surpassing 1 million COVID-19 deaths and variants continuing to evolve.

We asked experts their thoughts on the future of COVID-19 and how their perspectives have shifted over the years.

Where Are We Now With COVID-19?

While the Omicron variant is still lingering, we’re in a period of lower rates of COVID-19 transmission.

Vaccinations and boosters have helped. That, along with antiviral treatments and high rates of collective immunity, have kept COVID-19 at bay, but it’s important to remember that this virus isn’t going anywhere, says Ashwin Vasan, MD, the commissioner of the New York City Department of Health and Mental Hygiene.

“The federal emergency will expire in May, and compared to where we’ve been, we’re not in an emergency today,” he says. “But we will have to use the tools and strategies to really manage whatever COVID-19 throws at us going forward – if it were to change or if it ends up being more of a seasonal virus, like other coronaviruses.”

One thing is for certain: Health care will never be the same, says Jennifer Gil, a registered nurse and a member of the American Nurses Association Board of Directors.

“While cases in our area are steadily declining, patients and health care workers continue to experience the long-lasting effects of the pandemic,” she says. “I witness it every day when I see the long-term impact it has had on patients, access to care, and health care workers’ mental and emotional well-being.”

Is This the End of the Pandemic?

First, it’s important to understand the difference between a pandemic and an epidemic, Vasan says. An epidemic is the spreading of a disease that outpaces what would be expected within a certain time and location. A pandemic is an epidemic that spreads across various continents and regions of the world.

COVID-19 is a new virus, which makes things tricky. “Before 2020, our baseline was zero because COVID-19 didn’t exist,” says Vasan. “So, the question we can’t really answer from an epidemiologic standpoint is – ‘is it still a pandemic?’ Well, is it circulating beyond what’s to be expected? I think we’re going to have to figure out what those expectations are at baseline.”

Jim Versalovic, MD, pathologist-in-chief at Texas Children’s Hospital, deems this a “post-pandemic” period, since the virus isn’t impacting us as dramatically as it did in 2020 and 2021. This is thanks to the successful efforts “to diagnose, treat, and prevent COVID-19,” along with collective immunity after many being exposed and infected with the virus, he says.

Some experts believe that declaring the pandemic “over” is a long shot. Rather, it’s likely that we are changing to more of an endemic status, according to Natascha Tuznik, DO, an infectious disease specialist at the University of California, Davis. It’s best to view COVID-19 as a “permanently established infection” in both humans and animals, she says. So we should treat it like the seasonal flu and continue to be careful to update vaccinations.

“Vaccine uptake, overall, is still insufficient,” says Tuznik, “It’s important to not let our guard down and believe the problem no longer exists.”

The impact the pandemic has had on communities of color, frontline workers, and the health care system more broadly is also not to be forgotten, says Gil. “While the number of COVID-19 cases is subsiding, the invisible impact of the pandemic will continue to emerge in the coming years,” she says.

What Worries You Now About COVID-19?

Complacency can be an issue with any viral infection, says Versalovic, and it’s critical to continue to treat COVID-19 with extreme caution. For example, the U.S. will always need to track COVID-19 trends.

“It has become one of our major respiratory viruses affecting mankind around the globe,” he says. “Certainly, in the medical profession, we’re going to have to do our best to communicate and emphasize to everyone that these viruses aren’t going to disappear, and we need to continue to be aware and vigilant.”

Don’t forget that people still die from this virus every day, says Tuznik. “COVID-19 has killed over 1 million Americans and over 6.8 million people globally,” she says. “While the rates of death have declined, they have not stopped.”

Vasan poses another critical question: “What pieces are in place to ensure that we have a strong health system prepared to respond to COVID-19 changes or if another epidemic or pandemic illness arrives?”

Examples could include ensuring tests, vaccines, and treatments are deployed in a quick, strategic manner, and building a public health system that can make that happen, without failing to support health care workers, he says.

Challenges like staffing shortages and hazardous work conditions have resulted in mental health-related issues and burnout among health care workers, Gil says. Many have reported skyrocketing rates of PTSD, anxiety, depression, and stress. Some have chosen to leave the health care workforce entirely.

“Investing in our health care workforce by providing mental health and wellness resources is essential,” says Gil. “We must also equally address the underlying issues by enforcing safe staffing standards and investing in long-term solutions that aim to improve the work environment.”

Has the Pandemic Changed Your Relationship to Medicine?

The COVID-19 crisis has altered the health care world, likely for posterity. For many, like Vasan, the last 3 years have been a shining example of how fragile our health care system is.

“We continually spend on things that don’t deliver on health,” he says, referring specifically to the $4 trillion spent on health care, with only a small fraction of that dedicated to disease prevention efforts. “Had we spent more on prevention, fewer would have died from COVID. We need to have a reckoning in this country about whether we are willing not to design for health care and medicine, but to design for health.”

And while COVID-19 certainly brought to light the major – and minor – flaws in the health care system, the knowledge we’ve learned along the way is a silver lining for many doctors. Versalovic says that the chaos and anxiety forced those in medicine to rapidly refine their approaches to diagnostics, from in-hospital testing to drive-thru and at-home testing. Along the way, he says, there has also been a renewed gratitude for treatments like monoclonal antibodies and the preventive powers of RNA vaccines.

But for Tuznik, the pandemic has given her an entirely newfound appreciation for her career path.

“The infectious diseases community really came together as a tour de force during the pandemic, and it was humbling to be a part of such a mass effort and collaboration,” she says.

What Have the Last 3 Years Taught You?

COVID-19 has forced us all to learn new and often difficult lessons about ourselves, our relationships, and how we each fit into the world.

It’s a line we’ve heard over and over again: These are unprecedented times. A large part of that has been the extreme politicization of science and the growing divisiveness across the country. But despite what feels like unyielding friction in the medical community and beyond, people were still able to come together and tackle the pandemic’s challenges.

Vasan says that our ability to work together on life-saving treatments and prevention strategies is “a testament to human endeavor, ingenuity, collaboration, in the face of an existential threat.”

For nurses, the pandemic brought about pervasive burnout and fatigue. But that’s not the end of the story.

“Personally, it has driven me to go back to school to gain the research and analytical skills necessary to develop evidence-based policies and programs that aim to improve health care delivery,” says Gil. “Now, more than ever, nurses are key stakeholders at the policy and decision-making table.”

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