What UK cases tell us about long COVID

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According to government data, the number of people with long COVID in the United Kingdom has been rising since July. Hollie Adams/Getty Images
  • According to the latest estimates, 2.1{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the U.K. population, or 1 in 48 people, had long COVID.
  • The analysis showed that over half a million people have been experiencing lingering symptoms for at least a year.
  • Previous estimates showed that between 10-30{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of people with COVID-19 developed long COVID.
  • Although the number of people with COVID-19 is rising due to Omicron, the number of people reporting long COVID symptoms is not, which could mean vaccines are conferring protection.

As scientists discover more about long COVID — an array of symptoms that linger weeks and months after the initial infection has passed — governments have started to produce more reliable estimates.

The latest data, published on February 3, comes from the Office of National Statistics (ONS) in the U.K. and shows that around 1.3 million people reported having long COVID between December 2021 and January 2022.

The figure shows an increasing trend from previous months — 1.27 million at the beginning of December and 945,000 in early July.

Updates are expected to follow, but until then, here is a breakdown of what the analysis found:

According to ONS data collected from the Coronavirus (COVID-19) Infection Survey (CIS), 1.33 million people were experiencing symptoms post-infection

Furthermore, 836,000 people, almost two-thirds of those surveyed, said these symptoms limited their daily activities.

Dr. Donald J. Alcendor, associate professor of microbiology, immunology, and physiology at Meharry Medical College, and associate professor adjunct at the Vanderbilt University Medical Center, both in Nashville, TN, said the figure was surprising, as it was higher than expected for the U.K.

However, he pointed out that the nature of self-reporting could have likely skewed the results and that the duration of the symptoms would vary from one person to the next.

“[T]he diagnosis of post-COVID syndrome is not an exact science and is still controversial. Diagnosis is largely based on testing and the duration of symptoms that are mainly self-reported,” he told Medical News Today.

The most common long COVID symptoms that people reported were:

  • fatigue
  • shortness of breath
  • loss of smell
  • loss of taste

Although cognitive symptoms were not among the most common symptoms for this data set, they are also increasingly rising, added Dr. Alcendor.

Commenting on fatigue, in particular, Dr. Tutku Taşkınoğlu, clinical microbiologist and the head of the molecular biology unit at Düzen Laboratories in Turkey, told Medical News Today that it was common for some diseases to be triggered after viral infections.

“These include chronic fatigue syndrome, or myalgic encephalomyelitis, and a blood circulation disorder called postural orthostatic tachycardia syndrome (POTS), and this risk was higher [after COVID-19] than after the flu,” she said.

Dr. Taşkınoğlu underscored the importance of listening to people and that even symptoms as simple or inconspicuous as mild fatigue could be important for diagnosis.

Who is most affected by long COVID?

The data found that the prevalence of long COVID was greatest in people 35–69 years.

It also found that females, people living in low-income areas, and those with a health condition or disability that limits their ability to exercise were also more likely to report having long COVID.

Dr. Taşkınoğlu said that she has also observed a difference in long COVID symptoms reported by different groups. For females and younger people, persistent headaches, abdominal symptoms, and anxiety are more common, while males and those over 65 report breathing difficulties and cognitive impairments more often.

The professions that produced the highest number of people with long COVID were social care, teaching and education, and healthcare.

Dr. Alcendor pointed out that the professions most affected by long COVID involved a lot of direct, person-to-person contact and had a higher risk of exposure.

“These jobs may involve transmissions with higher viral loads because of little or no social distancing and prolonged exposure to a person [with the virus],” he said.

He also underscored that it was not surprising to see individuals with poor social determinants on the list.

“[L]imited access to healthcare services and underlying comorbidities that go unmanaged put them at high risk for the most severe outcomes of COVID-19. We must remember that long-COVID can be mild in some people and life-changing for others,” he explained.

As the analysis focuses on self-reported long COVID, many experts are skeptical about the results.

“Self-reporting would certainly skew the results. Documentation of infection via diagnosis after testing positive and then negative is important because COVID-19 clinical presentations can vary from one person to the other and must undergo differential diagnosis to rule [out] other conditions such as a cold, flu, chronic fatigue, respiratory syncytial virus (RSV), or reinfection (breakthrough infection/post immune infection),” explained Dr. Alcendor.

One challenge in diagnosing and treating undiagnosed long COVID cases will be determining how many people have had COVID-19.

Dr. Alcendor elaborated:

“Monitoring exposure at the community level using antigen testing could provide us with insights as to how many people [had contracted the virus] and not officially diagnosed with COVID-19.”

There is also the issue of diagnosing long COVID in children. Many estimates leave that data out.

In the U.K., the first “consistent” research definition for long COVID in kids and young people was only formally agreed on Feb. 8, 2022.

Dr. Alcendor said estimates in the United States were that between 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} and 30{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of people who get COVID-19 could develop long COVID.

Comparatively, he said the rate in the U.S. was much higher than the figure reported for the U.K.

“This could be related to awareness, vaccination, reporting, diagnosis, and the rate of infection in the U.S. compared to the U.K.,” he explained.

Dr. Taşkınoğlu said there was no clear picture about long COVID incidence in Turkey yet.

“It is not yet known exactly what percentage of people will have these symptoms months after [having acute] COVID-19,” she said.

She added that when factoring in the number of COVID-19 cases in a country, especially in places where numbers are rising like Turkey or the U.S., even 5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} would mean a lot of people will be affected.

On a global level, one pre-print study estimated that around 43{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of COVID-19 survivors either had or are still experiencing long-term effects after recovering from the disease.

Dr. Taşkınoğlu said that no matter what variant caused COVID-19, it could possibly lead to long COVID. She said with only 4 months into the Omicron wave, it was difficult to say what would happen in the long term.

“According to the data so far, there is no difference between Delta, Beta, or Omicron for long COVID symptoms. But most likely, the incidence of long COVID will be lower, as Omicron does not make a permanent change in the inflammatory process in the body during COVID-19 infection,” she said.

However, she pointed out one caveat with that way of thinking:

“Even if the incidence of long COVID decreases to 2-3{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of cases, as the number of cases is high, the number of people experiencing long COVID will increase [proportionately],” she added.

Although reports so far suggest less severe disease in individuals who get COVID-19 with Omicron, experts reiterate that this severity can vary between people and produce fatal outcomes in individuals with underlying illnesses.

“Therefore, we may see an increase in long COVID in targeted populations with more severe diseases,” said Dr. Alcendor.

“[This will be] due to many [people contracting the virus] and the likely increase in breakthrough infections, especially among underserved populations with poor social determinants of health,” he said.

Dr. Alcendor said he expects long COVID to have more of an impact on people who experienced symptoms of COVID-19 and/or those who were in the hospital.

Dr. Taşkınoğlu agreed: “The U.K. analysis shows that the risk [of long COVID] is much lower for those who are not hospitalized.”

“The greatest impact [of long COVID] will likely be among [unvaccinated people] that acquire a primary COVID-19 infection. It is clear that being completely vaccinated for COVID-19 offers some level of protection against Omicron and will reduce the likelihood of developing long COVID if you have a breakthrough infection.”

– Dr. Donald J. Alcendor

Studies have also shown that vaccination reduced the risk of long COVID.

“[They do so] by lowering the chances of contracting COVID-19 initially. Vaccinations have also been beneficial to some in that the development of a more robust immune response may complete viral clearance from a person’s system and will allow them to recover,” said Dr. Alcendor.

For live updates on the latest developments regarding COVID-19, click here.

Abnormal immune system activity may explain long COVID

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A new study suggests SARS-CoV-2 infections may cause long-term disturbances to the immune system, resulting in long COVID. Image credit: Jenny Evans/Getty Images
  • Researchers worldwide are continually updating the scientific knowledge around SARS-CoV-2, the virus that causes COVID-19.
  • In the most recent update, scientists in Australia report that atypical immune activity persists in people with long COVID 8 months after infection with SARS-CoV-2.
  • Their research shows that long COVID features increased levels of specific immune biomarkers in the body.
  • Their findings provide a crucial foundation to enhance our understanding of long COVID, an emerging chronic condition.

Scientists have spent the last few years trying to understand the novel coronavirus, SARS-CoV-2, which is responsible for the COVID-19 pandemic.

As new variants of the SARS-CoV-2 virus emerge, scientists continue to study their effects to find ways of keeping the global population safe.

In line with ongoing scientific efforts, a new study has reported that individuals with long COVID experience dysfunctional immune activity 8 months after the initial COVID-19 illness.

Long COVID, also known as post-acute COVID-19, is a term to describe the effects of COVID-19 that linger for weeks or months beyond the initial illness. The symptoms often involve respiratory and physical distress and, more recently, cardiovascular distress.

The study, led by scientists at The Kirby Institute, University of New South Wales, Australia, appears in the journal Nature Immunology.

“Our observations provide an important foundation for understanding the pathophysiology of this syndrome and [may suggest] potential therapeutic avenues for intervention,” the study authors write.

“Our study indicates an ongoing, sustained inflammatory response following even mild-to-moderate acute COVID-19, which is not found following prevalent common cold coronavirus infection,” Dr. Chansavath Phetsouphanh, a senior research associate and co-lead author of the study, told Medical News Today.

However, he added that “more research from bigger cohorts is required to validate [their] findings.”

The researchers followed 147 individuals for 8 months following a diagnosis of COVID-19.

They were interested in studying the pathophysiological, immunological, and clinical outcomes following infection with SARS-CoV-2.

In the study, the team defined long COVID as the occurrence of one of three major symptoms of fatigue, chest pain, or shortness of breath in the fourth month of infection. A total of 31 out of 147 individuals fitted the description.

The scientists then matched the individuals using gender and age, with 31 asymptomatic controls from the same cohort who did not report symptoms in the fourth month but were symptomatic during the acute phase of COVID-19.

The researchers also recruited a fresh population of individuals who tested negative for SARS-CoV-2 alongside individuals who had contracted other human coronaviruses but not SARS-CoV-2. This group served as the control.

Finally, the experimenters collected blood samples from each group to examine the biomarkers associated with long COVID. In medicine, a biomarker refers to “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”

At first glance, the scientists noted that the long COVID and control groups had significantly higher levels of six immune biomarkers compared with the control group.

However, from the fourth month, they noticed a drop in the elevated biomarker levels in the control group while the long COVID group still maintained high levels of biomarkers.

Specifically, the team noticed that two types of biomarkers — known as interferons — were elevated in the long COVID group 8 months after infection with SARS-CoV-2. Scientists describe interferons as a type of protein that body cells make in response to the presence of viruses.

As well as elevated levels of interferons, Dr. Phetsouphanh and his team discovered that the long COVID group had highly activated immune cells but lacked naive T and B cells. These cells are responsible for helping the immune system respond to novel pathogens that it has not yet encountered.

Taking these findings into consideration, the scientists concluded that:

“SARS-CoV-2 infection exerts unique prolonged residual effects on the innate and adaptive immune systems and that this may be driving the symptomology known as [long COVID],” the study authors write.

Dr. Deepti Gurdasani, a senior lecturer at the Queen Mary University of London, who was not involved in the research, responded to the study on Twitter, saying that its results “in practical terms [are] unclear — but concerning nevertheless.”

“Understanding [the meaning of the] immune dysregulation that was clearly present at least at 8 months, and possibly longer will take time,” she wrote, pointing out that “long COVID clearly shows a different immunological profile compared to people who don’t have persistent symptoms.”

She added:

“Whether this is because of [the] persistence of [the] virus, virus antigen, or auto-immunity post-infection isn’t known yet. It could be one of these or even a combination — but all possibilities should concern us.”

The study authors report several limitations in their research.

First, because of the timing of ethics approvals and cohort setup, the scientists could not collect samples during the period of acute infection. As a result, they were unable to determine whether elevations in biomarker levels during the recovery period correlated with the levels observed in acute infection.

Additionally, the definition of long COVID in the study was set internally by the researchers, given the lack of international consensus on its definition.

Nevertheless, the scientists note that the inclusion of the most common persisting symptoms of long COVID alongside rigorous research practices helped ensure the validity of their findings.

Needless to say, the research is still largely exploratory, and more studies are necessary to confirm the findings. However, the study results could one day potentially inspire better treatments for people living with long COVID.

For live updates on the latest developments regarding COVID-19, click here.

Long COVID: Is autoimmunity to blame?

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A new study looks at autoimmunity and its theoretical role in long COVID. VICTOR TORRES/Stocksy
  • One step in our body’s immune response to the SARS-CoV-2 virus may potentially inhibit our ability to fight SARS-CoV-2 infection.
  • Antibodies that the body produces after the initial immune response may also bind the same target cells as the SARS-CoV-2 virus.
  • This might perhaps explain why individuals experience long COVID symptoms months after infection.
  • Vaccine-produced neutralizing antibodies may also elicit these second-line antibodies, resulting in the rare, serious side effects of COVID-19 vaccines.

A group of researchers recently hypothesized that complex immune responses to the SARS-CoV-2 virus might explain the long-term effects of COVID-19.

They also suggest these immunologic mechanisms may contribute to the rare, serious side effects of the COVID-19 vaccine.

In a recent New England Journal of Medicine article, co-authors Dr. William J. Murphy and Dr. Dan L. Longo explain how autoimmunity may be the mechanism causing these two distinct complications of the worldwide SARS-CoV-2 pandemic.

When our bodies are exposed to a virus — or any infection — it recognizes proteins and other molecules on the invading virus as “not us.” Scientists refer to this as an antigen.

We then ramp up our immune systems to attack that antigen. Therefore, we try to neutralize infectious invaders, such as the SARS-CoV-2 virus.

Once we use our antibodies to attack the invading viral protein, parts of these neutralizing antibody-antigen complexes can also be viewed as “not us” by our bodies. We can also form secondary antibodies, called anti-idiotype antibodies.

What is the purpose of anti-idiotype antibodies? After the initial benefits of first-line immunity, our body has natural processes to try to flatten our response to challenges. These processes are known as downregulation.

Anti-idiotype antibody production is one of our body’s methods of achieving downregulation. However, the presence of anti-idiotype antibodies can have unexpected negative effects.

Firstly, they can neutralize our infection-fighting first-responder antibodies, so they interfere with our body’s ability to fight the infection if it persists.

Secondly, they can mimic the original invading organism and bind to our cells in the same way. This instigates the same symptoms as the infection or causes an immune-cell attack on our healthy cells.

Drs. Murphy and Longo report that this mimicking behavior by anti-idiotype antibodies has been demonstrated already in models, such as viral diarrhea in bovine animals.

For Medical News Today, Dr. Murphy elaborated:

“This concept of anti-idiotype antibodies mediating effects and limiting efficacy could have a profound impact in understanding how to increase effectiveness and duration of protective antibody responses,” he explained. It might also help us “determine if patients are at risk, based on their anti-idiotype responses or allow for therapeutic interventions to be developed.”

The SARS-CoV-2 spike protein on the surface of the virus binds to angiotensin converting enzyme 2 receptors (ACE2) on our cells.

ACE2 receptors are present on many cells throughout the body, including within the lung, heart, kidneys, nerves, and brain. So, any protein, including a virus protein, binding these receptors can profoundly affect our health.

Once bound to the cell, the spike protein allows the virus to enter it. But, the spike proteins’ negative effects do not stop at simply finding a gateway.

By binding the ACE2 receptors, the spike protein can suppress healthy cell function and stimulate the release of inflammatory proteins called cytokines.

Regardless of whether we produce first-line antibodies from the vaccine or a SARS-CoV-2 infection, anti-idiotype antibodies have the potential to produce the same symptoms and side effects as infection with the SARS-CoV-2 infection. They achieve this by binding to the ACE2 receptor.

Dr. Murphy clarified for MNT:

“The vast majority of research on both SARS-CoV-2 infection responses and vaccines solely centers on the protective antibody and T cell responses. There needs to be much more investment in basic research on the immunoregulatory pathways that both can limit responses and duration, but also on their ability to mediate off-target effects.”

“Given the strong dependency on the population for vaccines and the need for boosting, along with the emergence of viral variants, it is imperative that more research be directed to understanding the mechanisms involved using preclinical models, which simply has not been adequately done.”

Dr. Murphy elaborated further: “Despite being put forth by Nobel Laureate Niels Jerne in 1974 as a means for antibody regulation, research in this area of anti-idiotype antibodies has tapered considerably and is not usually in the conversation of antibody responses. This article brings the concept back to the forefront as a possible explanation for the myriad of effects observed with both SARS-CoV-2 infection and vaccine responses.”

Researchers Dr. Claudia Nold-Petry and Prof. Marcel Nold from Monash University in Australia also spoke with MNT. They discussed the potential role of anti-idiotype antibodies in complications associated with both COVID-19 vaccines and the disease:

“Confirmation of the presented hypotheses by basic research (as per the suggestions in the article) would represent a welcome advance in the understanding of the adverse events of vaccines and COVID-19 itself — including of SARS-CoV-2 variants, some of which may induce more and more problematic anti-idiotype antibodies than others!”

Regarding the medical implications of this research, Dr. Nold-Petry and Prof. Nold told MNT:

“Vaccines and antibody-based therapies could be screened for induction of anti-idiotype antibodies in preclinical tests, and modifications could be made to minimize such indications, as required.”

“Patients could be screened for anti-idiotype antibodies following vaccination or administration of antibody-based therapies, and an alternative vaccine could be selected if they were detected.”

Dr. Murphy added that these findings could provide many benefits, particularly “in understanding how to increase effectiveness and duration of protective antibody responses as well as potentially allowing for means to determine if patients are at risk based on their anti-idiotype response or allow for therapeutic interventions to be developed.”

“This article presents a hypothesis on a mechanism that could be at play,” he noted. “The research now needs to be done to ascertain if indeed this is occurring. A recent publication demonstrating the existence of anti-ACE2 anti-idiotypic antibodies in SARS-CoV-2 patients would appear to support this can indeed be a major factor.”

Covid-19 News: Nurse Shortage Forces Long Island Emergency Room to Close

ImageThe emergency room at Mount Sinai South Nassau in Oceanside, N.Y., will have to handle patients from the Long Beach Emergency Department during the closure.
Credit…Johnny Milano for The New York Times

A Long Island emergency room was forced to close its doors on Monday because of a nursing staff shortage, as a New York state rule took effect that bars unvaccinated medical workers from their jobs.

The free-standing Emergency Department at Long Beach, which is part of Mount Sinai South Nassau, said in a statement that patients would be directed to the hospital’s main campus in Oceanside, N.Y., about five miles north. An ambulance will be stationed at the shuttered facility, the statement said.

The hospital said the closure could last weeks or longer. But closing the Long Beach branch will allow the hospital to maintain adequate staffing at the Oceanside facility, the statement said.

“We regret having to take this step, but the safety of our patients is always our No. 1 priority,” said Dr. Adhi Sharma, the president of the medical center. “This closure should not be interpreted as anything beyond what it is — a temporary measure designed to relieve current staffing challenges in our emergency department. Our nurses, physicians and support staff have been on the front lines of the pandemic for more than 21 months. We will continue to be there for our patients.”

New York’s statewide vaccination mandate for health workers does not allow for religious exemptions, which spurred legal challenges. A federal court upheld the policy late last month.

Mount Sinai South Nassau said it had notified the state Health Department on Friday of the need to close the facility, and had submitted a formal closure plan. In a statement on Monday night, the Health Department said it was reviewing the plan and working with Mount Sinai South Nassau to “explore options.”

For now, Mount Sinai South Nassau is recruiting workers who can show proof of vaccination or valid medical exemptions in the hope of resuming full operations in mid-December.

Mount Sinai’s Oceanside emergency room is a designated trauma facility and sees about 70,000 patients a year, according to the medical center. The Long Beach branch, which opened in 2015, handles about 10,000 patients a year, most of whom are treated and discharged without being transferred to the hospital.

Credit…Don Treeger/The Republican, via Associated Press

A Massachusetts state judge on Monday dismissed criminal charges against two former administrators at a state-run facility for veterans, the Soldiers’ Home in Holyoke, where a coronavirus outbreak last year led to at least 76 deaths, reasoning that their actions did not lead to the infections.

The state’s attorney general, Maura Healey, had sought charges of criminal neglect and permitting body injury to an older person against the two men, Bennett Walsh, the former superintendent at the Soldiers’ Home in Holyoke, Mass., and David Clinton, the facility’s former medical director. Ms. Healey cited their decision to combine two understaffed dementia units, crowding together infected and uninfected men.

The criminal charges against the two men, who resigned their positions last year, were believed to be the first in the country brought against nursing home employees, and they had faced years or even decades in prison if convicted.

But Judge Edward J. McDonough Jr., of Hampden County Superior Court, wrote in his dismissal that he believed the five veterans named in the case had been exposed to the virus before the two units were merged, so the administrators could not be held legally responsible.

“There was insufficiently reasonably trustworthy evidence presented to the grand jury that, had these two dementia units not been merged, the medical condition of any of these five veterans would have been materially different,” he wrote.

Ms. Healey is weighing whether to appeal the decision, a spokeswoman said.

“We are very disappointed in today’s ruling, especially on behalf of the innocent victims and families harmed by the defendants’ actions,” said Jillian Fennimore.

Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of the most recent seven days of data.

Because of staffing shortages, the facility consolidated the units, which had a total of 42 residents who had different Covid-19 statuses, and residents who were positive or symptomatic were placed six in a room that typically held four veterans. An independent investigation of the deaths quoted nurses who said they knew that the move to combine units would prove deadly to many of their patients.

Relatives of the veterans who died at the facility expressed frustration at the judge’s decision on Monday.

“Absolutely disgusting, our veterans and their families apparently are a disposable commodity,” wrote Susan Perez, whose father, James Miller, died at the home, adding, “Apparently no one is responsible for the deaths of the veterans and trauma to their families.”

Correction: 

An earlier version of this briefing item misstated part of the name of the court where a Massachusetts state judge presides. It is Hampden County Superior Court, not Hampton.

Credit…Doug Mills/The New York Times

More than 90 percent of federal employees will have had at least one coronavirus vaccine shot by the end of Monday, the deadline set by President Biden when he announced vaccine mandates earlier this fall, according to a senior administration official.

The vast majority of those employees are fully vaccinated, and an additional 5 percent of employees are seeking or already have an exception or an extension, the official said. The news was first reported by Reuters.

This means the Biden administration will have achieved 95 percent compliance with the president’s requirement that federal employees have at least one shot or have an approved or pending exception or extension request by Nov. 22, according to the official, who spoke on the condition of anonymity to preview an announcement that White House officials will make later in the day.

Mr. Biden’s mandate for federal workers, announced in September, was part of an aggressive effort to combat the spread of the Delta variant, which has driven caseloads up to levels last recorded a year ago, before vaccines were widely available. The president also mandated vaccination for health care workers and ordered all companies with more than 100 workers to require vaccination or weekly testing for their employees.

“We’ve been patient,” Mr. Biden said then, in a pointed message to people who refused to be vaccinated. “But our patience is wearing thin. And your refusal has cost all of us.”

More than 3.5 million federal workers, both in the United States and around the world, are covered by Mr. Biden’s mandate. Employees who have not complied, and do not have a pending or approved exception or extension request, will be expected to undergo education and counseling, the official said, followed by “additional enforcement steps.”

On Wednesday morning, the Office of Management and Budget will release data on the percentage of employees at each agency who are in compliance with the requirement.

A personnel change in the White House’s coronavirus team is expected next week. On Monday, Dr. Bechara Choucair, the former Chicago health commissioner whom Mr. Biden brought in to oversee the vaccination effort, will leave the administration, according to Jeff Zients, the White House coronavirus response coordinator.

Dr. Choucair was a senior executive at Kaiser Permanente before joining Mr. Biden’s staff and is “returning to the West Coast after staying longer than originally planned,” Mr. Zients said.

Credit…Nic Antaya for The New York Times

A month ago, new coronavirus cases in the United States were ticking steadily downward and the worst of a miserable summer surge fueled by the Delta variant appeared to be over. But as Americans travel this week to meet far-flung relatives for Thanksgiving dinner, new virus cases are rising once more, especially in the Upper Midwest and Northeast.

Federal medical teams have been dispatched to Minnesota to help at overwhelmed hospitals. Michigan is enduring its worst case surge yet, with daily caseloads doubling since the start of November. Even New England, where vaccination rates are high, is struggling, with Vermont, Maine and New Hampshire trying to contain major outbreaks.

Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of the most recent seven days of data.

Nationally, case levels remain well below those seen in early September, when summer infections peaked, and are below those seen last Thanksgiving. But conditions are worsening rapidly, and this will not be the post-pandemic Thanksgiving that Americans had hoped for. More than 90,000 cases are being reported each day, comparable to early August, and more than 30 states are seeing sustained upticks in infections. In the hardest-hit places, hospitalizations are already climbing.

“This thing is no longer just throwing curveballs at us — it’s throwing 210-mile-an-hour curveballs at us,” said Michael Osterholm, an epidemiologist at the University of Minnesota. He said that the virus had repeatedly defied predictions and continues to do so.

The new rise in cases comes at a complicated moment. Last Thanksgiving, before vaccines were available, federal and local officials had firmly urged Americans to forgo holiday gatherings. But in sharp contrast, public health officials, including Dr. Anthony S. Fauci, the nation’s leading infectious-disease expert, have mostly suggested this year that vaccinated people could gather in relative safety.

Credit…Eric Gay/Associated Press

The chief elected official in Dallas County celebrated a victory on Tuesday in his legal dispute over the governor’s ban on mask mandates, after a state appeals court upheld an earlier injunction against the ban.

The ruling by Fifth Court of Appeals in Dallas affirmed an August ruling by a district judge that Gov. Greg Abbott’s executive order banning mask mandates impeded the ability of Judge Clay Jenkins, the top elected official in Dallas County, to protect his constituents from Covid.

Partisan tensions are at a fever pitch over whether students, teachers and school employees should be required to wear masks. Some Republicans have cast mask rules as an infringement on parental rights, while many Democrats hold that they are a matter of public health.

Mr. Abbott has faced a series of legal challenges since he signed an executive order in July barring mandates for both masks and vaccinations.

Officials in Dallas and elsewhere in Texas have defied the governor by requiring people to wear masks in schools and other indoor public settings.

Credit…Massimo Percossi/EPA, via Shutterstock

BRUSSELS — European governments are toughening their measures against Covid in the face of soaring infection rates and popular resistance, with violent protests over the weekend in numerous countries.

Austria went into lockdown on Monday to try to break the fourth wave of Covid spreading across Europe, while the German health minister, Jens Spahn, warned that by the end of this winter, “just about everyone in Germany will probably be either vaccinated, recovered or dead.”

Tens of thousands of people protested official crackdowns and vaccine requirements in Austria, the Netherlands, Belgium, Denmark, Italy, Switzerland and Croatia, with scattered violence and police use of tear gas and water cannons. Some protesters were organized by far-right parties, but many were simply fed up with almost two years of intermittent state controls over their lives in the name of public health.

Europe has accounted for more than half the world’s reported Covid deaths this month, according to the World Health Organization. On Monday, the Centers for Disease Control and Prevention advised Americans not to travel to Germany or Denmark because of the rising case rates there.

Chancellor Angela Merkel of Germany told her Christian Democratic Party on Monday that the latest surge was worse than anything Germany had suffered so far. And neighboring Austria began its fourth lockdown, one of the few in Western Europe since vaccines became widely available.

Most stores, restaurants, sporting venues and cultural institutions shut down, leaving the streets cold and quiet in the weeks before Christmas. The lockdown, which allows people to leave home only to go to work or to procure groceries or medicines, will last at least 10 days and as many as 20.

Austria has also announced that vaccination will be compulsory as of Feb. 1 — the first Western country to take that step, and one of only a handful around the world. On Saturday, some 40,000 Austrians marched in Vienna to protest the new measures.

In France, President Emmanuel Macron has relied more on persuasion. Proof of vaccination or a recent negative test is required to patronize restaurants and cinemas, which has encouraged many reluctant French to get vaccinated without a national mandate. But anti-vaccination groups remain active in France, as well.

Global roundup

Credit…Olivier Hoslet/EPA, via Shutterstock

France’s prime minister, Jean Castex, said on Tuesday that he had only “mild symptoms” after testing positive for the coronavirus, as the French news media criticized him for apparent past failures to follow the government’s social-distancing recommendations.

“I am well and am continuing to carry out my duties in isolation, strictly following the health protocol,” Mr. Castex said on Twitter.

On that same social network, however, many users shared videos of him appearing to flout distancing recommendations, including one from last week that showed a maskless Mr. Castex shaking hands with elected officials indoors.

The government itself has urged the French in recent weeks not to drop their guard and to continue observing distancing practices as much as possible, even when vaccinated.

Élisabeth Borne, the labor minister, recently warned companies not to become complacent about health guidelines. “Maybe we have lapsed a bit, barrier measures are being less respected,” she told the news channel BFMTV this month.

On Monday, Mr. Castex had just returned from an official trip to Belgium, where he met with Prime Minister Alexander De Croo, when he learned that his 11-year-old daughter had tested positive, his office said in a statement. He immediately took a test, which turned out positive.

President Emmanuel Macron of France chose Mr. Castex, 56, as prime minister in July 2020. Mr. Castex had previously been the top official in charge of lifting the strict nationwide lockdown France imposed during the first wave of the coronavirus pandemic.

Mr. Macron himself was sick with Covid-19 late last year.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

The number of daily infections has shot up in France, which is one of several European countries experiencing a new wave of cases.

On Monday evening, Mr. Castex met virtually with elected officials from Guadeloupe, a Caribbean archipelago governed by France that has been rocked by violent unrest over the past few days because of protests against French vaccination mandates.

In a televised statement after the meeting, Mr. Castex condemned the violence and said the government would try to “convince and assist, individually, humanely,” health workers who are reluctant to get vaccinated.

“Vaccination is necessary for protection, most notably against serious forms of the illness,” said Mr. Castex, who is fully vaccinated. “There is no other way.”

In other news from around the world:

  • Officials in South Korea said on Tuesday that they had shut down a religious facility in the city of Cheonan after 210 of its 427 residents tested positive for the coronavirus this week, an outbreak that comes as the country’s cases surge to record highs. At least 191 of those infected in Cheonan were unvaccinated, a health official said. Officials did not release the name of the religious organization, citing disease control laws meant to protect privacy.

  • Germany’s military is set to require service members to be vaccinated after a committee of soldier-representatives and defense ministry staff approved such a step on Monday. The move still requires formal approval. German soldiers abroad have already been required to be vaccinated since the spring. On Tuesday, the defense ministry announced that it would send 6,000 soldiers to help districts dealing with a spike in coronavirus cases.

  • A court in Spain rejected a plan by the government of the Basque region to make it compulsory to show a vaccination passport to enter restaurants, concert halls and other public spaces. The judges ruled on Monday that the latest Covid numbers did not justify the blanket obligation. The regional government said it found the ruling incomprehensible, but that it would not appeal. At least three other regions of Spain had been preparing similar measures.

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The protests in France’s Caribbean territory, fueled by longstanding social and economic frustrations, grew increasingly violent as protesters burned cars and looted businesses.CreditCredit…Ricardo Arduengo/Reuters

Violent protests over vaccine mandates have rocked France’s overseas department of Guadeloupe in the Caribbean over the past week, fueled by longstanding social and economic frustrations over inequality with the mainland and simmering anger at being overlooked by the French government.

Guadeloupe, an archipelago of islands, is one of several French overseas territories that have been hit hard by the pandemic over the past few months and where France’s vaccination campaign has been met with the most suspicion and resistance.

A mix of old grievances and new distrust over Covid-19 rules has made the unrest particularly volatile.

Demonstrations that started peacefully with road blocks and pickets in front of the main hospital in Pointe-à-Pitre, Guadeloupe’s largest city, grew increasingly violent over the weekend, as protesters burned cars, looted businesses and clashed with riot police officers, who responded with tear gas.

More than 30 people accused of violence or looting have been arrested, and the local authorities imposed a nighttime curfew. The central government also announced over the weekend that it was sending over 200 police reinforcements.

On Monday, the remains of charred cars littered roads and schools remained closed as President Emmanuel Macron of France appealed for calm and order.

“Our priority is to continue convincing that vaccination is the best protection,” Mr. Macron told reporters during a visit to Amiens, his hometown in northern France. “And to yield nothing to lies, disinformation and the manipulation by some of this situation.”

“There is a very explosive situation, tied to a very local context, to historical tensions that we know of,” Mr. Macron acknowledged, as he accused some of the government’s critics of “using this context and these anxieties” to aggravate the situation.

Over 40 percent of the adult population in Guadeloupe is fully vaccinated, but that figure is nearly 90 percent for all of France including overseas regions, according to official statistics.

The unrest started last week with a strike by local unions that are opposed to France’s vaccine mandate for health workers. Those unions say it was imposed by the central government with little consultation, and are particularly infuriated that unvaccinated health professionals are suspended without pay.

“That is an unheard level of violence against them and their families,” Jean-Marie Nomertin, the secretary general of the Confédération Générale du Travail de la Guadeloupe, one of the protesting unions, said in a statement last week.

Protesters have also rejected France’s health pass, which is needed to gain access to restaurants, museums and other public places and can only be obtained through full vaccination, proof of Covid recovery, or a recent negative test — which must now be paid for out of pocket for those who are not vaccinated and do not have a prescription.

As in other overseas departments like Réunion or French Guiana that are a legacy of France’s colonial empire, Guadeloupe has long felt overlooked by policymakers in Paris, with decades-old anger over stagnant unemployment, high living costs and dysfunctional public utilities that have fueled protests in the past.

Suspicion of public health policies is especially high in the French Caribbean, where the government authorized the use of a highly toxic pesticide called chlordecone on banana plantations for decades, despite repeated health warnings.

“People are afraid, they have no trust,” Harry Durimel, the mayor of Pointe-à-Pitre, told Franceinfo on Monday, adding that local residents were “ready for a confrontation” over vaccine rules if they felt they were being forced “to inject a product in their body.”

On the nearby island of Martinique, unions on Monday called for a general strike over similar concerns.

Credit…Brian Inganga/Associated Press

NAIROBI, Kenya — Kenya will require people to show proof of coronavirus vaccination to enter many businesses, restaurants and government offices starting next month, a major policy shift that has prompted outrage in a country where less than 5 percent of the total population is fully vaccinated.

Mutahi Kagwe, the cabinet secretary for health, said on Sunday that he was concerned about a slowdown in vaccinations and hoped the new rules would persuade more people to get their shots. With schools closing and the country heading into the festive season, he said there were concerns that people would become complacent about public health measures, including social distancing and wearing masks.

The new measure was swiftly criticized by lawyers, activists and the public, who cautioned against a stringent vaccine mandate just weeks after the lifting of a longstanding nationwide night curfew that dampened economic activity.

“It’s clearly unconstitutional,” Waikwa Wanyoike, a prominent constitutional lawyer, said of the mandate, adding that using “threats” to get more people to get inoculated will only create more apprehension about vaccines. “The requirement may be right in terms of asking as many people to be vaccinated but the approach is wrong,” he said in a phone interview.

Vaccination campaigns in Kenya have been hampered by a lack of funding. There have been few awareness campaigns. Nor are there widespread vaccination sites. The authorities at times have scrambled to access or purchase cold storage facilities needed to store the shots.

The new rules will also extend to those planning to visit hospitals, prisons, eateries, bars, national parks and any business serving 50 or more people daily. Drivers of public transportation, along with pilots and air hostesses, will be expected to always carry proof of vaccination. In addition, visitors from Europe will be required to be fully vaccinated to enter Kenya.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

The new rules are the most expansive introduced in the continent yet, according to Dr. Githinji Gitahi, who serves on the governing board of the Africa Centres for Disease Control and Prevention. Zimbabwe has mandated that civil servants get shots and requires congregants at places of worship to produce proof of vaccination. Uganda requires all teachers and health care workers to be vaccinated while Namibia has flouted the idea.

Kenya has recorded over 254,700 cases and 5,328 deaths from the coronavirus. While average case rates have dropped in recent weeks, the lag in vaccinations and the spread of the more contagious Delta variant had overwhelmed the country’s health care system. Kenya hopes to vaccinate at least 30 million people before the end of 2022, but like many African countries, it has also struggled to gain access to vaccines.

The new restrictions were met with skepticism, with many lamenting its impracticality. Some pointed to the low vaccination rates among the adult population, with just 8.8 percent of them fully vaccinated. Others said the mandate could open the door to more corruption, bribery and the proliferation of fake vaccine certificates.

Critics said the government should not only make sure that vaccines are available to all but also should come up with better strategies to address misinformation and resistance to getting vaccinated.

Irungu Houghton, the executive director of Amnesty International Kenya, said the new mandate, in its current format, risked depriving people of their right to not only work but also access critical services like health and education.

“This proposal risks domesticating the global vaccine apartheid and creating those with rights and those without,” Mr. Houghton said in a statement.

Credit…Emily Elconin for The New York Times

The American Medical Association voted last week to allow only licensed physicians to write requests for patients seeking medical exemptions from vaccine mandates.

But the association does not have the power to enforce what is, in effect, a symbolic action intended to show concern as tens of thousands of people seek exemptions. While some states prohibit alternative practitioners like homeopaths, chiropractors and naturopaths from writing medical exemptions for vaccines, other states allow it.

“Science supports a vaccine mandate,” said Dr. Gerald E. Harmon, the president of the American Medical Association, “and we do not need to offer routes to evade mandates and undermine public health by seeking out practitioners who are not licensed or medically trained.”

The A.M.A.’s stance reflects increasing frustration among doctors with the spread of misinformation about Covid-19 vaccines and the virus. The association says that alternative practitioners are less likely than licensed physicians to recommend vaccines, and that they may even advise people not be vaccinated.

But removing power from alternative practitioners would not stop patients from getting invalid medical exemption requests. Licensed medical doctors are also writing bogus requests, according to doctors who are being asked to rule on them.

Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco, sees the problem with invalid exemptions firsthand. Although California prohibits alternative practitioners from writing vaccine exemptions, patients are finding licensed doctors who will write them.

Dr. Chin-Hong said the university often called on him to evaluate the requests.

“I have never seen one that passed muster,” he said.

Some patients seeking a medical exemption will simply hop from one doctor to another if they are turned down, said Lawrence O. Gostin, a global health law professor at Georgetown University. If the university denies their request, he added, people often turn up again with a request for a religious exemption.

Correction: 

An earlier version of this article misstated which practitioners are prohibited by some states from writing medical exemptions for vaccines. Osteopaths can write exemptions, they are not among the alternative practitioners prohibited from doing so.

Credit…Joel Carrett/EPA, via Shutterstock

Australia, 20 months after shutting its borders, will allow skilled workers and international students to enter the country next month, the government announced on Monday.

The move comes as the Australian government, faced with a severe labor shortage, turns its focus to economic recovery, with 72 percent of the country fully vaccinated.

The new rules go into effect on Dec. 1, the beginning of summer in Australia. Some categories of visa holders, including skilled workers, international students, and those on working holiday and prospective marriage visas, will be allowed to enter Australia for the first time since the start of the pandemic. Over 200,000 people will fall into those categories.

“The return of skilled workers and students to Australia is a major milestone in our pathway back,” Prime Minister Scott Morrison said on Monday at a news conference. “The steps that we are taking today are about securing our economic recovery.”

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

At the start of the pandemic, Australia shut its borders to noncitizens, leaving hundreds of thousands of visa holders stranded outside the country and contributing to a significant worker shortage. Australia has relied on temporary workers for many industries, such as hospitality and agriculture. The travel restrictions also created a severe funding shortfall for universities.

Most tourists are still barred from traveling to Australia, except those from Singapore, South Korea and Japan, all countries that have established travel bubbles with Australia.

Visitors entering Australia will need to be fully vaccinated and return a negative PCR test within three days of boarding their flight. Upon arrival, they will need to follow some quarantine restrictions, depending on the state in which they arrive.

On Sunday, the first planes from Singapore arrived in Sydney and Melbourne under the new travel bubble arrangement, bringing the first tourists into the country since the start of the pandemic.

Credit…Gabby Jones for The New York Times

The lines are getting longer at the Halal Guys food cart in the heart of Manhattan. The number of international visitors buying Statue of Liberty tickets has jumped more than 50 percent. And a few thousand more people are walking through Times Square.

After more than 18 months, the United States reopened its borders on Nov. 8 to vaccinated foreign travelers. Early indications suggest that they have been trickling back to New York, the top American destination city for international tourists.

But many businesses that depend on international visitors, including hotel operators and restaurants, see signs that even more tourists could start streaming in as the year-end holiday season approaches, providing a badly needed boost as the city’s labor force struggles to recover from the pandemic.

The tourism industry has increasingly become a pillar of New York’s economy. A record 66.6 million travelers visited the city in 2019, and their spending supported hundreds of thousands of jobs, from restaurant workers to museum security guards to bus drivers.

Some airlines reported that their first flights carrying tourists to New York in 20 months were fully booked.

“It really seems like the city is happy to show itself to the world again,” said Christiaan Vander Kuylen, who arrived recently from Brussels. “The energy is amazing.”

Credit…Christopher Occhicone for The New York Times

As a company in India tests a cheap and possibly highly effective Covid-19 vaccine, a large group of researchers, most of whom are at Harvard, made the same vaccine and figured out how and why it could work so well, especially in vulnerable older adults.

The Harvard group began with a crucial question about Covid: Which population is most important to protect?

The answer, of course, is older people who are most at risk for severe disease and death.

The Harvard group began testing the vaccine with old mice. Like older people, old mice are much more susceptible to the coronavirus and much more likely to die.

The researchers made a vaccine that included a fragment of the virus’s spike protein, the part that latches onto cells, allowing the virus to enter. Vaccines like the ones made by Moderna and by Pfizer-BioNTech spur cells to make complete copies of the spike, prompting the immune system to make antibodies to block it if a coronavirus tried to infect the person.

But those vaccines are expensive to make and store. In contrast, a snippet of the spike is cheap and can be stored at room temperature. The problem was that it does not elicit much of an immune response.

The Harvard group, led by David Dowling, turned to adjuvants — chemicals that enhance the immune system’s response to vaccines — trying one adjuvant combination after another until they found one that seemed spectacularly successful. With that adjuvant, the vaccine protected mice at least as well as the Pfizer vaccine, said Dr. Ofer Levy, the director of Harvard’s Precision Vaccines Program.

But what about people? Dr. Levy recruited volunteers from his Cambridge synagogue — people in their 60s, 70s and 80s — to provide blood for lab tests to see if the adjuvant that was so good in mice also stimulated the immune system in older people.

It did.

Now the question is what will happen in the trial in India? If the vaccine works, the hope is that it could help solve one of the thorniest problems in stemming the pandemic — how to make vaccines accessible to everyone worldwide.

The Indian government seems to be betting on success. In June, while clinical trials were in their early stages the government preordered 300 million doses. Its maker, Biological E Limited, estimates it will cost $3 a dose.

In contrast, Pfizer’s price is $19.50 a dose but is expected to rise after its pandemic pricing phase ends.

Credit…Andrew Kutan/Agence France-Presse — Getty Images

Papua New Guinea will have vaccinated only a third of its adult population by 2026 if it continues at its current rate, according to new research by an Australian think tank that predicts that some countries in the Pacific will take years to vaccinate their populations.

The research by the think tank, the Lowy Institute, using modeling based on existing vaccination rates and factors such as demography, vaccine acceptance rates and health sector capacity, found that while some countries in the Pacific are leading the world in vaccination rates, others are lagging far behind.

“The Pacific is divided when it comes to vaccinations,” said Alexandre Dayant, the author of the study and a Lowy Institute research fellow, warning that the slow vaccination speed in some nations raised the risk of new variants emerging.

Palau has given 99 percent of residents at least one vaccine dose. Tonga and Samoa are set to vaccinate their adult populations before the end of the year, according to the modeling, which is subject to change.

However, the Solomon Islands are not expected to fully vaccinate their adult population until April 2026, while it is estimated to take Vanuatu until then to vaccinate 86 percent of its adult population. And Papua New Guinea, the slowest in the region, will have vaccinated only about 16 percent of its population by December 2022.

These countries have been hampered by overstretched health care systems and rampant vaccine misinformation, Mr. Dayant said.

Facebook is often people’s primary source of information there, and unsubstantiated theories of Western plots to inoculate people with microchips and black magic circulate on social media, he said, adding: “misinformation spreads much quicker than the virus in the Pacific.”

He said wealthy countries could do more, like bolstering local health care systems. “It is in the interest of the world to vaccinate developing countries,” he said.

Credit…Brendan Mcdermid/Reuters

Seeking to increase the supplies of coronavirus vaccines, treatments and diagnostic tests needed to quell the pandemic around the globe, 15 human rights groups have asked President Biden to apply maximum pressure on the World Trade Organization to grant an intellectual property exemption for the vaccines.

The exemption would mean that any country or company that has the ability to produce a vaccine could do so without having to worry about running afoul of the world economic body’s property right protections. Some public health experts see a W.T.O. exemption as key to bolstering the production of vaccine in developing countries, allowing drugmakers around the world access to closely guarded trade secrets on how viable vaccines have been made.

“The stakes could not be higher,” the groups wrote in a letter to the White House dated Nov. 19. “Failure to enact a waiver will prolong the pandemic leading to more death, illness, economic hardship, and social and political disruption.”

Only 5 percent of people in low-income countries have received at least one dose of a coronavirus vaccine, according to the Our World in Data project at the University of Oxford, a figure that is dwarfed by rates in wealthier countries.

Public Citizen, Oxfam, Amnesty International, Human Rights Watch, Doctors Without Borders and Partners in Health are among the organizations listed on the two-page letter.

“There are people talking about whether or not we should take boosters,” Dr. Joia Mukherjee, chief medical officer of Partners In Health, a global public health nonprofit, said at a news conference on Tuesday. “This, to me, is even a false argument because that plays into the narrative that this is a scarce commodity.”

“It is only a scarce commodity because Pharma wants it to be a scarce commodity so that they can maximize profit,” she said, using shorthand for the pharmaceutical industry. “And we just need to say enough is enough. This is the time for us to show leadership.”

The increase in pressure on the Biden administration comes one week before hundreds of officials converge on Geneva for the W.T.O.’s major ministerial conference on Nov. 30.

In May, the White House said that it supported waiving intellectual property protections for coronavirus vaccines, as it sought to bolster production amid concerns about vaccine access in developing nations.

But the rights groups said in their letter that they were disappointed that the administration had since “been unwilling to take further leadership.” They noted that more than 100 W.T.O. member nations supported a waiver.

Six times as many booster shots of coronavirus vaccine are being administered in wealthy countries around the world each day than primary doses are being given in low-income countries, according to the World Health Organization. The group’s director general, Dr. Tedros Adhanom Ghebreyesus, has called that disparity “a scandal that must stop now.”

The Biden administration said last week that it planned to spend billions of dollars to expand vaccine manufacturing capacity, with the goal of producing at least one billion additional doses a year beginning in the second half of 2022.

Credit…Emily Elconin for The New York Times

Coronavirus cases in children in the United States have risen by 32 percent from about two weeks ago, a spike that comes as the country rushes to inoculate children ahead of the winter holiday season, pediatricians said.

More than 140,000 children tested positive for the coronavirus between Nov. 11 and Nov. 18, up from 107,000 in the week ending Nov. 4, according to a statement on Monday from the American Academy of Pediatrics and the Children’s Hospital Association.

These cases accounted for about a quarter of the country’s caseload for the week, the statement said. Children under 18 make up about 22 percent of the U.S. population.

“Is there cause for concern? Absolutely,” Dr. Sean O’Leary, the vice chair of the academy’s infectious diseases committee, said in an interview on Monday night. “What’s driving the increase in kids is there is an increase in cases overall.”

Children have accounted for a greater percentage of overall cases since the vaccines became widely available to adults, said Dr. O’Leary, who is also a professor of pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado.

Though children are less likely to develop severe illness from Covid than adults, they are still at risk, and can also spread the virus to adults. Experts have warned that children should be vaccinated to protect against possible long-Covid symptoms, Multi-system Inflammatory Syndrome and hospitalization.

At the end of October, about 8,300 American children ages 5 to 11 have been hospitalized with Covid and at least 172 have died, out of more than 3.2 million hospitalizations and 740,000 deaths overall, according to the Centers for Disease Control and Prevention.

At a news conference on Friday, Dr. Janet Woodcock, the acting commissioner of the Food and Drug Administration, said hospitalizations and deaths among 5- to 11-year-olds were “really startling.”

Dr. O’Leary said it did not help that many schools had softened their safety protocols in the last few months.

“So any protection that might be happening in schools is not there,” he said.

Vaccinations of younger children are likely to help keep schools open. Virus outbreaks forced about 2,300 schools to close between early August and October, affecting more than 1.2 million students, according to data presented at a C.D.C. meeting on Nov. 2.

Dr. O’Leary said that he was especially concerned about case increases in children during the holiday season.

With the pace of inoculations stagnating among U.S. adults, states are rushing to encourage vaccinations for children 5 through 11, who became eligible earlier this month after the C.D.C. authorized the Pfizer-BioNTech vaccine for that age group. In May, the federal government recommended making the Pfizer-BioNTech vaccine available to children ages 12 to 15. Teenagers 16 and older became eligible in most states a month earlier.

The White House estimated on Nov. 10 that nearly a million young children had gotten vaccinated; 28 million are eligible. They receive one-third of the adult dose, with two injections three weeks apart.

All of the data so far indicates that the vaccines are far safer than a bout of Covid, even for children.

Still, about three in 10 parents say they will definitely not get the vaccine for their 5- to 11-year-old child, according to a recent poll by the Kaiser Family Foundation. Only about three in 10 parents said they would immunize their child “right away.”

Long COVID may affect how women recover from exercise

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New research explores the link between long COVID and women’s ability to exercise. Artur Widak/NurPhoto via Getty Images
  • Long COVID or post-acute COVID syndrome is characterized by a multitude of symptoms that persist beyond the acute phase of 3–4 weeks after getting the SARS-CoV-2 virus.
  • Women hospitalized with COVID-19 are more likely to experience persistent deficits in cardiovascular and lung function than men in the months following discharge.
  • A new study found that even women with mild-to-moderate COVID-19 may experience slower declines in their resting heart rate after physical activity in the post-acute phase of the SARS-CoV-2 infection.
  • Such deficits in cardiovascular function during exercise are associated with reduced capacity for physical exercise and, potentially, activities of daily life.
  • Women presenting with specific long COVID symptoms, namely shortness of breath or joint or muscle aches, were also more limited in their ability to do a walking test than people who had had a SARS-CoV-2 infection but experienced no lingering symptoms.

Although the majority of individuals recover within the first 3–4 weeks after contracting COVID-19, a considerable number continue to experience lingering symptoms for weeks or months after this initial or acute phase of the disease.

These symptoms, which people refer to collectively as long COVID or post-acute COVID-19, include shortness of breath, loss of smell and taste, brain fog, headaches, and fatigue.

Studies have shown that more than half of the individuals hospitalized with COVID-19 during the initial phase of the SARS-CoV-2 infection show persistent impairments in cardiovascular and lung function several months after discharge. Furthermore, women hospitalized with severe COVID-19 are more likely than men to present with such persistent deficits in cardiovascular and lung function after discharge.

Individuals may present with persistent symptoms during the post-acute phase of COVID-19, regardless of the severity of symptoms during the acute phase of the illness. The effects of mild-to-moderate COVID-19 on lung and cardiovascular function and, subsequently, on daily physical functioning during the post-acute phase is not well-understood.

Researchers at Indiana University, Bloomington, recently examined how mild-to-moderate COVID-19 affected exercise capacity or tolerance during the post-acute phase in women. Exercise tolerance or capacity refers to the ability of an individual’s cardiovascular system to sustain physical activity.

The researchers used an exercise test called the 6-minute walk test to assess the persistent effects of SARS-CoV-2 infection on cardiovascular function in women during the post-acute phase of the infection.

They found that women with COVID-19 who had mild-to-moderate illness during the acute phase showed a slower decline in their heart rate after the 6-minute walk test than the participants in the control group. This difference was more pronounced in women actively experiencing long COVID symptoms.

However, encouragingly, they found no statistically significant differences in a range of other measures, including pre- and post-test oxygen saturations, pre- and post-test heart rate, ratings of perceived exertion, and ratings of perceived breathlessness.

The study’s lead author, Dr. Stephen Carter, a professor at Indiana University, told Medical News Today: “A puzzling feature of post-acute COVID-19 syndrome is the variable presentation of symptoms that appear to be independent of initial illness severity. The present work shows even those with mild-to-moderate initial symptoms can be affected with underlying cardiac-related irregularities with the potential to affect exercise tolerance and/or activities of daily living.”

“It’s also plausible that lingering symptoms, particularly muscle/joint pain and/or shortness of breath, may trigger a maladaptive pattern that accelerates systemic deconditioning. However, further research is needed.”

Dr. Ziyad Al-Aly, chief of research and education service at Veterans Affairs St. Louis Health Care System, also spoke with MNT. Dr. Al-Aly, who was not involved with the study, said, “Studies like this are important to help us understand why some people with long COVID experience profound exertional fatigue that may limit their ability to exercise and their ability to carry out activities of daily living.”

The study appears in the journal Experimental Physiology.

The study included 29 women who had experienced mild or moderate illness due to COVID-19. These women had received a positive SARS-CoV-2 diagnosis at least 4 weeks prior to the study, with the average time of diagnosis being 94 days before the study. The control group consisted of 16 women who had never tested positive for a SARS-CoV-2 infection.

Out of the 29 participants in the test group, 17 women reported experiencing at least one long COVID symptom at the time of the study. These long COVID symptoms included shortness of breath, fatigue, cough, muscle or joint pain, loss of smell or taste, and skin irritation.

The researchers administered pulmonary function tests to assess various aspects of lung function. They found that the women who had tested positive for SARS-CoV-2 exhibited reduced total lung capacity compared with those in the control group.

The researchers then evaluated changes in cardiovascular function during and after the 6-minute walk test. The test measures the distance that participants walk in 6 minutes at their normal pace, and researchers use it to assess exercise tolerance. The team adjusted the results for age, sex, and body mass index (BMI) to prevent these variables from influencing the test results.

There was no significant difference between the distances that the two groups covered during the test.

However, women with SARS-CoV-2 who experienced shortness of breath or joint or muscle pain had a lower adjusted distance value than those with SARS-CoV-2 who did not experience these long COVID symptoms.

The researchers assessed the blood pressure, heart rate, and blood oxygen or oxygen saturation levels before and immediately after the 6-minute walk test. They calculated the heart rate response during exercise by subtracting the heart rate at rest from the heart rate after the completion of the test.

The heart rate response during exercise is a measure of cardiovascular function, with a lower heart rate response being a predictor of reduced exercise capacity and cardiovascular disease-associated mortality.

The women in the SARS-CoV-2 group showed a lower heart rate response than those in the control group.

Moreover, the participants in the SARS-CoV-2 group who reported shortness of breath as a long COVID symptom at the time of the study had a lower heart rate response during the test than those in the SARS-CoV-2 group who did not have this symptom.

The researchers also measured heart rate recovery, which is another indicator of cardiovascular health and all-cause mortality.

Heart rate tends to drop immediately after strenuous exercise. Heart rate recovery measures the decrease in heart rate after the cessation of exercise. Specifically, heart rate recovery quantifies the decrease in heart rate at a predefined time interval — generally 1 minute — from the end of the physical activity.

In the current study, the researchers measured the participants’ heart rate at the end of each minute during the 5-minute recovery period after the 6-minute walk test.

The SARS-CoV-2 group participants showed a less significant decrease in heart rate at 1 minute after the completion of the test than those in the control group. This suggests that the decline in heart rate occurred more gradually in the women in the SARS-CoV-2 group. Such a delay in heart rate recovery is associated with reduced exercise capacity.

Furthermore, women in the SARS-CoV-2 group who exhibited specific long COVID symptoms at the time of the study had decreased heart rate recovery compared with the SARS-CoV-2 group participants without these symptoms.

Specifically, women in the SARS-CoV-2 group with symptoms such as fatigue, loss of taste or smell, joint and muscle aches, or shortness of breath had decreased heart rate recovery compared with women who had not had SARS-CoV-2.

“A lot of long COVID-19 patients are placed into rehabilitation programs that are designed for non-COVID-19 patients. These programs may not be suitable for long COVID patients. It is important to understand that people with long COVID need programs designed for them (pacing, etc.). Findings from this study and others should be taken into account when designing rehabilitation programs for people with long COVID,” said Dr. Al-Aly.

Dr. Carter noted: “SARS-CoV-2 participants and [people without the infection] were matched for age, BMI, smoking status, and history of cardiopulmonary disease. As such, we have better assurance that reported differences were attributed to SARS-CoV-2, as opposed to another comorbidity.”

“A strength of the work is that comparisons were performed among women — who appear to be susceptible to persistent SARS-CoV-2-related symptoms — during and following a 6-minute walk test.”

Dr. Carter acknowledged that the study had a few limitations. He said: “Indeed, the 6-minute walk test is a widely used clinical tool that offers insight into exercise capacity and walking autonomy. However, it should be noted we cannot disregard the possibility of undiagnosed pulmonary abnormalities and/or autonomic dysfunction that existed prior to a SARS-CoV-2 infection. Additionally, it is conceivable some controls may have had an asymptomatic SARS-CoV-2 infection and/or a previous false-negative diagnostic test for SARS-CoV-2.”

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

How long will ‘natural immunity’ last?

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A new review asks how long purely natural immunity may very last. Noam Galai/Getty Illustrations or photos
  • Obtaining COVID-19 must confer some immunity versus creating the sickness yet again, but wellness experts do not know how extended this immunity lasts.
  • Experts know that some folks have created COVID-19 much more than once, but there are not adequate information for scientists to be able to evaluate how extended “natural” immunity lasts.
  • Acquiring examined the genome of SARS-CoV-2, scientists counsel that, among unvaccinated folks, reinfection could take place as quickly as 3 months soon after contracting the virus.

In accordance to Our Planet in Data, almost 50 percent of the world’s populace have been given at the very least a person dose of the vaccine in opposition to SARS-CoV-2, the virus that will cause COVID-19.

Scientists have shown that COVID-19 vaccines reduce the severity of illness but do not confer total defense in opposition to COVID-19.

At the beginning of the pandemic, some jurisdictions, including those in the United Kingdom and Sweden, pursued a policy of herd immunity, which assumed that letting more than enough persons to catch the virus would confer sufficient immunity on the population to close the pandemic.

Whilst there have been some reports of people today creating COVID-19 more than when, these figures are too modest to have out an epidemiological examine. This suggests that it is difficult to determine how extended immunity conferred from a SARS-CoV-2 an infection lasts.

In the present examine, researchers have performed an evaluation of beforehand released details on viruses identical to SARS-CoV-2. They set out to ascertain how long immunity pursuing COVID-19 could previous.

The investigate, which seems in The Lancet Microbe, reveals that unvaccinated people can hope immunity versus reinfection to last 3–61 months soon after developing COVID-19 — if the virus is nevertheless circulating in the local community.

This examine could enable stimulate persons to get vaccinated, stated Dr. Ajay Sethi, affiliate professor of inhabitants health and fitness sciences at the University of Wisconsin-Madison, who was not involved in the exploration. He told Health care Information Currently,

“The review underscores the value for the general public to understand that immunity from pure infection is not as extensive long lasting as some may perceive, and surely not lifelong.”

He also discussed that “research has demonstrated that vaccination adhering to organic an infection provides an even more robust immune reaction as as opposed [with] vaccination without having any prior background of COVID-19. Hopefully, far more folks who’ve had infection in the earlier will select to get vaccinated.”

A crew from Yale School of Public Health in New Haven, CT, and the College of North Carolina at Charlotte looked at the genes of 177 coronaviruses recognized to affect individuals. The scientists then established which had been the closest viral family of SARS-CoV-2.

They recognized five viruses that satisfied this criterion. They involved SARS-CoV, responsible for the SARS outbreak in 2003, and MERS-CoV, which was very first detected in 2012. They also incorporated viruses that induce the common chilly.

The scientists then analyzed present facts on how antibody amounts decrease around time — from 128 days to 28 a long time immediately after infection. They also looked at the possibility of reinfection at various antibody levels for people viruses.

Making use of this details, they predicted that purely natural immunity conferred by contracting SARS-CoV-2 would very likely past considerably less than 50 percent as very long as the immunity due to contracting similar coronaviruses.

They located that reinfection with SARS-CoV-2 in men and women who had not gained a vaccine could manifest as soon as 3 months following preliminary an infection, with a median danger of reinfection inside of 16 months, beneath endemic situations.

Co-chief of the analyze Alex Dornburg, assistant professor of bioinformatics and genomics at the University of North Carolina, states:

“As new variants come up, previous immune responses develop into a lot less successful at combating the virus. These who had been in a natural way infected early in the pandemic are increasingly very likely to turn into reinfected in the around future.”

The study authors conclude that as novel variants could evade existing immunity, it is crucial to emphasis efforts on accelerating global vaccine systems to cut down the likelihood of variants emerging in the very first area.

It is of notice that the analyze had specified limitations. For instance, it did not glance at how severity of initial SARS-CoV-2 infection or immune standing of an unique might affect how extended their pure immunity would past.

Talking on this level, Dr. Alexander Edwards, affiliate professor in biomedical technological innovation at the College of Looking through in the U.K., who was not involved in the examine, advised MNT:

“Reinfection isn’t seriously the crucial issue for COVID-19. In its place, the most essential point is severity of an infection. If earlier infection guards from severe disease building, it becomes significantly less important to the specific if they get contaminated a second time.”

“However,” he ongoing, “for COVID-19, we still never know if preceding infection will thoroughly protect from serious illness and dying for everyone.”

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