How eye tests could help detect diabetes, MS, and dementia

How eye tests could help detect diabetes, MS, and dementia

The eyes have long been called the “windows to the soul,” and increasingly, evidence is suggesting that they might be also windows to both the brain and body. Several health conditions can be detected by examination of the eyes, among them diabetes, multiple sclerosis, and even Alzheimer’s disease. Medical News Today spoke to experts in the field to discover how the eye can reveal the body’s secrets.

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How much could our eyes reveal about our health? Image credit: A.J. Schokora/Stocksy.

Most of us have our eyes tested regularly, but few may be aware that an eye test is not just for checking vision and correcting sight problems.

Because it has a “window” at the front, the eye is the only part of the body where doctors can, non-invasively, examine the inside of an organ. At the back of the eye is the retina, where blood vessels and the optic nerve can be clearly seen.

Thanks to this, optometrists and ophthalmologists could diagnose not only disorders of the eye, but also systemic diseases — those that affect other organs in the body or the whole body.

If a routine eye test raises concerns, the optometrist can refer a person to a medical ophthalmologist who will investigate by carrying out further eye examinations. If their investigations reveal a systemic disease, they can then refer the person to the relevant specialist.

Dr. Hagar Ibrahim, senior specialist trainee (ST6) in medical ophthalmology at St. Paul’s Eye Unit, Liverpool University Hospitals NHS Trust, in the United Kingdom, told Medical News Today that “a routine eye examination in which the pupils are dilated using eye drops can provide a full and clear view of the optic nerve, which connects to the brain, the retina, […] and all the blood vessels supplying the retina.”

“Therefore, pathology in the eye can be clearly seen during [an] eye examination, both in localized eye conditions and in systemic disease, truly making the eye a window into the rest of the body,” she added.

“People are often surprised when an eye doctor diagnoses them with a systemic illness but they shouldn’t be. Many people with systemic illnesses are first diagnosed by their eye doctor, which is just one reason why all adults should have regular eye examinations at least every 2 years.”

Dr. Philip Storey, a board-certified ophthalmologist and fellowship-trained retina specialist at Austin Retina Health

As well as identifying problems with vision, such as nearsightedness, farsightedness, and astigmatism, a routine eye test will detect other eye disorders, such as glaucoma, and age-related macular degeneration.

By examining the blood vessels in the retina and the optic nerve, the optometrist can also discover a lot about a person’s general health.

This non-invasive process can detect many other health conditions that may seem unconnected to the eyes, among them hypertension, diabetes, thyroid disorders, and neurodegenerative diseases such as Alzheimer’s disease, and multiple sclerosis (MS).

“Ocular inflammation can affect many parts of the eye, and can often be the first sign of a systemic disease. The key to diagnosing the cause is in focused history taking followed by [a] guided investigation of the relevant body systems, including blood tests,” explained Dr. Ibrahim.

Changes in the blood vessels in the retina can be early indicators of both diabetes and hypertension.

Dr. Storey told MNT that “[d]iabetes is the most commonly diagnosed disease given the frequency of the illness as well as the classic findings on retina exam, which can include bleeding, leakage of fluid, and areas of poor blood flow.”

Although a firm diagnosis of diabetes can only be made with a blood glucose test, changes in the blood vessels of the retina can give a strong indication that a person may have diabetes. They can then be referred for further testing.

According to the American Academy of Ophthalmology, the signs of diabetic retinopathy can sometimes be detected by eye examination even before a person suspects they may have diabetes.

Once diagnosed, provided the diabetes is well controlled, the person can then minimize the risk of further eye damage, as Dr. Ibrahim explained: “In addition to localized eye therapies such as laser treatment or intravitreal eye injections, improving blood sugar levels by sticking to the proper pharmacological treatment, restricting sugar intake and making necessary lifestyle changes, can result in regression of diabetic retinopathy.”

However, for those with diabetes, the most important eye tests take place after diagnosis, to monitor changes in the eyes and take steps to prevent further damage, as Dr. Howard R. Krauss, surgical neuro-ophthalmologist and director of Pacific Neuroscience Institute’s Eye, Ear & Skull Base Center at Providence Saint John’s Health Center in Santa Monica, CA, noted:

“In most cases, diabetes is diagnosed before changes become evident in the retina, but the retinal examination is a vital part of routine diabetic evaluations, so as to aid in the management of the disease, and to intervene when indicated, with any of a variety of treatments to reduce the risk of blindness from diabetic retinopathy.”

Studies have shown that signs of hypertension, or high blood pressure, are found in the eyes of around 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the adult, diabetes-free population.

On examination, an eye doctor might see traces of narrowing of arterioles in the retina, arteriovenous nicking, retinal hemorrhages, and, as in diabetic retinopathy, microaneurysms. All these are indicators of hypertensive retinopathy.

“Hypertension also presents with classic signs within the eye. The earliest signs of hypertension are narrowing of the vessels, often referred to as ‘silver wiring’ because of their appearance.”

– Dr. Philip Storey

The good news is that if the hypertension is controlled, the damage can be halted, as Dr. Ibrahim explained.

“Early detection means that appropriate precautions are taken and necessary lifestyle changes are made, such as eating a healthy diet and exercising regularly, in addition to starting the proper medical treatment thereby reducing the risk of heart disease,” she told us.

During a routine eye test, the eye doctor will also examine the optic nerve to look for any abnormalities or changes.

Dr. Ibrahim explained why: “The optic nerve connects the eye to the brain and is therefore an extension of the central nervous system. It is the only part of the brain that can be clearly visualized by examining the back of the eye.”

“Optic nerve swelling or inflammation can be detrimental to vision and color vision, and can diagnose MS, [which is] an autoimmune demyelinating disease of the brain and spinal cord, [as well as] neuroinflammatory disorders such as neuromyelitis optica or brain tumor,” she added.

Vision problems in MS, which tend to flare up then resolve within a few weeks, are usually a result of optic neuritis, an acute inflammatory demyelinating disorder of the optic nerve.

Optic neuritis is the first symptom in up to 20{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of people who are subsequently diagnosed with MS, although it can indicate other disorders, or even be the result of a viral infection or vitamin deficiency.

If an optometrist suspects optic neuritis in a routine eye examination, they will refer a person for further testing to confirm the diagnosis and identify the cause.

“Retinal screening of Alzheimer’s disease is an exciting prospect at the forefront of current medical research. The retina […] is made up of multiple layers of specialized neural cells and there is strong evidence that the same changes in the brain can occur in the retina, potentially allowing screening patients for early signs of Alzheimer’s disease.”

– Dr. Hagar Ibrahim

Current methods of diagnosing Alzheimer’s are often lengthy, invasive and expensive, so being able to diagnose the condition from the retina would be a huge advance.

Although this is not yet a disease that can be diagnosed from a routine eye examination, recent research has suggested that doctors could, in the future, diagnose Alzheimer’s through retinal scans.

The new technique, so far tested only in mice, combines the results of two scans to assess the condition of the retina. Those with Alzheimer’s disease have a much rougher retinal surface than those without.

Other research has identified beta-amyloid plaques on the retina as an indication of Alzheimer’s disease, and also in the lens of the eye, both of which can be detected by non-invasive methods.

Dr. Ibrahim explained some of the new developments:

“There are several areas under research. Firstly, looking for the presence of beta-amyloid fragments in the retina, which may be detected by specialist retinal imaging modalities, before symptom onset. […] Secondly, looking at biomarkers detectable on retinal OCT-A images in the form of differences of retinal microvasculature in patients with Alzheimer’s disease and mild cognitive impairment compared to healthy controls.”

Perhaps these findings may lead to easier, earlier diagnosis of Alzheimer’s disease enabling treatment to begin before symptoms become severe.

As well as allowing an optometrist to detect diseases elsewhere in the body, changes in the eyes can tell a physician how a systemic disease is progressing.

So regular eye tests are important, particularly as we get older, as Dr. Benjamin Bert, an ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, told MNT:

“While eye exams are mostly to check the health of the eyes, they do help to screen for systemic diseases. For adults, if you don’t have any need for glasses or contact lenses, it is still recommended to get an annual exam at least once in your 20s, twice in your 30s, and more regularly after 40. After 40 is when eye-specific ailments can start to become more common — including presbyopia, glaucoma, cataract, and changes to the retina from diabetes or high blood pressure.”

Dr. Krauss reiterated the same advice.

But it is also important to remember that eye examinations are only one tool in monitoring health conditions.

“An examination of the retina often reflects the severity of a disease throughout the body. […] However, patients should not rely on an eye examination to assess how well their systemic disease is controlled,” Dr. Storey cautioned.

“The damage that we see in the eye can take years to occur. Even when a patient’s eye examination is normal, their systemic disease — hypertension or diabetes for example — could be poorly controlled,” he explained.

So, make sure a regular eye test is part of your overall health care, particularly as you get older — it may just detect a condition that you were unaware of, helping you to take control of your health.

Freedom Convoy arrests continue in Canada; Vivek Murthy tests positive

Freedom Convoy arrests continue in Canada; Vivek Murthy tests positive

Travel news live: Pre-departure tests axed from today

Thousands of travellers entering the UK today will benefit from the country’s less onerous restrictions, which came into play at 4am this morning.

From that time, fully vaccinated arrivals will have swerved the requirement to present a negative Covid test before departure.

They will still have to take a post-arrival PCR test on the day they enter the UK or the following two days – but they need not isolate while awaiting the result.

From Sunday at 4am, rules will ease even further, as double-jabbed travellers may swap this “day two” PCR test for a cheaper lateral flow.

The travel industry has welcomed the change to the travel testing rules, with a surge in holiday bookings expected in the coming weeks.

As many travel companies reported a surge in enquiries and website traffic, Kuoni’s CEO Derek Jones predicted that travel will be “90 per cent back before the end of spring”.

Follow all the latest updates below.

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These are the most popular holiday destinations for Brits in 2022

Spain has topped a list of countries Britons are planning to visit this year, according to a survey by ABTA, the Travel Association.

The poll of 2,000 consumers, taken at the end of 2021, revealed nearly a third (29 per cent) of respondents planned to visit the Med holiday favourite in 2022.

Second most popular was the US, with 18 per cent saying that they had plans to visit the States this year.

Third on the list was France – which has currently banned most British visitors – with 17 per cent saying they’d like to visit.

Lucy Thackray7 January 2022 15:56

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France loosens some travel restrictions on UK arrivals

France has loosened its strict travel ban on visitors from the UK, making it possible for some business travellers and those journeying to their home in an EU country to enter.

“From 6 January 2022 onwards, the list of compelling reasons is being expanded. Among other things, work journeys in both directions and travel through France to reach your home in the EU are being made easier,” read a statement from the French Consulate in London.

Previously, Britons needed one of a small number of “compelling reasons” to enter France from the UK, such as those with French citizenship, a right to residency, a diplomatic role or those working in the transport sector.

Now, the French government has added two extra items to the list of compelling reasons, allowing for “passing through through France to his/her main residence in a European Union country or equivalent”, and “missions necessary for the pursuit of an economic activity requiring presence on site (which cannot be postponed)”.

Lucy Thackray7 January 2022 14:32

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Expert Simon Calder answers your questions on the latest travel changes

In January, the travel correspondent of The Independent is normally to be found on the practice courts at Australia’s National Tennis Centre in Melbourne. But in the era of coronavirus, he chose instead to respond to questions from readers as the travel testing rules are relaxed.

Click below to see readers’ key questions – and Simon Calder’s answers – following the latest update to the UK’s travel rules:

Simon Calder7 January 2022 14:12

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Thousands of passengers arriving into UK benefit from eased travel testing rules

Thousands of passengers have arrived in the UK since the travel rules were eased at 4am this morning.

Fully vaccinated travellers no longer need to take a pre-departure test, nor self-isolate on arrival until they get a negative test result.

The first arrival was Côte Des Flandres – a DFDS ferry from Calais that arrived in Dover at 4.04am.

Few travellers were on board, due to the travel ban currently imposed by France on the UK.

Simon Calder7 January 2022 12:19

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Cruise line cancels eight sailings due to Covid restrictions

A major cruise line has cancelled eight sailings in response to tighter travel restrictions introduced in the wake of the Omicron coronavirus variant.

Norwegian Cruise Line cited “ongoing travel restrictions” and “Covid related circumstances” when announcing it was axing future itineraries.

“Our first priority is the health and safety of our guests, crew and the communities we visit,” the brand said in a statement.

Helen Coffey7 January 2022 11:28

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Israel lifts UK travel ban

Israel has removed the UK from its red list for travel, lifting a travel ban that has been in place for nearly a month.

“Starting tonight (Thursday to Friday, midnight 07.01.2022), all countries will be removed from the list of red countries, subject to the approval of the Government and the Knesset’s Constitution Committee,” Israel’s Ministry of Health announced yesterday on Twitter.

“Despite the change, it should be noted that in many countries around the world the morbidity situation is higher than in Israel, and therefore it is advisable to avoid reaching these places unnecessarily as much as possible,” the Ministry added.

Lucy Thackray7 January 2022 10:43

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Propeller smashes through cabin window after bird strikes plane midflight

A bird struck a plane’s propeller on Monday, causing it to disintegrate and smash through one of the cabin windows.

The Airlink Jetstream JS-41 was running a charter flight from Johannesburg to Venetia Mine, South Africa, on 3 January when the incident happened shortly before landing, the airline reported.

According to an Airlink statement, none of the passengers or crew were injured and pilots were able to land safely, but the aircraft sustained substantial damage.

Dramatic passenger photos show an almost entirely shattered cabin window, a frayed segment of the right hand propeller, damage to the inside of the fuselage and debris strewn across the plane aisle.

Lucy Thackray7 January 2022 09:54

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Pre-departure travel tests scrapped from today

Travel to the UK has become easier for those who are fully vaccinated from today, as the government has scrapped the need for pre-departure Covid tests.

From 4am, travellers who can prove they’ve been double jabbed need not show a negative test result before embarking on their journey to the UK.

They also need not quarantine while awaiting the result of their “day two” post-arrival coronavirus test.

However, all previous rules remain in place for arrivals who aren’t fully vaccinated.

Read our travel correspondent Simon Calder’s full explainer on the new rules here:

Helen Coffey7 January 2022 08:48

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Good morning, and welcome to The Independent’s travel liveblog. We’ll be bringing you all the latest updates throughout the day.

Helen Coffey7 January 2022 08:29

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Scotland eases restrictions in line with rest of UK

Scotland has become the last UK nation to relax travel restrictions, in line with England, Wales and Northern Ireland.

Cabinet Secretary for Net Zero, Energy and Transport Michael Matheson said:

“Given the rapid spread of Omicron last year it was essential that we took immediate steps to protect public health in Scotland, particularly with regards to international travel.

“We still have significant concerns over Omicron, but we recognise that, now it is the most dominant strain in Scotland and across the UK, it is sensible to review the measures currently in place.

“We also fully understand the impact of the restrictions on staff and businesses in the travel and aviation sectors and these changes demonstrate our commitment not to keep measures in place any longer than necessary.

“However, people still need to be extremely careful when travelling and to remember that both our and other countries’ Covid-19 requirements can change at short notice as things can evolve very quickly.

“People should therefore ensure they have travel insurance and carefully check their booking terms and conditions, as well as ensuring compliance with the latest regulations for the country being visited.”

Simon Calder6 January 2022 17:24

Today’s coronavirus news: Ontario reports 508 new cases, three more deaths; expands eligibility for booster shots; U.S. COP26 delegate tests positive

The latest coronavirus news from Canada and around the world Saturday. This file will be updated throughout the day. Web links to longer stories if available.

5:45 p.m.: In a gathering with more than 20,000 people from nearly every country in the world, one of the biggest major international summits since the pandemic began, a COVID-19 outbreak was always going to be a danger. So far, organizers have not revealed the number of positive COVID-19 …

GLASGOW, Scotland — In a gathering with more than 20,000 people from nearly every country in the world, one of the biggest major international summits since the pandemic began, a COVID-19 outbreak was always going to be a danger.

So far, organizers have not revealed the number of positive COVID-19 test results. But on Saturday, the State Department confirmed that a member of the U.S. delegation had tested positive. Earlier, Mayor Eric Garcetti of Los Angeles tested positive days after arriving in Scotland.

The State Department statement Saturday declined to identify the person but said the official had been fully vaccinated and was quarantining. The statement also said John Kerry, the U.S. presidential envoy for climate change who is leading the negotiations at the summit, had received several negative COVID-19 results, including daily lateral flow tests and a PCR test, since the delegate tested positive.

Asked this week about the number of positive tests at the conference, Alok Sharma, the British president of the talks, said the numbers were lower than in the rest of Scotland. “At this point, we’re comfortable where we are,” he said.

5:23 p.m.: Winter is coming, COVID-19 is accelerating at an alarming pace in Colorado and the state’s 43 rural hospitals continue to struggle through debilitating staff shortages.

Employees have left small-town health care facilities complaining of burnout, and now that vaccine mandates are in place, some have quit over being forced to receive the shot.

In one rural hospital, a pharmacist and a business office employee died of COVID-19 within a week of one another, leaving co-workers at Holyoke’s Melissa Memorial Hospital grief stricken and overworked as those positions remain unfilled.

“They died very tragically,” said MMH CEO Cathy Harshbarger. “Both required a lot of support and medical care. We had to ship them out to other hospitals for care. We’re stretched to the max.”

Holyoke, about three hours northeast of Denver, has a population of 2,200 people.

MMH has run a help wanted ad in the Holyoke Enterprise for 10 openings including a dietary cook, a paramedic and an EMT. The hospital has a separate ad for an executive director to lead its hospital foundation.

“More and more my employees are asking, ‘Why am I in health care?’ ” said Harshbarger.

5:20 p.m.: A month ago the coronavirus seemed headed for a long winter’s nap in masked and well-vaccinated California. Gov. Gavin Newsom boasted that the Golden State “continues to lead the nation” as the only state to reach the Centers for Disease Control and Prevention’s yellow “moderate” tier of community virus transmission.

But COVID-19 cases aren’t falling in California anymore. They have climbed back up to the CDC’s blood-red “high” level of virus transmission as the highly contagious delta variant continues to wreak havoc.

Meanwhile, the virus has gone quiet in Deep South states that abandoned mask orders, opposed vaccine mandates, posted lower vaccination rates and saw larger outbreaks over the summer. California’s case rate is now well above Texas’ and double Florida’s, which along with the rest of the Gulf Coast are down to the CDC’s orange “substantial” transmission level.

“There are early indications that the decline in the delta surge at the national level in the U.S. has ended,” said Ali H. Mokdad, professor of health metrics sciences at the University of Washington, which runs a widely followed model projecting the course of the pandemic. Currently, 19 states have increasing transmission, including several like California “that had previously appeared to have been declining.”

And while much of the Golden State’s current coronavirus woes are driven by virus spread in the less-vaccinated and restricted inland counties, the Bay Area hasn’t been immune. Most Bay Area counties that hoped to reach the yellow moderate level by now remain stubbornly stuck in orange. Marin and Santa Cruz counties, which had reached the yellow level, are back up to orange. San Francisco is the only county in yellow.

4:20 p.m.: A federal appeals panel in Louisiana has temporarily blocked the Biden administration’s new safety regulations directing businesses with more than 100 workers to require their employees to get vaccinations against the coronavirus by early January.

The three-judge panel from the U.S. Court of Appeals for the 5th Circuit granted a temporary stay to a group of businesses, religious groups, advocacy organizations and several Republican-led states that had filed a joint petition in court, arguing the administration had overstepped its authority.

Numerous Republican-led states have filed legal challenges against the new rule, among them Texas, Mississippi, South Carolina and Utah.

4:04 p.m.: A Rhode Island man who federal prosecutors said used stolen identities to obtain more than $450,000 in pandemic-related unemployment assistance was arrested in Michigan, authorities said.

Dquintz Alexander, 34, of Cranston, Rhode Island, was indicted and charged in federal court in Boston on five counts of wire fraud, one count of conspiracy to commit wire fraud and one count of aggravated identity theft, according to the U.S. attorney for the District of Massachusetts.

As the coronavirus pandemic devastated the economy in March 2020, Congress passed the Coronavirus Aid, Relief, and Economic Security Act, which among other things created a temporary federal unemployment insurance program called Pandemic Unemployment Assistance. The program granted unemployment insurance benefits to people who lost their jobs or were unable to work because of the coronavirus.

The pandemic unemployment program, which is administered by each state, lowered the barriers to collecting benefits, and the usual security methods intended to prevent fraud were not able to keep up with security breaches. Last year in California, an underground internet bazaar that specialized in selling stolen accounts and data had for-sale ads for filched unemployment insurance claims in the state that had been approved and offered benefits worth $17,550.

2:31 p.m.: New Brunswick is reporting 50 new cases of COVID-19 and 51 recoveries.

The active confirmed case count now sits at 476 across the province.

Health officials say 13 people are currently in hospital, with eight in intensive care.

Twenty-two of the new cases were identified in the Moncton region.

Sixty per cent of the new cases are in people who are unvaccinated against the disease.

Officials also say nearly 86 per cent of eligible New Brunswickers are fully vaccinated against COVID-19, while 92.8 per cent have received their first dose of a vaccine.

1:30 p.m.: Quebec is reporting 688 new cases of COVID-19 today and four deaths attributed to the virus.

Health officials say COVID-19-related hospitalizations dropped by 11 to 229, while the number of people in intensive care declined by six to 51.

The seven-day average for new cases stands at 561.

Of the latest reported infections, 409 were among people who were either unvaccinated or who had only received a first dose within the past two weeks.

Quebec says another 6,869 vaccine doses have been administered, most of which were given in the past 24 hours.

The province’s public health institute says about 91 per cent of Quebecers aged 12 and older have received at least one dose, while 87 per cent are considered fully vaccinated with two shots.

12 p.m.: Ukraine’s health ministry on Saturday reported a one-day record of 793 deaths from COVID-19.

Ukraine has been inundated by coronavirus infections in recent weeks, putting the country’s underfunded medical system under severe strain.

The ministry said 25,063 new infections had been tallied over the past day; a record 27,377 were reported on Thursday.

Although four different coronavirus vaccines are available in Ukraine, only 17.9 per cent of the country’s 41 million people have been fully vaccinated, the second-lowest rate in Europe after Armenia.

11:25 a.m.: Nearly two years of being caged in Canada during the COVID-19 pandemic has some snowbirds anxiously waiting in their motorhomes and trailers in southern Alberta.

The Eight Flags Campground in the small windswept town of Milk River, 18 kilometres from the Canada-United States border crossing at Coutts, is full of shiny, large RVs.

It’s in anticipation of land and sea border crossings reopening Monday for fully vaccinated Canadians. Such crossings were closed to non-essential travel at the beginning of the pandemic in March 2020.

10:45 a.m.: An Independent member of Ontario’s legislature has apologized for a post in which he used names and photos of people who had died to suggest without evidence that they had died due to COVID-19 vaccination.

Randy Hillier, who represents Lanark-Frontenac-Kingston, has frequently posted COVID-19 misinformation and conspiracy theories throughout the pandemic.

In one recent social media post, he used an array of photos from news articles about what he believed to be the sudden and unexplained deaths of young people and called on police to investigate links to vaccines.

Family members of some of those people told various media outlets that they were angered by Hillier’s post and denied his allegations, while the legislature unanimously passed a motion last month condemning him.

Hillier shared an apology Friday night saying he has removed that post and offering sincere regrets for further distress his actions caused the grieving families.

Public Health Ontario says all deaths following vaccination that are reported to public health units are thoroughly investigated, and it has so far determined in one case that vaccine-induced immune thrombotic thrombocytopenia was a cause of death in someone who received the AstraZeneca vaccine.

There are seven other reports of death after COVID-19 vaccination that meet the provincial surveillance definition. In four, the adverse events were found to have possibly contributed to the death but were not the underlying cause, and in the remaining three the vaccine was not a cause of death.

Public Health Ontario says another 30 deaths following COVID-19 vaccination that have been reported to public health units are “persons under investigation.” They don’t meet the provincial surveillance definition, but investigations are underway.

“Preliminary information suggests that these events occurred in individuals with multiple co-morbidities which may be related to the cause of death,” a recent Public Health Ontario report said. “There has been no association with the vaccine identified at this time.”

Health officials say the approved vaccines are effective and safe.

10:20 a.m. (updated): Ontario is reporting 508 new COVID-19 cases and three additional deaths in the province in its latest daily count.

In Ontario, 203 people are hospitalized with COVID-19 — 151 are not fully vaccinated or have an unknown vaccination status and 52 are fully vaccinated.

The province also says due to data cleanup, three deaths were removed from the overall count.

10 a.m.: Green Bay Packers quarterback Aaron Rodgers will miss Sunday’s game at Kansas City after being placed in the NFL’s COVID-19 protocol. Because he is considered unvaccinated, he must stay isolated for at least 10 days.

Here’s an explanation of the NFL’s protocols and a breakdown of Rodgers’ case.

9:20 a.m.: I live in a world where Mike McCarthy kept his job as my boss for 13 years. I don’t trust authority.

If Aaron Rodgers had just said that, maybe the rest would have been an easier ride. But then again, he may be the greatest quarterback in the biggest pro sports league of a country where at least 775,000 people have died during the pandemic, and Friday he spent 45 minutes pumping out the kind of misinformation that can get people killed. You know what that means? Rodgers could be president, one day.

All grim, tight-faced jokes aside, the Green Bay Packers great has had himself a week. Rodgers contracted COVID, it turned out he wasn’t vaccinated, and Friday he went on former punter and current shouty bro Pat McAfee’s Sirius XM show and delivered almost every anti-vaccine talking point you can imagine.

Read the column from the Star’s Bruce Arthur.

8:40 a.m. Unvaccinated people in Austria who also haven’t had COVID-19 will no longer be allowed to enter restaurants, hotels and hair salons or attend public events larger than 25 people under new rules that take effect Monday, the government said.

Austrian Chancellor Alexander Schallenberg outlined the rules Friday night after a meeting with state-level leaders to discuss the country’s response to rapidly rising coronavirus cases.

“It is simply our responsibility to protect the people in our country,” Schallenberg told reporters, noting the case numbers and increasingly full hospital intensive care units.

7:30 a.m.: You can almost forget about the ongoing collective nightmare of the pandemic when you’re sipping a mojito in the pink twilight on the edge of the undulating Atlantic, and a long arc of surf foams over the distant reef, and a soft breeze rustles the palm fronds and laps against your sun-tender skin.

But you can’t.

For despite having to navigate a whole bureaucracy of attestations and electronic paperwork to embark abroad these days, there’s no guarantee the people around you are COVID-free. You hope everyone is vaccinated. But you can’t be sure. And even then, it’s still possible to get infected.

Yet after almost two years living with the coronavirus, we are experiencing a cautious re-emergence. And the door is open to vacation again.

Travel is back, but is pandemic tourism fun? Read the story by the Star’s Alex Ballingall.

7:15 a.m. Russia’s COVID-19 cases hit another one-day record as the country struggles to contain a wave of infections that has persisted for more than a month.

The national coronavirus task force on Saturday reported 41,335 new cases since the previous day, exceeding the previous daily record of 40,993 from Oct. 31. The task force said 1,188 people with COVID-19 died, just seven fewer than the daily death record reported Thursday.

Officials cite Russia’s low vaccination rate as a major factor in the sharp rise in cases that began in mid-September. The task force reported about 57.2 million full-course vaccinations, or less than 40{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the country’s 146 million people.

7 a.m. Several groups of high-risk Ontarians will be eligible to book COVID-19 booster shots starting this morning at 8 a.m.

An additional 2.75 million people become eligible for boosters today, following the quarter of a million people already eligible who include certain immunocompromised individuals and residents of long-term care and retirement homes.

Starting today, people can book an appointment for a booster dose if they are aged 70 and older, health-care workers or essential caregivers in congregate settings, people who received two doses of the AstraZeneca vaccine or one dose of Janssen, and First Nations, Inuit and Metis adults and their non-Indigenous household members.

They can make appointments that are at least six months after their second dose. Ontario’s chief medical officer of health says evidence suggests that’s when immunity starts to wane.

Dr. Kieran Moore says those groups of people are at an increased risk of waning immunity and greater risk of exposure and serious illness.

Ontario officials say the protection from two doses is still very high for the general population after six months, especially against severe illness and death, so a booster dose would provide additional protection against more mild illness.

The province is planning to eventually offer booster doses to everyone, and is eyeing early 2022 to start the broader rollout.

6:45 a.m.: The United States is steadily chipping away at vaccine hesitancy and driving down COVID-19 cases and hospitalizations to the point that schools, governments and corporations are lifting mask restrictions yet again.

Nearly 200 million Americans are fully vaccinated and the nation’s over-65 population, which bore the brunt of the pandemic when it started nearly two years ago, is enthusiastically embracing vaccines.

Nearly 98{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the over-65 population has received at least one COVID-19 shot and more than 25{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of them have gotten boosters, just weeks after they were authorized. The improving metrics could get a boost from President Joe Biden’s workplace mandate unveiled Thursday and the launch of COVID-19 shots in elementary-age students.

6:30 a.m. Green Bay Packers quarterback Aaron Rodgers said Friday he sought alternative treatments instead of the NFL-endorsed COVID-19 vaccinations because he is allergic to an ingredient in two of the FDA-approved shots.

Speaking on SiriusXM’s “Pat McAfee Show,” Rodgers said: “I’m not an anti-vax, flat-earther. I have an allergy to an ingredient that’s in the mRNA vaccines. I found a long-term immunization protocol to protect myself and I’m very proud of the research that went into that.”

Rodgers, who turns 38 on Dec. 2, did not say what ingredient he was allergic to, or how he knows he is allergic.

Rodgers, who has been tested daily as part of NFL protocols for the unvaccinated, found out he contracted COVID-19 on Wednesday. The reigning NFL MVP said he didn’t feel well on Thursday but was much better on Friday.

6 a.m. Monday’s reopening of the Canada-U.S. land border is sparking a mixed reaction among Canadian business leaders: They’re excited that people and not just goods will be crossing the border again but are wary of remaining red tape.

The Canadian Chamber of Commerce and the Business Council of Canada say the Canadian requirement for returning travellers to provide a recent, negative molecular test is an unnecessary obstacle to kick-starting business travel and tourism.

They say proof of vaccination is all that should be needed and the test requirement should be scrapped.

They argue that the continued testing requirement is too cumbersome for Canadian business travellers wanting a quick visit to an American destination, and too expensive for families who want a vacation or reunion with loved ones.

“If we believe, as we should, that being fully vaccinated is the best way of minimizing risk, we should be trusting the vaccination systems. We should be monitoring what’s taking place in terms of outbreaks in the two countries,” chamber president Perrin Beatty said in an interview.

5:45 a.m. As Ontario slowly creeps toward the goal of having 90 per cent of the eligible population vaccinated against COVID-19, new data shows vaccine rates are stubbornly lagging in some neighbourhoods and among groups of people across the province.

The latest numbers from non-profit research group ICES, formerly known as the Institute for Clinical Evaluative Sciences, out Friday, show there are still stark differences hiding behind the overall vaccination rate.

“There is a huge range, with some areas hovering around 50 per cent of the population fully vaccinated and some areas as high as 90 per cent,” said Dr. Jeff Kwong, lead of the Populations and Public Health Research Program at ICES.

“The risk of outbreaks in these areas with low vaccination coverage is worrisome. It means there is a lot of fuel for a fire to burn.”

Read the full story from the Star’s Megan Ogilvie and May Warren here.

5:30 a.m. Eleven patients died Saturday after a fire broke out in a hospital’s COVID-19 ward in the western Indian state of Maharashtra, police said.

An official told New Delhi Television that around 17 patients were in the ward when the fire broke out. The remaining patients have been moved to a COVID-19 ward in another hospital, district collector Rajendra Bhosle said.

While the fire has since been brought under control, the cause was not immediately clear, he added, saying officials will carry out an investigation.

The former chief minister of the state, Devendra Fadnavis, took to Twitter to express his condolences and called for “strict action” against those responsible.

Such incidents are not uncommon in India. In May, when the country was battling a devastating surge in coronavirus cases, a fire in a COVID-19 ward in western India killed at least 18 patients.

Poor maintenance and lack of proper firefighting equipment often cause deaths in India.

Aaron Rodgers, unvaccinated Packers star, tests positive for COVID-19