tag:theconversation.com,2011:/fr/topics/coronavirus-5830/articlesCoronavirus – The Conversation2024-03-11T15:54:23Ztag:theconversation.com,2011:article/2249912024-03-11T15:54:23Z2024-03-11T15:54:23ZAs the pandemic turns four, here’s what we need to do for a healthier future<figure><img src="https://images.theconversation.com/files/580827/original/file-20240310-18-cn2r0.jpg?ixlib=rb-1.1.0&rect=4%2C1%2C994%2C657&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
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<p>March 11 2024 marks four years since the World Health Organization (WHO) <a href="https://www.who.int/europe/emergencies/situations/covid-19">declared COVID-19</a> a pandemic. </p>
<p>Although <a href="https://theconversation.com/covid-is-officially-no-longer-a-global-health-emergency-heres-what-that-means-and-what-weve-learned-along-the-way-205080">no longer</a> officially a public <a href="https://www.who.int/publications/m/item/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum">health emergency</a> of international concern, the pandemic is <a href="https://www.scientificamerican.com/article/rampant-covid-poses-new-challenges-in-the-fifth-year-of-the-pandemic/">still with us</a>, and the <a href="https://www.bu.edu/articles/2024/is-covid-19-still-a-pandemic/">virus is still</a> causing serious harm. </p>
<p>Here are three priorities – three Cs – for a healthier future.</p>
<h2>Clear guidance</h2>
<p>Over the past four years, one of the biggest challenges people faced when trying to follow COVID rules was understanding them. </p>
<p>From a behavioural science perspective, one of the major themes of the last four years has been whether guidance was clear enough or whether people were receiving too many different and <a href="https://www.bbc.co.uk/news/uk-wales-59920485">confusing</a> messages – something colleagues and I called <a href="https://blogs.bmj.com/bmj/2021/02/19/the-public-arent-complacent-they-are-confused-how-the-uk-government-has-created-alert-fatigue/">“alert fatigue”</a>.</p>
<p>With colleagues, I conducted an <a href="https://royalsocietypublishing.org/doi/10.1098/rsta.2023.0129">evidence review</a> of communication during COVID and found that the lack of clarity, as well as a lack of trust in those setting rules, were key barriers to adherence to measures like social distancing. </p>
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<p>In future, whether it’s another COVID wave, or another virus or public health emergency, clear communication by trustworthy messengers is going to be key.</p>
<h2>Combat complacency</h2>
<p>As Maria van Kerkove, COVID technical lead for WHO, puts it there is no <a href="https://x.com/mvankerkhove/status/1741384947892441165?s=20">acceptable level of death</a> from COVID. <a href="https://theconversation.com/covid-barely-gets-a-mention-these-days-heres-why-thats-a-dangerous-situation-220867">COVID complacency</a> is setting in as we have moved out of the emergency phase of the pandemic. But is still much work to be done. </p>
<p>First, we still need to understand this virus better. Four years is not a long time to understand the longer-term effects of COVID. For example, evidence on how the virus affects the <a href="https://www.bmj.com/content/384/bmj-2023-075387">brain</a> and <a href="https://www.nejm.org/doi/10.1056/NEJMoa2311330">cognitive functioning</a> is in its infancy. </p>
<p>The extent, severity and possible treatment of <a href="https://www.nature.com/articles/s41579-022-00846-2">long COVID</a> is another priority that must not be forgotten – not least because it is still causing a lot of long-term <a href="https://www.thetimes.co.uk/article/tens-of-thousands-out-of-work-due-to-long-covid-sndcrpsjx">sickness and absence</a>.</p>
<h2>Culture change</h2>
<p>During the pandemic’s first few years, there was a question over how many of our new habits, from elbow bumping (remember that?) to remote working, were <a href="https://theconversation.com/two-years-into-the-pandemic-which-of-our-newly-formed-habits-are-here-to-stay-178204">here to stay</a>. </p>
<p>Turns out old habits die hard – and in most cases that’s not a bad thing – after all <a href="https://theconversation.com/handshakes-and-hugs-are-good-for-you-its-vital-they-make-a-comeback-after-the-pandemic-158174">handshaking and hugging</a> can be good for our health.</p>
<p>But there is some pandemic behaviour we could have kept, under certain conditions. I’m pretty sure most people don’t wear masks when they have respiratory symptoms, even though some health authorities, such as the <a href="https://www.nhs.uk/conditions/covid-19/how-to-avoid-catching-and-spreading-covid-19/">NHS</a>, recommend it. </p>
<p>Masks could still be thought of like <a href="https://theconversation.com/living-with-covid-how-treating-masks-like-umbrellas-could-help-us-weather-future-pandemic-threats-187377">umbrellas</a>: we keep one handy for when we need it, for example, when visiting vulnerable people, especially during times when there’s a spike in COVID.</p>
<p>If masks hadn’t been so politicised as a symbol of <a href="https://www.theguardian.com/world/2020/jun/29/face-masks-us-politics-coronavirus">conformity and oppression</a> so early in the pandemic, then we might arguably have seen people in more countries adopting the behaviour in parts of east Asia, where people <a href="https://theworld.org/stories/2023-03-07/three-years-pandemic-mask-usage-varies-country-country">continue to wear masks or face coverings</a> when they are sick to avoid spreading it to others. </p>
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<p>Although the pandemic led to the growth of remote or hybrid working, <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.748053/full">presenteeism</a> – going to work when sick – is still a <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2022.854976/full">major issue</a>. </p>
<p><a href="https://www.bbc.co.uk/news/uk-england-68006813">Encouraging parents</a> to send children to school when they are unwell is unlikely to help public health, or attendance for that matter. For instance, although one child might recover quickly from a given virus, other children who might catch it from them might be ill for days.</p>
<p>Similarly, a culture of presenteeism that pressures workers to come in when ill is likely to backfire later on, helping <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7138-x">infectious disease</a> spread in workplaces. </p>
<p>At the most fundamental level, we need to do more to create a culture of equality. Some groups, especially the most <a href="https://www.local.gov.uk/health-inequalities-deprivation-and-poverty-and-covid-19">economically deprived</a>, fared much worse than others during the pandemic. Health inequalities <a href="https://www.bma.org.uk/advice-and-supporcovid-19/what-the-bma-is-doing/the-impact-of-the-pandemic-on-population-health-and-health-inequalities#:%7E:text=Underlying%20many%20health%20inequalities%20is,affected%20certain%20at%2Drisk%20groups.">have widened</a> as a result. With ongoing pandemic impacts, for example, long COVID rates, also <a href="https://pubmed.ncbi.nlm.nih.gov/37164035/">disproportionately affecting those from disadvantaged groups</a>, health inequalities are likely to persist without significant action to address them. </p>
<p>Vaccine inequity is still a problem <a href="https://www.bmj.com/content/380/bmj.p8">globally</a>. At a national level, in some wealthier countries like the UK, those from more deprived backgrounds are going to be less able to afford <a href="https://theconversation.com/the-jab-market-of-private-covid-vaccines-is-a-good-thing-for-public-health-but-not-for-health-inequality-222721">private vaccines</a>.</p>
<p>We may be out of the emergency phase of COVID, but the pandemic is not yet over. As we reflect on the past four years, working to provide clearer public health communication, avoiding COVID complacency and reducing health inequalities are all things that can help prepare for any future waves or, indeed, pandemics.</p><img src="https://counter.theconversation.com/content/224991/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Nicholas Williams has received funding from Senedd Cymru, Public Health Wales and the Wales Covid Evidence Centre for research on COVID-19, and has consulted for the World Health Organization. However, this article reflects the views of the author only, in his academic capacity at Swansea University, and no funding or organizational bodies were involved in the writing or content of this article.</span></em></p>On the fourth anniversary of the pandemic, a public health researcher offers four principles for a healthier future.Simon Nicholas Williams, Lecturer in Psychology, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2234702024-02-21T13:17:46Z2024-02-21T13:17:46ZWhat is Alaskapox? A microbiologist explains the recently discovered virus that just claimed its first fatality<figure><img src="https://images.theconversation.com/files/575275/original/file-20240211-16-m5e8r4.jpg?ixlib=rb-1.1.0&rect=29%2C32%2C993%2C617&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Red-backed voles may be harboring Alaskapox.</span> <span class="attribution"><a class="source" href="https://ecuador.inaturalist.org/">iNaturalist Ecuador</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p><em>Alaskapox, a virus in the same family as smallpox, cowpox and mpox, <a href="https://abcnews.go.com/Health/wireStory/alaskapox-recent-death-brings-attention-virus-small-animals-107207953">claimed its first fatality</a> in January 2024 when an elderly Alaskan man died of the illness.</em></p>
<p><em>The virus, which was discovered in 2015, had previously resulted in only relatively mild illnesses in the six other people infected by it. So why did the Alaskan man die?</em></p>
<p><em>Raúl Rivas González, a microbiologist at the University of Salamanca in Spain, explains what we know about Alaskapox, what happened to the man in Alaska, and the threat posed by the thousands of similar viruses out there.</em></p>
<h2>What’s the origin of Alaskapox?</h2>
<p>Alaskapox is an orthopox virus <a href="https://doi.org/10.1093%2Fcid%2Fcix219">discovered in 2015</a> in the Fairbanks area of Alaska. </p>
<p>Until the most recent case, there were only six known human infections, which all involved mild illnesses consisting of a localized rash and the swelling of lymph nodes. </p>
<h2>How did the man in Alaska die?</h2>
<p>In mid-September 2023, the man was living on the Kenai Peninsula, south of the city of Anchorage, Alaska, and <a href="https://abcnews.go.com/Health/wireStory/alaskapox-recent-death-brings-attention-virus-small-animals-107207953">undergoing drug treatment for cancer</a>, and so had a suppressed immune system. He noticed a tender red papule – a type of skin lesion – in his right armpit.</p>
<p>Understandably, he was scared and decided to go to the doctor immediately. Over the next six weeks, he made several visits to the primary care center and the local emergency department for clinical evaluation of the lesion.</p>
<p>The case was confusing and the possible infection difficult to identify. He did not respond to antibiotic treatment. A needle biopsy revealed no evidence of malignancy or bacterial infection. The health care providers were puzzled. </p>
<p>After the situation worsened, the man was hospitalized in Anchorage. Eventually, doctors performed an extensive battery of tests and sent a sample to the Centers for Disease Control and Prevention, which determined he had <a href="http://www.doi.org/10.3390/v11080708">Alaskapox</a>.</p>
<p>He was immediately given treatment for the virus, but it was too late and he died at the end of January. Officials <a href="https://epi.alaska.gov/bulletins/docs/b2024_02.pdf">confirmed the cause of death</a> was Alaskapox in February.</p>
<h2>Where do viruses like Alaskapox come from?</h2>
<p>Currently, more than <a href="https://doi.org/10.1128%2Fjcm.00337-22">10,000 species of viruses</a> have been recognized by the International Committee on Taxonomy of Viruses. We know that about 270 of them can infect people. </p>
<p>Some of these viruses have been known for centuries, such as polio and smallpox, while others like Alaskapox have only recently emerged. In fact, viruses constitute about <a href="https://doi.org/10.1098%2Frstb.2011.0354">two-thirds of all new human pathogens</a>. These new viruses differ widely in their risk to human health, ranging from the rare and mild illness caused by the Menangle virus to the <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">devastating public health impact</a> of the virus that causes COVID-19. </p>
<p>Of the viruses known to infect humans, about 80% are naturally occurring in nonhuman hosts, primarily <a href="https://doi.org/10.1016%2Fj.scitotenv.2020.142372">in mammals and birds</a> and, to a lesser extent, in arthropods and other wildlife. </p>
<p>Infectious agents transmitted from animals to humans are estimated to constitute about 60% of known human pathogens and up to <a href="https://doi.org/10.1073/pnas.1919176117">75% of emerging human pathogens</a>. Unfortunately, there is insufficient knowledge about wild animals that may harbor thousands of unknown virus species that could be human pathogens. </p>
<p>The evidence so far indicates that the Alaskapox virus is present in several species of <a href="https://doi.org/10.1093%2Fcid%2Fcix219">small mammals</a>, most notably shrews and the red-backed vole. In other words, Alaskapox is a new example of an infectious disease that can make the leap from animals to humans, a process known as zoonosis. Although available data suggests that the public health impact of Alaskapox virus is limited, it is likely widespread in small mammal populations in Alaska, and other infections in people may not have been diagnosed. </p>
<p>At present, no person-to-person transmission of Alaskapox has been documented. However, because some types of orthopoxviruses can be transmitted by direct contact with skin lesions, it is recommended that people with wounds that are suspected to be caused by Alaskapox keep the affected area covered with a bandage.</p>
<h2>What other orthopoxviruses pose a risk?</h2>
<p>In addition to Alaskapox virus, some other orthopoxviruses have recently been recognized, such as Akhmeta virus and/or Abatino virus, that highlight the possibility of unknown members of this genus with <a href="https://doi.org/10.1056%2FNEJMoa1407647">zoonotic potential</a>. </p>
<p>Other orthopoxviruses with zoonotic potential, such as mpox virus and cowpox virus, are increasingly being reported as a cause of human disease. In fact, the ongoing mpox outbreak that started in May 2022 has resulted in more than <a href="https://www.cdc.gov/poxvirus/mpox/response/2022/index.html">93,000 cases and 177 deaths</a>. This situation may have been facilitated by the discontinuation of routine vaccination against the eradicated human smallpox, as this vaccine gave rise to <a href="https://doi.org/10.1038/s41392-023-01574-6">some degree of population immunity</a> against other orthopoxviruses.</p>
<p>In addition to the above, there are many other orthopoxviruses that infect mammals. Examples are the ectromelia virus that causes mousepox, camelpox, raccoonpox, gerbilpox and skunkpox or some sublineages of vaccinia virus such as rabbitpox and buffalopox. </p>
<p>Poxviruses infect a broad spectrum of hosts, including insects, birds, reptiles and mammals. The wide host range, the wide geographical distribution and the constant global emergence of zoonotic viruses, including new orthopoxviruses, pose a global health threat that requires close monitoring and appropriate preventive measures. </p>
<p>In this situation, I believe the most prudent course of action is to urgently adopt a <a href="https://www.cdc.gov/onehealth/basics/index.html">One Health approach</a> that recognizes that the health of humans, animals, plants and the wider environment are interconnected, and accept that we cannot address human health without also addressing animal and environmental health.</p><img src="https://counter.theconversation.com/content/223470/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Raúl Rivas González does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Alaskapox was discovered in 2015 and has generally only caused mild illness – until now.Raúl Rivas González, Catedrático de Microbiología. Miembro de la Sociedad Española de Microbiología., Universidad de SalamancaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2204842024-01-09T13:42:19Z2024-01-09T13:42:19ZSome believe the 1889 Russian flu pandemic was actually caused by a coronavirus – here’s why that’s unlikely<p>COVID-19 was the first coronavirus pandemic. The original Sars virus from 2003 and the Mers virus that created a health emergency in South Korea <a href="https://theconversation.com/explainer-what-is-the-mers-outbreak-in-south-korea-43344">in 2015</a> were both coronaviruses, but fortunately failed to turn into pandemics in the way that COVID did. </p>
<p>Four years on from its appearance, Sars-CoV-2 (the virus that causes COVID) now seems to be making the transition to an <a href="https://www.unc.edu/discover/covid-19-has-become-endemic/">endemic virus</a>: one that circulates in humans all the time, at least somewhere in the world. As is common in respiratory viruses, it also seems to be developing a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9994397/">seasonal preference</a> for the colder, wetter times of the year.</p>
<p>But Sars-CoV-2 isn’t alone. There are four other <a href="https://theconversation.com/coronaviruses-a-brief-history-135506">circulating coronaviruses</a>, named OC43, NL63, HKU-1 and 229E. The consensus is that these viruses are also descendants of past pandemics and that Sars-CoV-2 is just the latest member of their club. </p>
<p>This theory is based on the model provided by influenza viruses, where the familiar seasonal flus H3N2 and H1N1 are the descendants of the flu pandemics of <a href="https://www.britannica.com/event/1968-flu-pandemic">1968</a> and <a href="https://www.who.int/emergencies/situations/influenza-a-(h1n1)-outbreak">2009</a>, respectively.</p>
<h2>Pinning a date on the last coronavirus pandemic</h2>
<p>But when could these supposed four previous coronavirus pandemics have occurred? </p>
<p>The 19th century had three flu pandemics and so did the 20th century. We can read about these in the medical journals and newspapers of the time. However, we cannot do the same for coronavirus pandemics as the very idea of such a thing only reared its head with Sars-CoV-1 in 2003 (which caused severe acute respiratory syndrome or <a href="https://www.who.int/health-topics/severe-acute-respiratory-syndrome#tab=tab_1">Sars</a>). </p>
<p>Surely a past pandemic of COVID-like coronavirus pneumonia would have made the news? Or are we missing something?</p>
<p>Scientific interest in this topic has focused on one particular member of the endemic coronavirus quartet: OC43. Genome sequencing tells us it is closely related to bovine coronavirus. </p>
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<img alt="OC43 virions taken with a transmission electron microscopic." src="https://images.theconversation.com/files/567848/original/file-20240104-15-q5itn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567848/original/file-20240104-15-q5itn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567848/original/file-20240104-15-q5itn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567848/original/file-20240104-15-q5itn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567848/original/file-20240104-15-q5itn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567848/original/file-20240104-15-q5itn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567848/original/file-20240104-15-q5itn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">OC43 virions taken with a transmission electron microscopic.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=89425412">CDC/Erskine Palmer</a></span>
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<p>Indeed, in 2005, the date for its zoonotic transmission – meaning the jump from cattle to humans – was roughly calculated as sometime <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC544107/">between 1870 and 1890</a>. </p>
<p>The historical veterinary record confirms there was an unexplained disease circulating globally in cattle at that time. Could it have jumped to humans, kicking off an <a href="https://www.theguardian.com/world/2020/may/31/did-a-coronavirus-cause-the-pandemic-that-killed-queen-victorias-heir">OC43 pandemic</a>? </p>
<p>Suspiciously, the pandemic of “Russian influenza” began in 1889 and ran well into 1893. Was that pandemic, always supposed to be influenza, really the last coronavirus pandemic prior to COVID? </p>
<p>The idea has caught on, even receiving a mention in the UK COVID <a href="https://covid19.public-inquiry.uk/wp-content/uploads/2023/06/14181206/INQ000207453_1.pdf">public enquiry</a>.</p>
<h2>Or was it flu after all?</h2>
<p>Flu virologists are unconvinced. Although the oldest flu genome sequences are those recovered from the frozen bodies of Alaskan victims of the <a href="https://theconversation.com/world-war-ones-role-in-the-worst-ever-flu-pandemic-29849">devastating 1918-20 influenza pandemic</a>, there is another way to investigate the ancient history of flu: seroarchaeology. </p>
<p>This method takes old blood samples out of the freezer and mixes them with flu viruses. An immunological reaction indicates that the blood sample contains antibodies to the specific types of flu viruses in the experiment. This implies that the person from whom the sample was taken successfully fended off such a flu virus at some time in their lives. </p>
<p>Seroarchaeology on archived blood samples shows that well before the H3N2 flu pandemic of 1968, there were elderly people in the population who mysteriously already had antibodies to similar types of flu viruses. And back in 1968, it had already been observed that older people had better survival rates than young ones, contrary to the usual pattern in influenza outbreaks. </p>
<p>Those octogenarians of 1968 had all been around in 1889-1893. The combination of that clinical observation and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050607/">further seroarchaeology</a> pinned down the pandemic of 1889-1893 to an influenza of type H3N8.</p>
<h2>But if not 1889, then when?</h2>
<p>The OC43 pandemic theory thus disappeared off the scientific radar. But it left a question: if the 1889-1893 pandemic was influenza H3N8, then when did OC43 make its zoonotic leap from cattle to humans? </p>
<p>A study <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0285481">from 2023</a> examined all the OC43 virus genome information that has accumulated since the original study. The date of the zoonotic transfer from cattle to humans was recalculated, using the latest generation of virus genome analysis software, at 1899-1900. </p>
<p>Examination of the total <a href="https://theconversation.com/why-excess-deaths-have-varied-so-greatly-around-the-world-during-the-pandemic-172255">excess deaths</a> per million of population in England and Wales over 1899 and 1900 gave a figure of 1,576 deaths per million, less than the 2,275 deaths per million for the Russian influenza, but only just short of the 1,866 deaths per million for the two worst COVID years of 2020 and 2021.</p>
<p>So why was this OC43 pandemic not spotted before? The answer is that the pneumonia epidemic of 1899-1900 had always been dismissed as a late wave of the 1889-1893 influenza. The missing coronavirus pandemic had been hiding in plain sight.</p><img src="https://counter.theconversation.com/content/220484/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Derek Gatherer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The mysterious case of the OC43 coronavirus pandemic.Derek Gatherer, Lecturer, Biomedical and Life Sciences, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2063892023-10-18T12:32:09Z2023-10-18T12:32:09ZCOVID-19 vaccine mandates have come and mostly gone in the US – an ethicist explains why their messy rollout matters for trust in public health<figure><img src="https://images.theconversation.com/files/553070/original/file-20231010-15-y48qlo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Proof of COVID-19 vaccination was once required to access many venues during the pandemic.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-hand-of-doctor-put-label-covid-19-vaccine-royalty-free-image/1313591390">skaman306/Moment via Getty Images</a></span></figcaption></figure><p>Ending pandemics is a <a href="https://www.scientificamerican.com/article/people-not-science-decide-when-a-pandemic-is-over1/">social decision, not scientific</a>. Governments and organizations rely on <a href="https://www.science.org/content/article/who-ends-pandemic-emergency-covid-19-deaths-fall">social, cultural and political considerations</a> to decide when to officially declare the end of a pandemic. Ideally, leaders try to minimize the social, economic and public health burden of removing emergency restrictions while maximizing potential benefits.</p>
<p>Vaccine policy is a particularly complicated part of pandemic decision-making, involving a variety of other complex and often contradicting interests and considerations. Although COVID-19 vaccines have <a href="https://doi.org/10.26099/whsf-fp90">saved millions of lives</a> in the U.S., vaccine policymaking throughout the pandemic was often <a href="https://dx.doi.org/10.2139/ssrn.3680832">reactive</a> and <a href="https://doi.org/10.1186/s12889-021-12432-x">politicized</a>.</p>
<p>A late November 2022 Kaiser Family Foundation poll found that <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-december-2022/">one-third of U.S. parents</a> believed they should be able to decide not to vaccinate their children at all. The World Health Organization and the United Nations Children’s Fund reported that between 2019 and 2021, global childhood vaccination experienced its <a href="https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades">largest drop</a> in the past 30 years.</p>
<p>The Biden administration formally <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/01/the-biden-administration-will-end-covid-19-vaccination-requirements-for-federal-employees-contractors-international-travelers-head-start-educators-and-cms-certified-facilities/">removed federal COVID-19 vaccination requirements</a> for federal employees and international travelers in May 2023. Soon after, the U.S. government officially <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/end-of-phe.html">ended the COVID-19 public health emergency</a>. But COVID-19’s burden on health systems <a href="https://doi.org/10.1001/jamanetworkopen.2022.1760">continues globally</a>.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=wSbI9hUAAAAJ">public health ethicist</a> who has spent most of my academic career thinking about the ethics of vaccine policies. For as long as they’ve been around, vaccines have been a classic case study in <a href="https://academic.oup.com/phe/pages/vaccination-ethics">public health and bioethics</a>. Vaccines highlight the tensions between <a href="https://doi.org/10.1186%2F1742-7622-3-13">personal autonomy and public good</a>, and they show how the decision of an individual can have <a href="https://doi.org/10.1073/pnas.1731324100">populationwide consequences</a>. </p>
<p>COVID-19 is <a href="https://www.unc.edu/discover/covid-19-has-become-endemic/">here to stay</a>. Reflecting on the ethical considerations surrounding the rise – and unfolding fall – of COVID-19 vaccine mandates can help society better prepare for future disease outbreaks and pandemics.</p>
<h2>Ethics of vaccine mandates</h2>
<p>Vaccine mandates are the <a href="https://doi.org/10.1136%2Fbmjgh-2020-004877">most restrictive form</a> of vaccine policy in terms of personal autonomy. Vaccine policies can be <a href="https://doi.org/10.1016/j.vaccine.2018.10.019">conceptualized as a spectrum</a>, ranging from least restrictive, such as passive recommendations like informational advertisements, to most restrictive, such as a vaccine mandate that fines those who refuse to comply. </p>
<p>Each sort of vaccine policy also has different forms. Some recommendations <a href="https://doi.org/10.1016/j.lana.2022.100205">offer incentives</a>, perhaps in the form of a monetary benefit, while others are only a <a href="https://doi.org/10.2105%2FAJPH.2014.302425">verbal recommendation</a>. Some vaccine mandates are mandatory in name only, with <a href="https://www.wsj.com/articles/enforcing-vaccine-mandates-is-messy-business-11630582742">no practical consequences</a>, while others may trigger <a href="https://www.wusf.org/health-news-florida/2022-12-27/thousands-of-workers-were-fired-over-vaccine-mandates-for-some-the-fight-goes-on">termination of employment</a> upon noncompliance. </p>
<p>COVID-19 vaccine mandates took many forms throughout the pandemic, including but not limited to <a href="https://www.commonwealthfund.org/blog/2021/covid-19-vaccine-mandates-and-incentives-under-federal-law">employer mandates</a>, <a href="https://nashp.org/states-address-school-vaccine-mandates-and-mask-mandates/">school mandates</a> and <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/key-questions-about-covid-19-vaccine-passports-and-the-u-s/">vaccination certificates</a> – often referred to as <a href="https://www.nytimes.com/2021/02/04/travel/coronavirus-vaccine-passports.html">vaccine passports</a> or <a href="https://doi.org/10.1016/S1473-3099(20)30766-0">immunity passports</a> – required for travel and participation in public life.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/553072/original/file-20231010-21-irjnph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sign on window reading 'New York City requires you to be vaccinated against COVID-19 to enter this business,' with a person sitting at a desk inside the room" src="https://images.theconversation.com/files/553072/original/file-20231010-21-irjnph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553072/original/file-20231010-21-irjnph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553072/original/file-20231010-21-irjnph.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553072/original/file-20231010-21-irjnph.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553072/original/file-20231010-21-irjnph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553072/original/file-20231010-21-irjnph.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553072/original/file-20231010-21-irjnph.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">COVID-19 vaccine requirements were intended to protect the health and safety of the public.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreak/409216582fb54b8f9f74c207206f789e">Seth Wenig/AP Photo</a></span>
</figcaption>
</figure>
<p>Because of ethical considerations, vaccine mandates are typically <a href="https://doi.org/10.1111/bioe.13141">not the first option</a> policymakers use to maximize vaccine uptake. Vaccine mandates are <a href="https://doi.org/10.1016/j.vaccine.2018.10.019">paternalistic by nature</a> because they limit freedom of choice and bodily autonomy. Additionally, because some people may see vaccine mandates as invasive, they could potentially create challenges in maintaining and garnering trust in public health. This is why mandates are usually the last resort. </p>
<p>However, vaccine mandates <a href="https://doi.org/10.1111/bioe.13141">can be justified</a> from a public health perspective on multiple grounds. They’re a <a href="https://doi.org/10.1016%2FS0140-6736(22)00875-3">powerful and effective</a> public health intervention. </p>
<p>Mandates can provide <a href="https://doi.org/10.1016/S0140-6736(22)00875-3">lasting protection</a> against infectious diseases in various communities, including schools and health care settings. They can provide a public good by ensuring widespread vaccination to reduce the chance of outbreaks and disease transmission overall. Subsequently, an increase in community vaccine uptake due to mandates can protect immunocompromised and vulnerable people who are at higher risk of infection.</p>
<h2>COVID-19 vaccine mandates</h2>
<p>Early in the pandemic, <a href="https://www.brookings.edu/articles/vaccine-mandates-are-more-popular-than-you-think/">arguments in favor</a> of mandating COVID-19 vaccines for adults rested primarily on evidence that COVID-19 vaccination prevented disease transmission. In 2020 and 2021, COVID-19 vaccines seemed to have a <a href="https://doi.org/10.1093%2Fcid%2Fciab079">strong effect on reducing transmission</a>, therefore justifying vaccine mandates. </p>
<p>COVID-19 also <a href="https://doi.org/10.1007%2Fs40615-021-01170-w">posed a disproportionate threat</a> to vulnerable people, including the immunocompromised, older adults, people with chronic conditions and poorer communities. As a result, these groups would have <a href="https://doi.org/10.1371%2Fjournal.pmed.1004086">significantly benefited</a> from a reduction in COVID-19 outbreaks and hospitalization.</p>
<p>Many researchers found <a href="https://doi.org/10.1377/forefront.20211029.682797">personal liberty and religious objections insufficient</a> to prevent mandating COVID-19 vaccines. Additionally, decision-makers in favor of mandates appealed to the COVID-19 vaccine’s ability to <a href="https://pubmed.ncbi.nlm.nih.gov/34924609">reduce disease severity and therefore hospitalization rates</a>, alleviating the pressure on overwhelmed health care facilities. </p>
<p>However, the emergence of <a href="https://theconversation.com/what-is-the-new-covid-19-variant-ba-2-and-will-it-cause-another-wave-of-infections-in-the-us-179619">even more transmissible variants</a> of the virus dramatically changed the decision-making landscape surrounding COVID-19 vaccine mandates.</p>
<p>The public health intention (and ethicality) of original COVID-19 vaccine mandates became less relevant as the scientific community understood that achieving herd immunity against COVID-19 was <a href="https://doi.org/10.1038/d41586-021-00728-2">probably impossible</a> because of uneven vaccine uptake, and <a href="https://doi.org/10.1038/d41586-022-00283-4">breakthrough infections</a> among the vaccinated became more common. Many countries like <a href="https://doi.org/10.1136/bmj.o353">England</a> and <a href="https://www.venable.com/insights/publications/2022/02/as-the-federal-vaccine-mandates-fall-one-by-one">various states in the U.S.</a> started to roll back COVID-19 vaccine mandates.</p>
<p>With the rollback and removal of vaccine mandates, decision-makers are still left with important policy questions: Should vaccine mandates be dismissed, or is there still sufficient ethical and scientific justification to keep them in place?</p>
<p>Vaccines are lifesaving medicines that can help everyone eligible to receive them. But vaccine mandates are context-dependent tools that require considering the time, place and population they are deployed in. </p>
<p>Though COVID-19 vaccine mandates are less of a publicly pressing issue today, many other vaccine mandates, <a href="https://www.nytimes.com/2022/12/16/health/vaccines-public-opinion.html">particularly in schools</a>, are currently being challenged. I believe this is a reflection of decreased trust in public health authorities, institutions and researchers – resulting in part from <a href="https://theconversation.com/18-months-of-the-covid-19-pandemic-a-retrospective-in-7-charts-166881">tumultuous decision-making</a> during the COVID-19 pandemic.</p>
<p>Engaging in transparent and honest conversations surrounding vaccine mandates and other health policies can help rebuild and foster trust in public health institutions and interventions.</p><img src="https://counter.theconversation.com/content/206389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Gur-Arie does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Vaccine policies fall on a spectrum, from mandates to recommendations. Deciding what to use and when is not so much a science but a balancing act between personal autonomy and public good.Rachel Gur-Arie, Assistant Professor of Nursing and Health Innovation, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2141522023-09-22T10:50:15Z2023-09-22T10:50:15ZView from The Hill: We can’t prepare for a future pandemic without fully looking at state governments’ decisions in the last one<figure><img src="https://images.theconversation.com/files/549736/original/file-20230922-26-xus58y.jpg?ixlib=rb-1.1.0&rect=10%2C5%2C3338%2C2389&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>Nearly a year ago, a privately financed inquiry, led by Peter Shergold, a former head of the prime minister’s department, finished a review of Australia’s handling of the COVID pandemic.</p>
<p>The report, Fault Lines, was a solid piece of work, delving into the commendable and poor aspects of the response to what was such a massive health and economic crisis.</p>
<p>Among its findings were that lockdowns and border closures should have been used less and schools in the main should have been kept open. Both internal borders and schools were state responsibilities.</p>
<p>Australia always needed a federal government-commissioned inquiry into the management of the pandemic. Anthony Albanese recognised this and before the election he indicated Labor would have one. But he was vague about its form.</p>
<p>Now we have seen that form, and it’s clearly inadequate.</p>
<p>The terms of reference, issued on Thursday, say the inquiry will take a “whole-of-government” view. A whole of Commonwealth government, that is.</p>
<p>They are very detailed. But Albanese and Health Minister Mark Butler summed up the inquiry’s remit when they said in a statement it would consider Commonwealth responses, including “the provision of vaccinations, treatments and key medical supplies to Australians, mental health support for those impacted by COVID-19 and lockdowns, financial support for individuals and business, and assistance for Australians abroad”.</p>
<p>While looking at these areas will inevitably lead the inquiry into the various interfaces with the states, the terms of reference specifically say it will not extend to “actions taken unilaterally by state and territory governments”.</p>
<p>The inquiry will be done by a three-member panel, comprising Robyn Kruk, who has formerly headed departments at state and federal level; Catherine Bennett, an eminent epidemiologist, and Angela Jackson, a health economist.</p>
<p>There was immediate criticism that the inquiry is not a royal commission. Albanese dismissed this line of attack, suggesting royal commissions took a long time, and judges weren’t necessarily the best people for this job. These arguments sounded somewhat strange, however the fact it isn’t a royal commission is not the central problem here.</p>
<p>That problem is its failure to include the decisions of the states and territories – and notably that line emphasising their specific exclusion.</p>
<p>The COVID response was as much at state as federal level – in fact, on many aspects the states were the drivers. For example the Morrison government did not favour schools being closed, but state governments took a different view and did it.</p>
<p>So why exclude the states’ decisions? There is no logic about that, but it looked like some obvious politics was at play.</p>
<p>Facing criticism that he was protecting Labor states, Albanese pointed to the political mix of these governments at the time, when half of them were non-Labor. He also said there had been changes of government and leadership in some states.</p>
<p>One, more credible, reason for excluding state decisions is to avoid giving ammunition for a possible future change of government. The Palaszczuk government goes to an election in late October next year. That government came under much criticism over its uncompromising border closure during COVID, with damaging publicity about a lack of compassion. It is already facing an uphill fight to hang onto power. The last thing it would want would be an inquiry – which reports by September 30 next year – revisiting earlier decisions.</p>
<p>(Victoria’s Dan Andrews, who ran the harshest lockdowns, has his election behind him, but likely wouldn’t appreciate any potentially tough findings either.)</p>
<p>After what the government must have found an unexpectedly fierce attack over its inquiry, Butler on Friday argued it could get into state matters.</p>
<p>It would examine the health response – which included the public health and social measures. And they covered “distancing, contact tracing, border closures, lockdowns, all of those things are in scope. They’re utterly in scope of the inquiry. It would be extraordinary for them not to be,” he told the ABC.</p>
<p>That leaves the whole thing as clear as mud. On Butler’s words, it would seem up to the panel how far it wants to push the probing of state areas.</p>
<p>But broadly, it appears the Morrison government will have the blow torch applied, while the state administrations of the time will at most only get some indirect heat.</p>
<p>Albanese says the inquiry is aimed at looking forward to how we can be better prepared for the future.</p>
<p>But without a forensic eye on what was good and bad in the decisions taken by all governments, we will only receive partial advice on how to put Australia in the best position to deal with another such crisis. And by limiting the inquiry, the government has invited a cynical response from the public, who got to know quite a lot about how various governments performed in those hard times.</p><img src="https://counter.theconversation.com/content/214152/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Australia needed a federal government-inquiry into the management of the pandemic. Albanese recognised this and before the election he indicated Labor would have one. But he was vague about its form.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2131702023-09-08T16:30:15Z2023-09-08T16:30:15ZWhy are those lost to COVID not formally memorialised? How politics shapes what we remember<p>Every Friday, volunteers gather on the Albert Embankment at the River Thames in London to lovingly retouch thousands of red hearts inscribed on a Portland stone wall directly opposite the Houses of Parliament. Each heart is dedicated to a British victim of COVID. It is a deeply social space – a place where the COVID bereaved come together to honour their dead and share memories.</p>
<p>The so-called <a href="https://www.nationalcovidmemorialwall.org/">National Covid Memorial Wall</a> is not, however, officially sanctioned. In fact, ever since activists from COVID-19 Bereaved Families for Justice (CBFFJ) daubed the first hearts on the wall in March 2021 it has been a thorn in the side of the authorities. </p>
<p>Featured in the media whenever there is a new revelation about <a href="https://theconversation.com/europe/topics/partygate-115248">partygate</a>, the wall is a symbol of the government’s blundering response to the pandemic and an implicit rebuke to former prime minister Boris Johnson and other government staff who breached coronavirus restrictions. </p>
<p>As one writer put it, viewed from parliament the hearts resemble “<a href="https://www.mirror.co.uk/news/uk-news/guerrilla-act-memorial-began-180000-26550275">a reproachful smear of blood</a>”. Little wonder that the only time Johnson visited the wall was under the cover of darkness to avoid the TV cameras. His successor Rishi Sunak has been similarly reluctant to acknowledge the wall or say what might take its place as a more formal memorial to those lost in the pandemic.</p>
<p>Though in April the UK Commission on COVID Commemoration presented Sunak with a <a href="https://www.gov.uk/government/news/the-uk-commission-on-covid-commemoration">report</a> on how the pandemic should be remembered, Sunak has yet to reveal the commission’s recommendations. </p>
<p>Lady Heather Hallett, the former high court judge who chairs the public inquiry into COVID, has attempted to acknowledge the trauma of the bereaved by commissioning a <a href="https://covid19.public-inquiry.uk/news/first-commemorative-tapestry-panels-unveiled-at-covid-inquiry-hearing-centre/">tapestry</a> to capture the experiences of people who “suffered hardship and loss” during the pandemic. Yet such initiatives are no substitute for state-sponsored memorials.</p>
<h2>What is remembered and what is forgotten?</h2>
<p>This political vacuum is odd when you consider that the United Kingdom, like other countries, engages in many other commemorative activities central to national identity. The fallen of the first world war and other military conflicts are commemorated in a Remembrance Sunday ceremony held every November at the <a href="https://www.britishlegion.org.uk/get-involved/remembrance/remembrance-events/remembrance-sunday">Cenotaph</a> in London, for example. </p>
<p>But while wars lend themselves to compelling moral narratives, it is difficult to locate meaning in the random mutations of a virus. And while wars draw on a familiar repertoire of symbols and rituals, pandemics have few templates.</p>
<p>For instance, despite killing more than 50 million globally, there are <a href="https://markhonigsbaum.substack.com/p/drinking-the-waters-of-lethe">virtually no memorials</a> to the 1918-1919 “Spanish” influenza pandemic. Nor does the UK have a memorial to victims of HIV/AIDS. As the memory studies scholar <a href="https://journals.sagepub.com/doi/10.1177/1750698020943014">Astrid Erll puts it</a>, pandemics have not been sufficiently “mediated” in collective memory. </p>
<p>As a rule, they do not feature in famous paintings, novels or films or in the oral histories passed down as part of family lore. Nor are they able to draw on familiar cultural materials such as poppies, gun carriages, catafalques and royal salutes. Without such symbols and schemata, Erll argues, we struggle to incorporate pandemics into our collective remembering systems.</p>
<p>This lacuna was brought home to me last September when tens of thousands of Britons flocked to the south bank of the Thames to pay their respects to Britain’s longest serving monarch. By coincidence, the police directed the queue for the late Queen’s lying-in-state in Westminster Hall over Lambeth Bridge and along Albert Embankment. </p>
<p>But few of the people I spoke to in the queue seemed to realise what the hearts signified. It was as if the spectacle of a royal death had eclipsed the suffering of the COVID bereaved, rendering the wall <a href="https://markhonigsbaum.substack.com/p/reign-of-silence">all but invisible.</a></p>
<h2>Waiting for answers</h2>
<p>Another place where the pandemic could be embedded in collective memory is at the public inquiry. Opening the preliminary hearing last October into the UK’s resilience and preparedness for a pandemic, Lady Hallett promised to put the estimated 6.8 million Britons mourning the death of a family member or friend to COVID at the heart of the legal process. “I am listening to them; their loss will be recognised,” she said.</p>
<p>But though Lady Hallett has strategically placed photographs of the hearts throughout the inquiry’s offices in Bayswater and has invited the bereaved to relate their experiences to “<a href="https://covid19.public-inquiry.uk/every-story-matters/">Every Story Matters</a>”, the hearing room is dominated by ranks of lawyers. And except when a prominent minister or official is called to testify, the proceedings rarely make the news.</p>
<p>This is partly the fault of the inquiry process itself. The hearings are due to last until 2025, with the report on the first stage of the process not expected until the summer of 2024. As Lucy Easthope, an emergency planner and veteran of several disasters, <a href="https://policy.bristoluniversitypress.co.uk/when-this-is-over">puts it</a>: “one of the most painful frustrations of the inquiry will be temporal. It will simply take too long.”</p>
<p>The inquiry has also been beset by bureaucratic obfuscation, not least by the Cabinet Office which attempted (unsuccessfully in the end) to <a href="https://www.judiciary.uk/wp-content/uploads/2023/07/Cab-Off-v-Covid-Enquiry-6.7.23-approved-judgment-002.pdf">block the release of WhatsApp messages</a> relating to discussions between ministers and Downing Street officials in the run-up to lockdown. </p>
<p>To the inquiry’s critics, the obvious parallel is with the Grenfell inquiry, which promised to “learn lessons” from the <a href="https://theconversation.com/europe/topics/grenfell-tower-39675">devastating fire</a> that engulfed the west London tower in 2017 but has so far ended up <a href="https://assets.grenfelltowerinquiry.org.uk/GTI%20-%20Phase%201%20report%20Executive%20Summary.pdf">blurring the lines of corporate responsibility</a> and forestalling a political reckoning.</p>
<p>The real work of holding the government to account and making memories takes place every Friday at the wall and the other places where people come together to spontaneously mourn and remember absent loved ones. These are the lives that demand to be “seen”. They are the ghosts that haunt our amnesic political culture.</p><img src="https://counter.theconversation.com/content/213170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Honigsbaum receives funding from the Higher Education Innovation Fund.</span></em></p>Hundreds of thousands of red hearts adorn a wall directly opposite parliament, yet successive prime ministers have nothing to say about officially marking the lives lost in the pandemic.Mark Honigsbaum, Senior Lecturer in Journalism, City, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2124942023-09-08T09:13:31Z2023-09-08T09:13:31ZCOVID mutates rapidly in white-tailed deer, but here’s why we don’t need to worry – for now<figure><img src="https://images.theconversation.com/files/546708/original/file-20230906-22-m3sydi.jpg?ixlib=rb-1.1.0&rect=0%2C519%2C5585%2C3203&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/white-tail-deer-odocoileus-virginianus-young-1359728207">Michael Tatman/Shutterstock</a></span></figcaption></figure><p>At some point during the pandemic, Sars-CoV-2, the virus that causes COVID, spread from humans to white-tailed deer in the US. </p>
<p>In 2021, scientists revealed that <a href="https://www.pnas.org/doi/10.1073/pnas.2114828118">40% of white-tailed deer</a> sampled in Michigan, Pennsylvania, Illinois and New York state had COVID antibodies.</p>
<p>Surveillance of these deer continues, and a <a href="https://www.nature.com/articles/s41467-023-40706-y">new study</a> by researchers at Ohio State University found that the virus is still spreading among the animals – and back to humans. And it is evolving rapidly.</p>
<p>The researchers looked at the prevalence of COVID in a small sample of white-tailed deer in north-eastern Ohio. The samples were taken between November 2021 and March 2022. From 1,522 nasal swabs, 163 tested positive for alpha and delta variants of COVID. The researchers also found that the virus had spread many times from humans to deer and from deer to humans (known as “spillover”). </p>
<p>Coronaviruses are covered in spikes and it is these spikes that latch on to our cells to gain entry and begin replicating. The particular part of our cells that the spikes latch on to is called the ACE2 receptor. This receptor is similar in deer and humans, and coronaviruses have lost little time in exploiting this.</p>
<p>Human contact with deer is common in parts of the US, where many millions of white-tailed deer live as wild, urbanised or farmed animals. In these habitats, deer may be exposed to human waste. They can carry bacteria with similar antimicrobial resistance patterns to local humans.</p>
<figure class="align-center ">
<img alt="A graphic depicting a coronavirus" src="https://images.theconversation.com/files/546490/original/file-20230905-19-lsat4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546490/original/file-20230905-19-lsat4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=346&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546490/original/file-20230905-19-lsat4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=346&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546490/original/file-20230905-19-lsat4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=346&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546490/original/file-20230905-19-lsat4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=435&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546490/original/file-20230905-19-lsat4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=435&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546490/original/file-20230905-19-lsat4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=435&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A coronavirus with its distinctive spikes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/coronavirus-covid19-under-microscope-3d-illustration-1643947495">Andrii Vodolazhskyi/Shutterstock</a></span>
</figcaption>
</figure>
<p>The Ohio researchers found that COVID multiplied and spread in deer over several months, causing no obvious illness or deaths in the animals. Migrating deer – males in particular – spread the virus as they moved across the county. </p>
<p>It is not known if other potential hosts such as skunks, squirrels or rodents contracted the virus too, but spread from deer back to humans was seen. How this exchange happened, though, is unclear. </p>
<p>Deer sampled on Staten Island, New York, over the same period showed evidence of spillover infection from humans by another COVID variant, omicron. Viral exchanges between communities and their deer are happening often.</p>
<h2>Mutating three times faster in deer than in humans</h2>
<p>By measuring changes in the COVID genomes in the deer using a new statistical method, the researchers in Ohio estimated that the rate of COVID mutation was three times greater than in humans. The types of genetic changes were not the same as those in human COVID. The mutations appeared to be adaptive responses that might have increased viral spread in its new deer hosts. </p>
<p>COVID showed early increases in its diversity in humans, too, which was perhaps more rapid in the first years after 2019.</p>
<p>Crucially, the spill-back of virus from deer to humans has not caused new human outbreaks that are making doctors lose sleep. Evolutionary changes in COVID in deer populations have not resulted in a virus that can evade our antibodies. So there is no current public health risk linked to this increased mutation rate.</p>
<p>As with humans, some deer are “<a href="https://theconversation.com/what-is-a-super-spreader-an-infectious-disease-expert-explains-130756">super-spreaders</a>”. Social network analysis shows this process in deer’s use of scraping sites, where males leave their scents to set up breeding groups. Human-made feeding or bait stations (for hunting) exacerbate the rate of viral spread, too. </p>
<p>White-tailed deer could be referred to as a new reservoir of COVID viruses. Animal reservoirs encompass a continuous process of viral division and change. Hosts impose selective pressures on viruses that influence the rate at which a virus’s genome changes. For example, influenza A evolves more rapidly in populations of birds or pigs than in people. </p>
<p>Probably, the lifespan of an infected animal, metabolic processes within its cells, immune actions, damage to viral RNA from host enzymes or other pathogens all force viral mutation. Whatever the reasons, these observations from Ohio raise the possibility that in those millions of white-tailed deer, COVID viruses might develop into a new strain or variant capable of spreading significant illness to humans.</p>
<p>Blood tests of <a href="https://onlinelibrary.wiley.com/doi/10.1111/tbed.14534">UK deer in 2020-21</a> found no evidence of COVID in these animals. This could be because British deer species have distinctive ecological niches and COVID susceptibilities. But it is clear that this sort of ongoing surveillance provides valuable intelligence.</p><img src="https://counter.theconversation.com/content/212494/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>COVID has spread many times from humans to white-tailed deer and back again.Colin Michie, Deputy Lead, School of Medicine, University of Central LancashireIain Richards, Senior Lecturer, Animal Life, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2109932023-08-30T15:07:36Z2023-08-30T15:07:36ZHow folk remedies can fuel misinformation<figure><img src="https://images.theconversation.com/files/543439/original/file-20230818-29-a132t0.jpg?ixlib=rb-1.1.0&rect=0%2C41%2C5503%2C3575&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/womans-hands-holding-very-appetizing-garlic-2181544279">Gino Gallucci/Shutterstock</a></span></figcaption></figure><p>When London faced the bubonic plague in 1665, many people desperately sought a way to protect themselves and their loved ones from getting sick. One widely adopted method consisted of mixing two small cloves of garlic in a pint of fresh milk. People believed that drinking this cocktail in the morning, on an empty stomach, would prevent the feared disease.</p>
<p>Like those living through <a href="https://www.nationalarchives.gov.uk/education/resources/great-plague/">the great plague of London</a>, many people searched for remedies that would keep COVID at bay, which is why claims that garlic could cure or protect people proliferated on social media. The claims prompted an exasperated World Health Organization to post <a href="https://twitter.com/WHO/status/1223904465394249732">tweets of caution</a>.</p>
<p>Unfortunately, despite laboratory studies showing that <a href="https://link.springer.com/article/10.1007/s12223-020-00786-5">garlic does indeed have compounds with anti-microbial properties</a>, the idea of ingesting garlic to prevent becoming infected with any bacteria or virus is <a href="https://www.tandfonline.com/doi/full/10.1080/17415993.2012.712123">mostly folklore</a>.</p>
<p>Folk remedies may sound benign, but they can hurt people. A 72-year-old woman ended up with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242564/">chemical burn</a> on her tongue due to her daily use of raw garlic in an attempt to protect herself against the coronavirus, for example. </p>
<h2>Medical folk wisdom</h2>
<p>The idea of garlic as a blanket cure has its foundation in medical folk wisdom, which is an umbrella term for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329847/">unproven, widespread beliefs</a> about anything to do with health and disease. </p>
<p>Folk wisdom often has a certain level of seductive <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880218/">intuitiveness</a> and generally originates from cultural beliefs as well as long-held traditions. Folk wisdom can involve herbal remedies, dietary recommendations and advice about following specific behaviours. It is often passed down by <a href="https://www.researchgate.net/publication/263697937_Understanding_Folk_Medicine">word of mouth through generations</a> and may be one of the reasons myths about the causes and cures of diseases persist, despite the progress of medical science. </p>
<p>The unshakeable belief many people hold that eating before you go for a swim is dangerous, for example, has no scientific basis. Even though the logic seems compelling, the idea that <a href="https://theconversation.com/mondays-medical-myth-wait-30-minutes-after-eating-before-you-swim-10653">eating before swimming</a> causes drowning has been <a href="https://scholarworks.bgsu.edu/cgi/viewcontent.cgi?article=1144&context=ijare">debunked by researchers</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541041/original/file-20230803-23-vvur5h.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C663&q=45&auto=format&w=1000&fit=clip"><img alt="Sepia coloured newspaper front page." src="https://images.theconversation.com/files/541041/original/file-20230803-23-vvur5h.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C663&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541041/original/file-20230803-23-vvur5h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541041/original/file-20230803-23-vvur5h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541041/original/file-20230803-23-vvur5h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541041/original/file-20230803-23-vvur5h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541041/original/file-20230803-23-vvur5h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541041/original/file-20230803-23-vvur5h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A 17th-century newspaper advising readers to drink garlic and milk.</span>
<span class="attribution"><a class="source" href="https://digital.nls.uk/broadsides-from-the-crawford-collection/archive/144782414?mode=transcription">National Library of Scotland</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>Folk wisdom is complicated because on the one hand it broadly falls <a href="https://books.google.fr/books?hl=en&lr=&id=aUB_EAAAQBAJ&oi=fnd&pg=PA3&dq=Defining+Health+Misinformation+Yuan+Wang+Kathryn+Thier+Xiaoli+Nan+&ots=i2k6T3CkVf&sig=vGomAVFqe8epAO_XmMVRj7jtmys&redir_esc=y#v=onepage&q=Defining%20Health%20Misinformation%20Yuan%20Wang%20Kathryn%20Thier%20Xiaoli%20Nan&f=false">under the category of misinformation</a>, but on the other it doesn’t quite fit with the usual class of misinformation (such as fake news or misleading advertising). If someone endorses folk wisdom, it is not necessarily a strong indicator they have anti-science beliefs. </p>
<p>People who believe in “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329847/">starving a fever</a>”, for example, can also be pro-vaccines. Likewise, it would not be unusual for a person who <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0279122">follows official health recommendations</a> to also use folk wisdom as an additional safeguard against, for example, the coronavirus. </p>
<h2>Don’t underestimate it</h2>
<p>However, the idea that folk wisdom is predominantly benign might be why experts tend to pay less attention to it. For example, believing that drinking warm milk before bed helps you go to sleep is not going to harm you (<a href="https://uamshealth.com/medical-myths/will-drinking-warm-milk-make-you-sleepy/#:%7E:text=The%20%27milk%20myth%27%20may%20have,to%20cause%20any%20real%20drowsiness.">even if it’s not true</a>). However, other beliefs can be dangerous such as the idea that eating particular foods can bolster your immunity, which can lead people to think they don’t need to be vaccinated against the flu or COVID. </p>
<p>Folk wisdom, like other types of misinformation not backed by science, often proliferate on <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/hir.12320">social media</a>, which means it can pose a threat to public health. </p>
<p>For example, in 2020, when the UK went into lockdown, the Burns Centre at Birmingham Children’s Hospital saw a <a href="https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931145-4">30-fold increase</a> in the number of scald injuries from steam inhalation. This was caused by a folk wisdom on social media that misled parents into believing that inhaling steam could prevent or treat respiratory tract symptoms. This was particularly disheartening because <a href="https://bjgp.org/content/bjgp/66/644/e193.full.pdf">studies published worldwide</a> since 1969 have highlighted the dangers of steam inhalation.</p>
<p>While some examples of folk wisdom have a level of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8663842/">biological plausibility</a>, others do not. For instance, the belief that “an apple a day keeps the doctor away”, a <a href="https://cvc.cervantes.es/lengua/paremia/pdf/031/008_mieder.pdf">medical folk proverb from around 1870</a>, was probably based on the wisdom that apples are full of nutrients. Interestingly, scientists have found that though the vitamin content of apples may not be particularly exceptional, apples are considered a so-called <a href="https://theconversation.com/does-an-apple-a-day-really-keep-the-doctor-away-a-nutritionist-explains-the-science-behind-functional-foods-207191?utm_source=pocket_mylist">functional food</a> (which must meet a scientific criteria, unlike “superfoods”) because of the number of bioactive substances that they have which appear to be health promoting. </p>
<p>Folk wisdom isn’t likely to disappear anytime soon. So we need to understand what makes people believe in it and to what extent it challenges beliefs in science. There seems to be a complex relationship between beliefs in folk wisdom and what people actually do to protect their health. Understanding this relationship could be key to preventing its harmful effects. Lives may depend upon it.</p><img src="https://counter.theconversation.com/content/210993/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Medical folk wisdom is the complex problem health professionals can’t afford to ignore.Katrine K. Donois, PhD Candidate in Psychology (Science Communication), Anglia Ruskin UniversityHassan Vally, Associate Professor, Epidemiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2113152023-08-29T15:34:37Z2023-08-29T15:34:37ZBreastfeeding increased during the pandemic but what does that tell us about how to improve rates?<figure><img src="https://images.theconversation.com/files/541982/original/file-20230809-25-3v08a2.jpg?ixlib=rb-1.1.0&rect=20%2C30%2C6689%2C4436&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/serious-calm-careful-young-black-mom-1426845311">SeventyFour/Shutterstock</a></span></figcaption></figure><p>During the pandemic, there had been concerns from healthcare professionals that the restrictions placed on daily life would lead to a disruption in breastfeeding. But <a href="https://bmjpaedsopen.bmj.com/content/7/1/e001907.full#ref-13">our new research</a> shows that the number of women who continued to exclusively breastfeed for six months increased. </p>
<p>And in fact, women were 40% more likely to exclusively breastfeed for six months during COVID than they were before the pandemic or now, post-pandemic. </p>
<p>The World Health Organization (WHO) <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_2">recommends</a> exclusively breastfeeding for the first six months of a baby’s life. But the UK has had the <a href="https://www.unicef.org.uk/babyfriendly/about/breastfeeding-in-the-uk/">lowest</a> breastfeeding rates globally. Only <a href="https://www.thelancet.com/series/maternal-and-child-nutrition">0.5% of women breastfed</a> their baby until they were one year old in the UK. This is compared to 27% of mothers in the <a href="https://www.thelancet.com/series/maternal-and-child-nutrition">United States</a>, 35% in <a href="https://www.thelancet.com/series/maternal-and-child-nutrition">Norway</a> and 44% in <a href="https://www.thelancet.com/series/maternal-and-child-nutrition">Mexico</a>, who were still breastfeeding after one year. </p>
<p>When COVID hit, there had been concern that the virus could be <a href="https://link.springer.com/article/10.1007/s42399-020-00498-4">passed</a> from mothers to babies. </p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
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<hr>
<p>Numerous studies reported a lack of support for expectant and new mothers who were breastfeeding during the pandemic. For instance, <a href="https://www.sciencedirect.com/science/article/pii/S019566632031607X?via%3Dihub">one in three</a> women intending to breastfeed reported lacking assistance with proper positioning, while <a href="https://www.sciencedirect.com/science/article/pii/S019566632031607X?via%3Dihub">one in four</a> women stated insufficient hospital-based breastfeeding support. This was probably due to strained healthcare systems and the push to minimise infection risks. </p>
<p>Support for new mothers lessened, which hindered breastfeeding. And pregnant women reported very high levels of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267176">anxiety and stress</a>, including uncertainty about the <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07856-8">vaccine</a>. </p>
<p>We conducted surveys with women who gave birth in Wales between 2018 and 2021 and we examined anonymised NHS breastfeeding health data collected by midwives and health visitors. </p>
<p>Surprisingly, breastfeeding rates up to six months peaked in 2020, a time of strict pandemic restrictions. This conflicts with the anticipated decrease in breastfeeding rates due to reduced access to professional and social support. </p>
<p><a href="https://bmjpaedsopen.bmj.com/content/7/1/e001907.full">Our research</a> also shows that approximately six in ten women in Wales breastfeed for their baby’s first feed, but only three in ten are still breastfeeding at ten weeks. And more than 80% of women are not breastfeeding at all by six months. </p>
<p>This finding has surprised us and others working in healthcare since the pandemic had such a profound impact on daily life worldwide.</p>
<figure class="align-center ">
<img alt="A mother holds the hand of her baby who is breastfeeding." src="https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Breastfeeding rates up to six months peaked at the height of the pandemic.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-boy-sucking-milk-mothers-1968727780">Nastyaofly/Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://bmjpaedsopen.bmj.com/content/7/1/e001907.full#ref-13">Our study</a> also shows that when pregnant women report that they do not intend to breastfeed, then they are very unlikely to start breastfeeding. About 30% of women do not intend to breastfeed at all. </p>
<p>However, when women say in pregnancy that they intend to breastfeed, then approximately 90% of these women do start doing so. They are also 27 times more likely to breastfeed for six months compared to women who did not intend to breastfeed. </p>
<h2>The time factor</h2>
<p>But what is it that helps women who do want to breastfeed, do so for longer? We know that even without the support systems and training by midwives, more women who wanted to breastfeed were able to for longer during the pandemic. </p>
<p>These findings could mean that one thing women really need to help them to breastfeed is more time at home with their baby, more time with their partner at home with them, more privacy and more flexible working. </p>
<p>If we want to increase breastfeeding levels, it is possible that what the pandemic has taught us is the need to address working environments as well as medical services. </p>
<h2>Breastfeeding benefits</h2>
<p>Breastfeeding has many benefits, including fewer <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1693-2">infections</a>, increased <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894195/#:%7E:text=Breastfeeding%20was%20positively%20associated%20with,%2Dbreastfed%20participants%20(19).">intelligence</a> and the prevention <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/1107563#:%7E:text=Breastfed%20babies%20seem%20to%20be,she%20is%206%20months%20old.">obesity and diabetes</a>. Breastfeeding also has <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext">advantages for mothers</a> as it lessens the risk of cancers, postpartum bleeding and helps with weight loss after birth. </p>
<p>It is better for the <a href="https://www.unicef.org.uk/babyfriendly/breastfeeding-and-climate-change/#:%7E:text=Breastfeeding%20also%20requires%20less%20water,footprint%20(Binns%2C%202021).">environment</a> and can be cheaper for some families.</p>
<p>But a <a href="https://www.nature.com/articles/s41372-023-01646-z">study</a> by Yale School of Medicine earlier this year found that a year of breastfeeding can also cost families up to US$11,000 (£8,700) with increased food intake, vitamins, supplements and supplies. It stressed that the barrier of cost may impact a mother’s decision to breastfeed. </p>
<p>But the cost of breastfeeding involves more than just money. Another more hidden cost is the time dedicated to breastfeeding or pumping breast milk. This highlights how women need more time at home and how we should be reassessing working environments, especially for lower income families.</p>
<p>The short term gains of getting parents back to work should not outweigh the long term benefits to our society from having healthier families. If we want to improve breastfeeding rates in the UK, then we need to look at the working lives of women and their partners across the nation.</p><img src="https://counter.theconversation.com/content/211315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work is funded by the National Centre for Population Health and Wellbeing Research and the National Core Studies funded by the Medical Research Council.</span></em></p><p class="fine-print"><em><span>Sinead Brophy receives funding from Health Care Research Wales for Born In Wales and the National Centre for Population Health, MRC for Health Data Research UK, ESRC for Administrative Data Research. </span></em></p>New research shows that breastfeeding rates peaked in 2020, a time of strict COVID restrictions.Hope Jones, Research Assistant at the National Centre for Population Health and Wellbeing Research, Swansea UniversitySinead Brophy, Professor in Public Health Data Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2118402023-08-25T10:21:10Z2023-08-25T10:21:10ZCOVID: should we start wearing masks again?<p>One thing that can be guaranteed about COVID is that evolution will provide us with a more or less constant stream of new coronavirus variants, some of which will be more successful at infecting people. Talk of mutations sounds scary and it can lead to serious problems, but it would be a mistake to think that it’s always the case.</p>
<p><a href="https://www.nature.com/articles/d41586-023-02656-9">BA.2.86</a> (nicknamed pirola) is one such new variant that has aroused concern from some doctors and scientists because of the high number of mutations in its spike protein, the molecule on the virus surface that acts like a key for it to unlock and enter our cells. It’s also the target for the vaccines, so changes in the spike might mean changes in the way the virus behaves, perhaps significantly. </p>
<p>But as things stand, we don’t have good data to be certain about this. It’s this worry that there may be a new wave of infections that has got some people <a href="https://www.dailymail.co.uk/health/article-12410235/Gloomy-scientists-call-people-start-wearing-Covid-masks-sound-alarm-new-variant-BA-6-lot-new-mutations.html">talking</a> about the need to reintroduce measures that control viral spread.</p>
<p>At the start of the pandemic, one of the most persistent <a href="https://twitter.com/SkyNews/status/1235105792795136002">questions</a> asked was whether people should protect themselves and others by wearing some form of face covering. Initially, the prevailing opinion was that public use would not be <a href="https://www.independent.co.uk/news/uk/home-news/coronavirus-uk-news-professor-chris-whitty-no-masks-advice-a9374086.html">effective</a>. </p>
<h2>Loud calls for face coverings</h2>
<p>Government medical advisers in London and Edinburgh repeatedly assured the daily press conferences of this, only for <a href="https://news.sky.com/story/coronavirus-face-coverings-useful-when-uk-lockdown-is-eased-says-boris-johnson-11981298">politicians</a> to lead the way in changing that advice while their advisers looked on. Now that the threat of COVID has largely receded, whenever infection numbers start to climb there are loud <a href="https://www.independent.co.uk/news/health/covid-face-masks-arcturus-vaccine-b2329693.html">calls</a> to instruct people to wear face coverings again. </p>
<p>The issue of masks, which in reality should be taken as shorthand for face coverings of all sorts, is one that too often creates more heat than light. There have been <a href="https://fullfact.org/health/danish-mask-wearing-spectator/">overstated</a> claims of their effect and unwarranted claims of proof of <a href="https://fullfact.org/health/danish-mask-wearing-spectator/">ineffectiveness</a>. </p>
<p>The picture is complicated by the lack of comprehensive, well-designed studies. Sometimes a study size is too small, meaning that slight but real differences might be difficult to see, or the actual adherence to wearing a mask is too low. If people only wear them sometimes, it could be difficult to observe an effect.</p>
<p>Compelling people to change their behaviour to reduce the number of COVID infections might not be without some sort of cost in terms of public confidence. During the pandemic, a school of thought arose that the public doesn’t really take any notice until they see TV pictures of people struggling to breathe being admitted to hospital. A lack of such urgency might mean compliance would therefore be poor and enforcement weak or non-existent. </p>
<p>When introduced in the UK in the spring of <a href="https://www.theguardian.com/uk-news/2020/apr/28/sturgeon-urges-scots-to-wear-coronavirus-face-masks-for-shopping-and-travel">2020</a>, the instruction to cover our faces was part of a larger, more wide-ranging package of measures that, combined, did not prevent subsequent waves of infections and lockdowns. That being the case, it seems unlikely that masking on its own, without other measures, would have much effect, if any. </p>
<p>Coupled with the inevitable questioning of why it is necessary, any failure of masks to control infections when deployed as a sole measure could seriously jeopardise people’s willingness to comply with their use should a serious wave of respiratory infections occur that puts significant numbers of people in hospital and in which masks form part of a multi-component set of infection control measures. </p>
<p>As things stand, the chances of any reintroduction of significant multi-layered infection controls are virtually zero. A general election is due in the UK before the end of 2024, and it would take a very serious emergency of the type we saw at the height of the pandemic to make the government even contemplate it.</p>
<p>BA.2.86 has spread globally and we don’t know how many people it has infected. If it has spread widely, it seems to have put only a handful of people in <a href="https://www.dailymail.co.uk/health/article-12420697/Real-deal-Covid-variant-Britain-Patient-hospitalised-London-heavily-mutated-BA-X-strain-experts-think-caught-UK.html">hospital</a>, indicating that immunity derived from vaccines and previous infections is still protecting us against serious, life-threatening COVID.</p><img src="https://counter.theconversation.com/content/211840/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Clarke has received funding from the British Heart Foundation and the Defence Science & Technology Laboratory.</span></em></p>Some experts are calling for a return to masking as new variants emerge.Simon Clarke, Associate Professor in Cellular Microbiology, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2097742023-07-19T15:02:22Z2023-07-19T15:02:22ZAsymptomatic COVID-19 is linked to a gene variant that boosts immune memory after exposure to prior seasonal cold viruses<figure><img src="https://images.theconversation.com/files/538083/original/file-20230718-33186-1uz5zq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2429%2C1220&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Genetics may play a role in COVID-19 disease severity.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/virus-wide-royalty-free-image/1312985523">BlackJack3D/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>A <a href="https://www.nature.com/articles/s41586-023-06331-x">common genetic variant</a> explains why some people are asymptomatic after being infected with the virus that causes COVID-19, according to our recently published study in the journal Nature.</p>
<p>Early in the pandemic, we were intrigued that many people did not develop COVID-19 symptoms while still testing positive for it. Because asymptomatic people are unlikely to seek medical help, we knew that collecting DNA samples to study the role of genetics in asymptomatic infections would be difficult. So instead, we took advantage of existing genetic data stored in the <a href="https://bethematch.org/about-us/how-we-help-patients/be-the-match-registry/">Be The Match</a> U.S. bone marrow donor registry. </p>
<p>We invited volunteers registered as donors to track their experience with COVID-19 via a smartphone app developed by the <a href="https://covid19.eurekaplatform.org">COVID-19 Citizen Science Study</a>. This allowed us to analyze the genetics of nearly 30,000 people without collecting biological samples and to identify COVID-19 positive individuals who never became sick.</p>
<p>We were particularly interested in analyzing the variation of <a href="https://www.uptodate.com/contents/human-leukocyte-antigens-hla-a-roadmap">human leukocyte antigen, or HLA, genes</a>. These key components of the immune system encode for proteins that display the viral particles that <a href="https://theconversation.com/coronavirus-b-cells-and-t-cells-explained-141888">T cells</a> – a group of immune system cells critical for fighting infections – recognize. Because HLA molecules are important in the immune response to pathogens and are highly variable among people, we thought they might play a role in COVID-19.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/538087/original/file-20230718-18870-crqach.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Computer illustration of HLA-B*1501." src="https://images.theconversation.com/files/538087/original/file-20230718-18870-crqach.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/538087/original/file-20230718-18870-crqach.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=815&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538087/original/file-20230718-18870-crqach.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=815&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538087/original/file-20230718-18870-crqach.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=815&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538087/original/file-20230718-18870-crqach.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1024&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538087/original/file-20230718-18870-crqach.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1024&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538087/original/file-20230718-18870-crqach.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1024&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This is a 3D model of the protein that the gene variant HLA-B*15:01 codes for.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:HLA_B%5E1501.png">Pdeitiker/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>We found that 1,428 unvaccinated individuals reported a positive COVID-19 test, of whom 136 reported no COVID-19 symptoms. Our analysis identified a common variant of an HLA gene <a href="https://www.nature.com/articles/s41586-023-06331-x">called <em>HLA-B*15:01</em></a> that is associated with asymptomatic infection. This variant is present in <a href="https://doi.org/10.1016/j.humimm.2013.06.025">about 10% of the population with European ancestry</a>. </p>
<p>We found that people carrying the variant were more than twice as likely to remain asymptomatic after being infected with COVID-19, and those carrying two copies of this variant were more than eight times more likely to not have any symptoms. </p>
<p>Next, we used cells from people with the HLA variant who donated blood several years before the pandemic to see whether they had preexisting immunity to the virus that causes COVID-19. We found that people who had never been exposed to COVID-19 had memory T cells that worked against a specific particle of the virus, enabling them to elicit a very effective immune response against COVID-19. We also found that, when bound to HLA, this viral particle looks very similar to fragments of seasonal coronaviruses recognized by T cells. </p>
<p>Our findings suggest that <a href="https://www.nature.com/articles/s41586-023-06331-x">preexposure to seasonal cold viruses</a> allowed people with <em>HLA-B*15:01</em> to develop a very effective immune memory that helped them to quickly kill the virus before they developed symptoms. </p>
<h2>Why it matters</h2>
<p>Identifying the genetic factors associated with how the disease progresses after infection provides the basis for understanding why people respond differently to the virus that causes COVID-19 as well as other viral illnesses. Focusing on asymptomatic infections also sheds light on the early stages of infection and how the immune system fights against COVID-19. </p>
<p>Most existing vaccines protect against severe COVID-19 symptoms. Therefore, identifying the viral fragments that mediate asymptomatic infection, such as the one we discovered, can help develop more specific vaccines or therapies for COVID-19.</p>
<h2>What still isn’t known</h2>
<p>Although the genetic association we identified is strong, the immune system is very complex. It remains unclear what other mechanisms regulate asymptomatic infections, or why not everyone carrying this specific variant remains without symptoms.</p>
<h2>What’s next</h2>
<p>We want to know if the genetic variant we identified is shared by individuals from different ancestries. This will help us understand which genetic variants are important among those in these groups with asymptomatic COVID-19. We also hope to learn what makes the cross-reactive T cells in people with <em>HLA-B*15:01</em> so remarkably effective at keeping the symptoms associated with this virus at bay.</p><img src="https://counter.theconversation.com/content/209774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jill Hollenbach receives funding from National Institutes of Health</span></em></p><p class="fine-print"><em><span>Danillo Augusto receives funding from the National Institutes of Health</span></em></p>Researchers found that people with a specific gene variant were two to eight times more likely to not have symptoms after infection.Jill Hollenbach, Professor of Neurology, University of California, San FranciscoDanillo Augusto, Assistant Professor of Biological Sciences, University of North Carolina – CharlotteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2074482023-06-15T12:33:36Z2023-06-15T12:33:36Z96.4% of Americans had COVID-19 antibodies in their blood by fall 2022<figure><img src="https://images.theconversation.com/files/532214/original/file-20230615-15-koig6o.jpg?ixlib=rb-1.1.0&rect=110%2C30%2C6530%2C4403&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Infection and vaccination both leave their mark in your blood.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/covid-19-positive-test-tubes-on-the-pink-background-royalty-free-image/1225071884">Yulia Reznikov/Moment via Getty Images</a></span></figcaption></figure><figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/532033/original/file-20230614-21-a1dd6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="graphic of text '96.4%: Share of Americans who had coronavirus antibodies in their blood by September 2022.'" src="https://images.theconversation.com/files/532033/original/file-20230614-21-a1dd6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532033/original/file-20230614-21-a1dd6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532033/original/file-20230614-21-a1dd6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532033/original/file-20230614-21-a1dd6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532033/original/file-20230614-21-a1dd6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532033/original/file-20230614-21-a1dd6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532033/original/file-20230614-21-a1dd6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Antibodies to SARS-CoV-2, the virus that causes COVID-19, were present in the blood of <a href="http://dx.doi.org/10.15585/mmwr.mm7222a3">96.4% of Americans over the age of 16</a> by September 2022. That’s according to <a href="https://theconversation.com/covid-19-official-counts-can-miss-mild-cases-heres-how-serosurveys-that-analyze-blood-for-signs-of-past-infection-can-help-182112">a serosurvey</a> – an analysis testing for the presence of these immune defense molecules – conducted on samples from blood donors.</p>
<p>A serosurvey like this one helps researchers estimate how many people have been exposed to any part of the coronavirus, whether via vaccination or infection. Both can trigger the generation of antibodies to SARS-CoV-2. And by identifying which kind of antibodies someone has in their blood, researchers can break down the 96.4% into different types of immunity: infection-derived, vaccine-derived and hybrid.</p>
<p><iframe id="XVVEY" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/XVVEY/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>COVID-19 vaccines used in the United States are <a href="https://theconversation.com/how-do-mrna-vaccines-work-and-why-do-you-need-a-second-dose-5-essential-reads-157198">based on only one part of the virus</a> – the spike, or S, protein. Researchers can tell that a person has been vaccinated and has not been infected if their blood has only anti-S antibodies that target that spike protein. If someone has anti-N antibodies, which target the virus’s nucleocapsid protein, it’s a sign that they’ve been infected by SARS-CoV-2. To reliably identify someone with hybrid immunity, a researcher would need to match someone who has anti-N antibodies to an official vaccination database.</p>
<h2>What about the 3.6% without antibodies?</h2>
<p>Immunologists know that <a href="https://theconversation.com/how-long-does-protective-immunity-against-covid-19-last-after-infection-or-vaccination-two-immunologists-explain-177309">antibody levels decrease in the months after</a> a COVID-19 infection or vaccination, and this is <a href="https://doi.org/10.1093/infdis/jiac039">true for many pathogens</a>. It’s possible some people did have antibodies at one point, but they’re no longer detectable. And not every infection leads to a detectable antibody response, particularly if the case was mild or asymptomatic.</p>
<p>Another factor is <a href="https://theconversation.com/coronavirus-tests-are-pretty-accurate-but-far-from-perfect-136671">the accuracy of the antibody test</a>. No test is perfect, so a small percentage of people who truly have antibodies might come up negative.</p>
<p>Together, these considerations mean that the 96.4% number is likely an underestimate. It seems reasonable to conclude that almost no one in this population has neither been infected by SARS-CoV-2 nor received a COVID-19 vaccine.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/fgmhm4IX-M8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s how antibodies help your body fight against an invader like the coronavirus.</span></figcaption>
</figure>
<h2>A clearer picture of a virus’s spread</h2>
<p>Serosurveys are useful for understanding how likely different types of people – of varying ages or races, for example – were to have been infected. For this purpose, a serosurvey can be much more reliable than using data on people who received a positive PCR test, or who report having had a positive rapid antigen test, because getting a positive test is heavily influenced by access to care, health care behavior and how severe your illness is. These are sources of what is called bias.</p>
<p>This bias has two effects: It leads to large underestimation of the proportion of the overall population infected, and it can lead to spurious differences between groups. For example, people with mild symptoms are less likely to get tested and are also likely to be younger. Researchers might draw the wrong conclusion that because they’re not getting tested these people aren’t actually catching the virus.</p>
<p>Looking at antibodies as a marker of infection is not biased by such behavioral factors. Many serosurveys, including ones that <a href="https://doi.org/10.1093/aje/kwad103">we worked on in Chennai, India</a>, and <a href="https://doi.org/10.1371/journal.pmed.1004093">Salvador, Brazil</a>, found similar or even higher seroprevalence in children compared with young adults, contradicting an early narrative that children were less susceptible to the virus. Instead, our results suggested that infections in children were less likely to be detected.</p>
<h2>What does this statistic mean for future waves?</h2>
<p>Antibodies are not just a marker of previous infection; part of their job is to help prevent future infection with the same pathogen. So, serosurveys can be used to understand levels of immunity in the population.</p>
<p>For some diseases, like measles, immunity is essentially lifelong, and having antibodies means you are protected. However, for SARS-CoV-2 this is not the case, because the virus has continually evolved new variants that are able to reinfect people despite their antibodies.</p>
<p>Nevertheless, <a href="https://doi.org/10.1016/S1473-3099(22)00140-2">many studies have shown</a> <a href="https://doi.org/10.1371/journal.pmed.1004136">that individuals with hybrid immunity</a> <a href="https://doi.org/10.1016/S1473-3099(22)00143-8">will be more protected</a> against future infection and variants than those with vaccine- or infection-derived immunity alone. It may be useful to know the proportion of the population with single-source immunity in order to target certain groups with vaccination campaigns.</p><img src="https://counter.theconversation.com/content/207448/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matt Hitchings receives funding from Merck, Sharp and Dohme, US-CDC, National Science Foundation, US National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Derek Cummings receives funding from US NIH, US CDC, US NSF, and Merck, Sharp and Dohme.</span></em></p>There’s pretty much no one left in the US who hasn’t been exposed to the coronavirus, whether by vaccination, infection or both.Matt Hitchings, Assistant Professor of Biostatistics, University of FloridaDerek Cummings, Professor of Biology, the Emerging Pathogens Institute, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2023382023-04-26T20:08:27Z2023-04-26T20:08:27ZWhat to eat when you have COVID – and why reaching for the chicken soup is not a bad idea<figure><img src="https://images.theconversation.com/files/519161/original/file-20230404-28-mn04y7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Got COVID? Again?</p>
<p>Deciding what to eat can be mentally taxing, especially when you are not feeling well. However, our diet plays a role in preventing and managing poor health, including COVID.</p>
<p>Having a healthy diet is associated with a <a href="https://gut.bmj.com/content/70/11/2096">reduced risk of COVID</a>. And, if you do have COVID, a healthy diet is associated with <a href="https://gut.bmj.com/content/70/11/2096">milder symptoms</a>. </p>
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<a href="https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Deciding what to eat can be mentally taxing when you’re sick.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What should I eat during COVID infection?</h2>
<p>When we are sick it can be challenging to even think about food. However, the best way to fight the infection is by providing your body with foods that best support you to <a href="https://www.emro.who.int/nutrition/covid-19/nutrition-advice-for-adults-during-the-covid-19-outbreak.html">heal</a>.</p>
<p>Fresh fruit, vegetables, whole grains and various forms of protein are broken down into substances by the body to support your immune system. </p>
<p><a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">The Australian Guide to Healthy Eating</a> suggests we eat a variety of fresh foods every day including:</p>
<ul>
<li><p>two serves of fruit and five serves of vegetables</p></li>
<li><p>whole grains, such as wholemeal pasta, brown rice or wholemeal bread</p></li>
<li><p>healthy fats, such as avocado or olive oil </p></li>
<li><p>meat and meat alternatives (such as lean beef, chicken, tofu or legumes) and dairy (such as cheese or milk). </p></li>
</ul>
<p>Eating these kinds of foods every day helps provide our body with the nutrients required to fight infections and remain healthy. </p>
<p><a href="https://doi.org/10.3390/nu10050587">Avoiding processed and ultra processed foods</a> is also encouraged due to the high levels of salt and sugar and lack of nutrition found in these types of foods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fresh fruit, vegetables, whole grains and proteins help feed your immune system.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What about chicken soup or similar?</h2>
<p>A great way to get all the nutrition your body requires when sick with COVID is through homemade chicken soup, chicken avgolemono, chicken congee or other similar dishes. </p>
<p>Why? Here are four good reasons:</p>
<p><strong>1. It’s easy and cheap to make</strong></p>
<p>The great thing about chicken soup is you can pop it in one pan (or into a slow cooker), throw all the ingredients in together and let it simmer away. </p>
<p>While the ingredients in chicken soup pack a powerful nutritional punch, they don’t cost the Earth.</p>
<p><strong>2. It’s easy to absorb</strong></p>
<p>The boiling process releases the <a href="https://doi.org/10.3390/foods10071456">nutritional elements</a> found in the ingredients and aids in digestion and absorption of these vital nutrients. </p>
<p><strong>3. It’s full of vitamins and minerals</strong></p>
<p><a href="https://scuj.journals.ekb.eg/article_119478.html">Essential vitamins and minerals</a> found in chicken soup include: iron, magnesium, sodium, potassium, calcium, chromium, copper, zinc, vitamin A, vitamin C, vitamin B6 and vitamin B12. </p>
<p><strong>4. It’s flavoursome and powerful</strong></p>
<p>The tasty flavour of chicken soup is enhanced by the <a href="https://doi.org/10.1080/10942912.2017.1291678">seventeen different amino acids</a> found in chicken soup. These amino acids also provide strength for your <a href="https://pubmed.ncbi.nlm.nih.gov/17403271/">immune system</a> </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The ingredients in chicken soup pack a powerful nutritional punch.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Nutrition can support immune health but it’s not the only answer</h2>
<p>The best way to treat and manage a COVID infection is to avoid it in the first place. So remember to practise good hygiene, like washing your hands regularly, and maintain your recommended <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/clinical-recommendations">vaccine schedule</a>. </p>
<p>Practising a healthy lifestyle will also reduce your risks of not only contracting COVID, but also developing chronic disease. This includes not smoking or vaping, maintaining healthy physical activity habits, getting enough sleep and reducing alcohol consumption. </p>
<p>The current <a href="https://www.health.gov.au/news/australian-alcohol-guidelines-revised#:%7E:text=To%20reduce%20the%20risk%20of,risk%20of%20harm%20from%20alcohol.">recommendation</a> for maximum alcohol intake is ten standard drinks in one week, and no more than four standard drinks in one day. </p>
<h2>Don’t forget to drink plenty of water</h2>
<p>Water is <a href="https://health-study.joinzoe.com/post/how-much-fluid-should-i-drink-if-i-have-covid-19">crucial</a> when you’re sick. </p>
<p>Being dehydrated can enhance symptoms of colds and infections, including COVID. It is also associated with a higher risk of developing <a href="https://ccforum.biomedcentral.com/articles/10.1186/s13054-022-04203-w">long COVID</a>. </p>
<p>Aim to drink at least two litres of water per day, even more if you have a high body weight or have been losing fluids through vomiting or sneezing/runny nose.</p>
<p>If you don’t feel like having plain water, there are many healthy alternatives such as tea, broth or soup. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-like-drinking-plain-water-10-healthy-ideas-for-staying-hydrated-this-summer-191859">Don’t like drinking plain water? 10 healthy ideas for staying hydrated this summer</a>
</strong>
</em>
</p>
<hr>
<h2>Let’s remember to eat healthy anyway</h2>
<p>Eating a healthy and balanced diet is an important part of maintain good health and vitality.</p>
<p>Getting caught up in fads or buying supplements can be expensive and there is <a href="https://theconversation.com/dont-listen-to-gwyneth-paltrow-ivs-are-not-a-shortcut-to-good-health-202621">controversy</a> around their effectiveness. </p>
<p>In the long run, eating healthy will make you feel better and save you money.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-taking-vitamins-and-supplements-help-you-recover-from-covid-182220">Can taking vitamins and supplements help you recover from COVID?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/202338/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Julie Marsh works in her own private dietetic practice as an Accredited Practising Dietitian. She is currently enrolled as a PhD Candidate with the School of Human Movement and Nutrition Sciences at The University of Queensland. Julie is based at the Centre for Community Health and Wellbeing at Springfield Qld. </span></em></p>Deciding what to eat can be mentally taxing, especially when you are not feeling well. But, our diet plays a role in preventing and managing poor health, including COVID.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandJulie Marsh, PhD Candidate, Accredited Practising Dietitian, BNutrDiet (Hons), The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2001372023-03-09T11:50:15Z2023-03-09T11:50:15ZCOVID poetry: how a new genre is helping readers to comprehend the pandemic<figure><img src="https://images.theconversation.com/files/511706/original/file-20230222-14-7qud13.jpg?ixlib=rb-1.1.0&rect=81%2C99%2C5957%2C3911&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research has shown that the UK read more during the pandemic.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sarajevo-bosnia-herzegovina-october-2021-book-2134626207">Ajdin Kamber/Shutterstock</a></span></figcaption></figure><p>Research has shown that in the early months of the COVID pandemic people in the UK both <a href="https://readingagency.org.uk/news/media/new-survey-says-reading-connects-a-nation-in-lockdown.html">reported reading more</a> and used reading <a href="https://theconversation.com/how-reading-habits-have-changed-during-the-covid-19-lockdown-146894">to cope with the anxieties</a> brought on by sudden changes to their lifestyle.</p>
<p>Since those early lockdown days, people have been writing about their experiences of the pandemic. And now, nearly three years since the lockdowns began, books are still being written and being published on COVID. Like other significant catastrophic events (think wars, 9/11, Brexit), this new genre of writing could continue for some time.</p>
<p>Poetry enjoyed <a href="https://www.penguin.co.uk/articles/2020/05/lockdown-poetry-phenomenon-pharmacy">a resurgence in public interest</a> during the pandemic. As a literary form, it is easy to share and can capture emotion in widely relatable and comprehensible ways.</p>
<p>During the lockdown months, reading and sharing of poetry increased. For example, King’s College London ran a “<a href="https://twitter.com/kings_college/status/1255866496435343362?lang=en">#poemsfromlockdown</a>” initiative that saw contributors record themselves reading a favourite poem and then share it via Twitter.</p>
<p>The website <a href="https://poetrygeneration.wordpress.com/">Poetry Generation</a> posted videos of poetry being read by elderly people who were feeling isolated. Many established poets published <a href="https://www.theguardian.com/books/2021/may/08/windows-on-the-world-pandemic-poems-by-simon-armitage-hollie-mcnish-kae-tempest-and-more">lockdown poems</a> offering their own perspective on the power of poetry to make sense of the catastrophe. Slowly but surely whole collections inspired by the pandemic began to appear.</p>
<p>Over the last year, I have been researching the language of what I have termed “COVID poetry” (collections of poetry written during or directly influenced by the pandemic) and the ways that readers respond to these poems.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/YcwhlmPXv8M?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An example of The Poetry Generation’s COVID project.</span></figcaption>
</figure>
<p>Although poets’ experiences of the pandemic and lockdowns vary, there are some shared characteristics. Often the collections will draw attention to the pandemic in immediate and explicit ways. For example, George Sandifer-Smith’s <a href="https://www.brokensleepbooks.com/product-page/george-sandifer-smith-empty-trains">Empty Trains</a> (2022) draws attention to reduced commuter travel and Kate Fox’s <a href="https://ninearchespress.com/publications/poetry-collections/the-oscillations.html">The Oscillations</a> (2021) has “After” and “Before” sections relating to life post- and pre-lockdown.</p>
<p>Many of the collections reflect public concerns about social distancing – isolation, fear and uncertainty about the future. But many other collections, and the poems within them, cover more personal concerns. Jamie Hale’s <a href="https://jamiehale.co.uk/shield/">Shield</a> (2021), for example, is a powerful set of 21 unpunctuated sonnets about living through the pandemic as an immunocompromised person.</p>
<h2>Reading COVID poetry</h2>
<p>The poet Claire Shaw <a href="https://ninearchespress.com/publications/poetry-collections/why-i-write-poetry">argues</a> that during the pandemic: </p>
<blockquote>
<p>We discovered we needed poetry more than ever before – its ability to console and connect, to express sorrow, to find beauty, to create meaning.</p>
</blockquote>
<p>Some critics have suggested that literature offered much needed ways to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00831-X/fulltext">reexamine the world around us</a> in light of the changes forced on us by the pandemic. Not everyone feels the same. <a href="https://www.tandfonline.com/doi/full/10.1080/08893675.2021.1899630">A study of public attitudes towards “corona poetry” in the Netherlands and Belgium</a>, for example, revealed more negative feelings towards the genre than positive ones.</p>
<p>Research has shown however, that not only does <a href="http://www.scielo.edu.uy/scielo.php?pid=S2301-13782021000200006&script=sci_arttext">reading have therapeutic value</a> but that it provides <a href="https://hbr.org/2020/03/the-case-for-reading-fiction">a space for empathy</a>. When we read, we build representations of the minds of others and can gain a better insight into their experiences.</p>
<p>As part of my own research, I have begun to look at how readers – a few years on from the onset of the pandemic – talk about COVID poetry to make sense of both their own pandemic experiences and those they read about.</p>
<figure class="align-center ">
<img alt="A young black man reclines on a sofa in a white t-shirt and jeans. He reads a red book." src="https://images.theconversation.com/files/511712/original/file-20230222-16-v4n4eb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511712/original/file-20230222-16-v4n4eb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511712/original/file-20230222-16-v4n4eb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511712/original/file-20230222-16-v4n4eb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511712/original/file-20230222-16-v4n4eb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511712/original/file-20230222-16-v4n4eb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511712/original/file-20230222-16-v4n4eb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Research participants often used COVID poems as a springboard for exploring their memories.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-smart-man-thoughtfully-reading-1659526393">GaudiLab/Shutterstock</a></span>
</figcaption>
</figure>
<p>In <a href="https://www.tandfonline.com/doi/full/10.1080/08893675.2022.2155078">a recent paper</a>, which reports on participants’ responses to The New Shape of Fear from poet Michele Witthaus’s collection <a href="http://www.wildpressedbooks.com/from-a-sheltered-place.html">From a Sheltered Place</a> (2020), I found that readers reported being drawn into the world of the poem and aligning its events and experiences with those of their own. </p>
<p>They often used the poem as a springboard for exploring their memories of similar events and aligned themselves with the viewpoint in the poem, showing empathy with the situation being described. </p>
<p>They were able to move away from the specifics of the poem to reflect on, for example, how people might feel about social distancing and mask wearing at the time of reading, even when it was no longer compulsory to do so.</p>
<p>So what might the future hold? It may be that there is a space for COVID poetry to play an important role in education in order to help people come to terms with their pandemic experiences and encourage empathy. </p>
<p>Poetry is capable of conveying the emotional experience of living through the pandemic in powerful ways that resonate with readers. It’s likely that we will continue to turn to poets to help us understand the strange events of the COVID pandemic for years to come.</p><img src="https://counter.theconversation.com/content/200137/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marcello Giovanelli does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many established poets published lockdown poems offering their perspective on the power of poetry to make sense of the pandemic.Marcello Giovanelli, Reader in Literary Linguistics, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1985632023-02-23T06:15:28Z2023-02-23T06:15:28ZRejecting science has a long history – the pandemic showed what happens when you ignore this<figure><img src="https://images.theconversation.com/files/510300/original/file-20230215-14-2g2twv.jpg?ixlib=rb-1.1.0&rect=0%2C38%2C5184%2C3406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-united-kingdom-august-29-2020-1805067544">I T S/Shutterstock</a></span></figcaption></figure><p>Fear engulfed everyone during the pandemic. Yet when a vaccine became available, it was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622531/">met with fierce resistance</a>. Anti-vaccination crowds formed, and some of these groups argued this vaccine was against their religious beliefs. </p>
<p>Many didn’t trust the scientists and their explanation for how they said the disease spread. A lot of people didn’t believe the <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-19-vaccines-myth-versus-fact">vaccine worked as well as governments claimed</a>, or they felt mandatory vaccinations violated their personal freedom. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123944/">Misinformation</a> also proliferated, sowing doubt about the safety of vaccines and accusing governments and <a href="https://babel.hathitrust.org/cgi/pt?id=aeu.ark:/13960/t7wm29713&view=1up&seq=5">scientists of sinister motives</a>.</p>
<p>You may think I am referring to the COVID-19 pandemic. However, I am not. This eerily familiar scenario played out <a href="https://historyofvaccines.org/vaccines-101/misconceptions-about-vaccines/history-anti-vaccination-movements#">in the 19th century</a> when smallpox was still raging across Europe.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508096/original/file-20230203-7520-rcs7sf.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/508096/original/file-20230203-7520-rcs7sf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508096/original/file-20230203-7520-rcs7sf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508096/original/file-20230203-7520-rcs7sf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508096/original/file-20230203-7520-rcs7sf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508096/original/file-20230203-7520-rcs7sf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508096/original/file-20230203-7520-rcs7sf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508096/original/file-20230203-7520-rcs7sf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Excerpt of an 1885 Canadian pamphlet published by a leading anti-vaccinationist, Dr. Alexander M. Ross.</span>
<span class="attribution"><a class="source" href="https://babel.hathitrust.org/cgi/pt?id=aeu.ark:/13960/t7wm29713&view=1up&seq=5">University of Alberta</a></span>
</figcaption>
</figure>
<p>Anti-vaccination groups, as well as other anti-science movements, are not new phenomena, nor are the nature of their objections. Unfortunately, because history is usually <a href="https://link.springer.com/article/10.1007/s10739-009-9208-x">ignored</a> when dealing with current scientific issues, people fail to acknowledge that most anti-science arguments have been <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/9780470719848.ch3?saml_referrer">around for centuries</a>. </p>
<p>The fact that we live in a <a href="https://estsjournal.org/index.php/ests/article/view/268">misinformation era</a> shows these anti-science movements are also quite <a href="https://www.pnas.org/doi/10.1073/pnas.2120755119">effective</a>. And they have had a deadly impact on our society. For example, researchers found that between January 2021 and April 2022, vaccinations could have prevented at least <a href="https://globalepidemics.org/2022/05/13/new-analysis-shows-vaccines-could-have-prevented-318000-deaths/">318,000 COVID-19 deaths in the US</a>. </p>
<h2>Questioning the experts</h2>
<p>A good example of how <a href="https://link.springer.com/article/10.1007/s10739-009-9208-x">history is being overlooked</a> is the notion that <a href="https://journals.sagepub.com/doi/pdf/10.1177/1050651920958503">people’s rejection of expertise</a> is a new phenomenon. Yet, in 1925, a Tennessee high school teacher, John Scopes, went <a href="http://moses.law.umn.edu/darrow2/trialsid=7.html">on trial</a> for teaching the theory of evolution to his students, which (due to the recent <a href="https://www.britannica.com/topic/Butler-Act">Butler Act</a>) was considered illegal.</p>
<p>What became known as <a href="https://www.history.com/topics/roaring-twenties/scopes-trial">the Scopes monkey trial</a> started as a publicity stunt by the American Civil Liberties Union, which was itching to challenge the Tennessee state’s Butler Act. But it quickly turned into a face-off between an anti-evolutionist prosecutor and a defence team eager to debunk fundamentalist Christianity. </p>
<p>The trial ended with <a href="https://archive.nytimes.com/www.nytimes.com/learning/general/onthisday/big/0721.html">Scopes pleading guilty</a> and handed a small fine. He is, however, still seen by many as <a href="https://www.pbs.org/wgbh/americanexperience/features/monkeytrial-john-scopes/">a defender of science</a>, likely because of the <a href="https://www.imdb.com/title/tt0053946/">1960 movie based on Scopes’ story</a>. </p>
<p>The trial is important to science communication because of the <a href="https://famous-trials.com/scopesmonkey/2327-a-defense-expert-s-impressions-of-the-scopes-trial">rejection of expert witnesses</a>. Seven out of eight experts were blocked from speaking (their <a href="http://moses.law.umn.edu/darrow2/trialsid=7.html">testimonies were deemed irrelevant</a>).</p>
<figure class="align-center ">
<img alt="Close up of Donald Trump speaking into a microphone and pointing" src="https://images.theconversation.com/files/510352/original/file-20230215-18-gsshk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510352/original/file-20230215-18-gsshk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510352/original/file-20230215-18-gsshk3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510352/original/file-20230215-18-gsshk3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510352/original/file-20230215-18-gsshk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510352/original/file-20230215-18-gsshk3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510352/original/file-20230215-18-gsshk3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Donald Trump told his supporters to ignore expert advice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/october-15-2016-edison-nj-donald-636139745">Joseph Sohm/Shutterstock</a></span>
</figcaption>
</figure>
<p>We saw a repeat of such rejection of expertise nearly a century later with COVID-19. Dr Anthony Fauci, the most prominent US government public health spokesperson during the pandemic, was often <a href="https://journals.sagepub.com/doi/full/10.1177/2378023120947337">met with distrust</a> by many members of the public, and was <a href="https://edition.cnn.com/2020/05/14/politics/donald-trump-anthony-fauci-science-coronavirus/index.html">criticised by</a> <a href="https://edition.cnn.com/2020/10/19/politics/donald-trump-anthony-fauci-coronavirus/index.html">Donald Trump</a> when he was president. Trump had paved the way for this by pronouncing that <a href="https://www.cbsnews.com/news/trump-the-experts-are-terrible/">“experts are terrible”</a> during his 2016 presidential campaign.)</p>
<p>Fauci was even falsely accused of funding research to <a href="https://www.politifact.com/factchecks/2021/feb/08/worldnetdaily/no-dr-anthony-fauci-did-not-fund-research-tied-cov/">develop the virus</a> and of <a href="https://www.nytimes.com/2022/02/26/us/robert-kennedy-covid-vaccine.html">conspiring with Microsoft co-founder Bill Gates and the pharmaceutical industry</a> to become rich from COVID vaccines. All this is likely to have <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192025">affected how some people</a> responded to Fauci’s crucial information during the pandemic.</p>
<p>Expertise, trustworthiness, and objectivity are the components that <a href="https://www.researchgate.net/publication/361959019_Why_are_people_antiscience_and_what_can_we_do_about_it">make up someone’s credibility</a>. So when scientists are portrayed as biased, the effectiveness of their communication <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323766/">plummets</a>. </p>
<h2>Treating sceptics with disrespect achieves nothing</h2>
<p>Most scientists <a href="https://online.ucpress.edu/abt/article-abstract/84/7/390/192186/Combatting-Misinformation-through-Science">get little (if any) communication training</a>, which can leave them unprepared for online showdowns over contested science. Take the immunologist Roberto Burioni as an example. In 2016, he caused a row when he deleted all comments relating to a Facebook discussion about vaccination. Burioni added a <a href="https://it-it.facebook.com/robertoburioniMD/photos/una-delle-bugie-che-pi%C3%B9-mi-infastidiscono-%C3%A8-quella-secondo-la-quale-gli-attuali-/2205456229679548/">highly insensitive post</a> that read:</p>
<blockquote>
<p>“Here only those who have studied can comment, not the common citizen. Science is not democratic.”</p>
</blockquote>
<p>This post did attract some <a href="https://www.linkiesta.it/blog/2017/01/la-scienza-non-e-democratica-bravissimo-il-prof-burioni-che-su-faceboo/">likes</a> but also <a href="https://www.science.org/content/article/italian-scientist-has-become-celebrity-fighting-vaccine-skeptics">many death threats</a> and alienated countless people. </p>
<p>Of course, <a href="https://reutersinstitute.politics.ox.ac.uk/news/misinformation-evidence-its-scope-how-we-encounter-it-and-our-perceptions-it">the scale of the misinformation</a> problem can feel overwhelming. And partly since some research suggests countering falsehoods <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462781/#:%7E:text=A%20backfire%20effect%20occurs%20when,%2C%20%26%20Cook%2C%202012">can end up reinforcing them</a>), experts often avoid these <a href="https://www.nytimes.com/2022/12/10/opinion/anthony-fauci-retirement.html">types of debates</a>. </p>
<p>However, a growing body of work suggests correcting misinformation <a href="https://www.ualberta.ca/law/media-library/faculty-research/hli/media/images/caulfield-debunking-works-vulnerable-caulfield.pdf">can be worthwhile and effective</a>. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566313/">information needs to be tailored to the audience, though,</a> because a standard explanation may not fit everyone.</p>
<h2>A fork in the road</h2>
<p>Many scientists have an aptitude for engaging the public. <a href="https://www.thespacegal.com/">MIT-engineer and Emmy-nominated</a> science TV host Emily Calandrelli and<a href="https://www.amazon.com/Primates-Memoir-Neuroscientists-Unconventional-Baboons/dp/0743202414"> blow-gun-wielding neurobiologist</a> Robert Sapolsky have captured the imaginations of millions of people with no background in science. </p>
<p>The <a href="https://www.oliversacks.com/oliver-sacks-books/on-the-move/">late neurologist</a> Oliver Sacks was known as the “poet laureate of medicine” for his work writing about poorly understood conditions such as Tourette’s syndrome and autism. There are science YouTube channels with <a href="https://www.youtube.com/@veritasium">tens of millions</a> of subscribers and <a href="https://www.southernfriedscience.com/support-southern-fried-science/">blogs that attract millions of views</a>. </p>
<p>But the smallpox protests and the Scopes trial are <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/9780470719848.ch3?saml_referrer">not isolated historical events</a>. History can help scientists reevaluate how they communicate, stop repeating mistakes, and form better relationships with the public.</p><img src="https://counter.theconversation.com/content/198563/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katrine K. Donois does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You’d be surprised how far back the roots of anti-vaccine arguments stretch.Katrine K. Donois, PhD Candidate in Science Communication, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1978782023-01-25T13:25:09Z2023-01-25T13:25:09ZEven bivalent updated COVID-19 boosters struggle to prevent omicron subvariant transmission – an immunologist discusses why new approaches are necessary<figure><img src="https://images.theconversation.com/files/506017/original/file-20230124-17-uye0hb.jpg?ixlib=rb-1.1.0&rect=61%2C51%2C6816%2C3434&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The FDA is proposing an annual shot against COVID-19, signaling that a new approach is needed.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/antibodies-background-royalty-free-image/1358868801?phrase=antibodies&adppopup=true">wildpixel/iStock via Getty Images Plus</a></span></figcaption></figure><p>By almost any measure, the vaccination campaign against SARS-CoV-2, the virus that causes COVID-19, has been <a href="https://www.unicef.org/coronavirus/the-covid-19-vaccine-success-stories">a global success</a>. </p>
<p>As of January 2023, more than <a href="https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/">12 billion</a> vaccines against SARS-CoV-2 have been administered in an effort that has saved countless lives – more than <a href="https://doi.org/10.1016/S1473-3099(22)00320-6">14 million</a> in the first year of vaccine availability alone. With a <a href="https://doi.org/10.1056/NEJMoa2034577">95% efficacy</a> in the prevention of severe infection and death, and better safety profiles than similar <a href="https://doi.org/10.1001/jama.294.21.2734">historically effective vaccines</a>, the biomedical community hoped that a combination of vaccination and natural immunity might bring the pandemic to a relatively quick end.</p>
<p>But the emergence of new viral variants, <a href="https://theconversation.com/will-omicron-the-new-coronavirus-variant-of-concern-be-more-contagious-than-delta-a-virus-evolution-expert-explains-what-researchers-know-and-what-they-dont-169020">particularly omicron</a> and its <a href="https://theconversation.com/how-the-omicron-subvariant-ba-5-became-a-master-of-disguise-and-what-it-means-for-the-current-covid-19-surge-187132">array of subvariants</a>, upended those expectations. The latest omicron strain, XBB.1.5. – dubbed “Kraken”, after a mythical sea creature – has rapidly become the dominant subvariant in the U.S. The World Health Organization is calling it <a href="https://www.washingtonpost.com/health/2023/01/05/new-omicron-variant-xbb15-covid-who/">the most contagious strain so far</a>, with its success almost certainly attributable to an ability to dodge immunity from previous vaccines or infections.</p>
<p>The effort to get ahead of these ever-changing variants is also in part what has led the Food and Drug Administration to <a href="https://www.statnews.com/2023/01/23/fda-scientists-propose-an-annual-covid-shot-matched-to-current-strains/?utm_campaign=daily">reconsider its approach</a> to COVID-19 vaccination. On Jan. 23, 2023, the agency proposed that current guidelines for a series of shots followed by a booster be replaced by an annual COVID-19 vaccine that is updated each year to combat current strains. The proposal is set to be reviewed by the FDA’s science advisory committee on Jan. 26.</p>
<h2>Limitations of current mRNA vaccination strategies</h2>
<p>Unfortunately, the new bivalent shots, which include components from both the original SARS-CoV-2 strain as well as a recent omicron variant, have <a href="https://doi.org/10.1056/NEJMp2215780">not performed as well</a> as some scientists had hoped. Although there is no question that the updated jabs are capable of <a href="https://doi.org/10.1056/NEJMc2214293">boosting antibody levels</a> against SARS-CoV-2 and <a href="http://dx.doi.org/10.2139/ssrn.4314067">helping to prevent severe illness and hospitalization</a>, <a href="https://doi.org/10.1101/2022.10.22.513349">several</a> <a href="https://doi.org/10.1101/2022.10.24.513619">studies</a> have suggested that they are not necessarily more capable of preventing omicron infections than their predecessors.</p>
<p>As <a href="https://scholar.google.com/citations?user=-oDHlFYAAAAJ&hl=en">an immunologist</a> who studies how the immune system <a href="https://doi.org/10.1016/j.celrep.2018.09.029">selects which antibodies to produce</a> and <a href="https://doi.org/10.1038/s41586-022-05273-0">immune responses to COVID-19</a>, these new results are disappointing. But they are not entirely unexpected. </p>
<p>When COVID-19 vaccines were being rolled out in early 2021, immunologists began having <a href="https://theconversation.com/immune-interference-why-even-updated-vaccines-could-struggle-to-keep-up-with-emerging-coronavirus-strains-156465">public discussions</a> about the potential obstacles to rapidly generating updated vaccines to emerging viral strains. At the time, there was no hard data. But researchers have known for a <a href="https://www.jstor.org/stable/985534">very long time</a> that immunological memory, the very thing that offers continued protection against a virus long after vaccination, can sometimes negatively interfere with the development of slightly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2138235/pdf/331.pdf">updated immune responses</a>. </p>
<p>The failure of these new bivalent vaccines in widely preventing omicron infections suggests that our current approach is simply not sufficient to interrupt the viral transmission cycle driving the COVID-19 pandemic. In my view, it’s clear that innovative vaccine designs capable of producing a broader immunity are badly needed. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/mlQ-B3UMBrY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The latest COVID-19 subvariant, XBB.1.5, accounts for a large portion of new cases.</span></figcaption>
</figure>
<h2>Vaccines are designed to generate immune memory</h2>
<p>In simplest terms, vaccines are a way to give your immune system a sneak peek at a pathogen. <a href="https://www.vaccines.gov/basics/types">There are several different ways to do this</a>. One way is to inject inactivated versions of a virus, as has been <a href="https://www.vaccines.gov/diseases/polio">done with polio</a>. Another is to use noninfectious viral components, such as the proteins used for <a href="https://www.cdc.gov/flu/prevent/different-flu-vaccines.htm">flu vaccines</a>. </p>
<p>And most recently, scientists have found ways to deliver mRNA <a href="https://theconversation.com/what-happens-when-the-covid-19-vaccines-enter-the-body-a-road-map-for-kids-and-grown-ups-164624">“instructions” that tell your body</a> how to make those noninfectious viral components. This is the approach used with the <a href="https://www.nytimes.com/interactive/2020/health/moderna-covid-19-vaccine.html">Moderna and Pfizer vaccines</a> targeted against COVID-19.</p>
<p>The mRNA-based vaccines all train your immune system to identify and respond against critical components of a potential invader. An important part of that response is to get your body to produce antibodies that will hopefully prevent future infections, helping to break the cycle of person-to-person transmission. </p>
<p>In a successful response, the immune system will not only produce antibodies that are specific to the pathogen, but will also remember how to make them in case you encounter that same pathogen again in the future.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/506020/original/file-20230124-11-xb1ovk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Vials and syringes containing COVID-19 vaccine are displayed on a tray." src="https://images.theconversation.com/files/506020/original/file-20230124-11-xb1ovk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506020/original/file-20230124-11-xb1ovk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506020/original/file-20230124-11-xb1ovk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506020/original/file-20230124-11-xb1ovk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506020/original/file-20230124-11-xb1ovk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506020/original/file-20230124-11-xb1ovk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506020/original/file-20230124-11-xb1ovk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The existing approach to COVID-19 vaccines has proved effective at preventing serious illness and death, but it has not prevented infections as well as scientists had hoped.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/vials-with-the-covid-19-vaccine-and-syringes-are-royalty-free-image/1303457369?phrase=immune%20system%20concept&adppopup=true">Morsa Images/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<h2>The specter of ‘original antigenic sin’</h2>
<p>But what happens when the virus evolves and that memory becomes obsolete?</p>
<p>Immunologists have wondered this <a href="https://theconversation.com/immune-interference-why-even-updated-vaccines-could-struggle-to-keep-up-with-emerging-coronavirus-strains-156465">since the initial COVID-19 vaccine rollout</a>. Recently, it has found new relevance in light of the <a href="https://www.statnews.com/2023/01/23/fda-scientists-propose-an-annual-covid-shot-matched-to-current-strains/?utm_campaign=daily">FDA’s proposal</a> for an updated annual COVID-19 shot. </p>
<p>While it is possible that immune responses to updated vaccines will <a href="https://doi.org/10.1016/j.it.2022.02.009">simply replace the old ones</a>, that has not been true for influenza. With flu, researchers have learned that preexisting immunity to one strain <a href="https://doi.org/10.4049/jimmunol.0900398">can actively inhibit</a> the ability to respond well against another.</p>
<p>Put in everyday language, think of a virus as a car trying to run you over. You might produce one kind of antibody against the hood, one against the bumper and one against the hubcaps that prevents the wheels from turning. You have produced three kinds of antibodies specific to the car, but it turns out that only the hubcap antibodies effectively slow it down.</p>
<p>Now the car mutates, like SARS-CoV-2 has. It changes the shape of the hubcaps or it removes them altogether. Your immune system still recognizes the car, but not the hubcaps. The system doesn’t know that the hubcap was the only effective target, so it ignores the hubcaps and ramps up its attack on the hood and bumper. </p>
<p>In ignoring the new hubcap response, the immune system’s memory of the original car is not only obsolete, but it is also actively interfering with the response necessary to target the new car’s wheels. This is what immunologists call “<a href="https://doi.org/10.4049/jimmunol.1801149">original antigenic sin</a>” – ineffective immune memory that hampers desired responses to new pathogen strains.</p>
<p>This sort of interference has been extremely difficult to quantify and study in humans, although it may become easier with the <a href="https://www.washingtonpost.com/health/2023/01/23/covid-vaccine-once-a-year/">FDA’s proposal</a>. A once-yearly approach to COVID-19 vaccination opens the door for more straightforward studies on how memory to each vaccine influences the next.</p>
<h2>Multi-strain vaccinations offer hope</h2>
<p>Simultaneously, <a href="https://www.niaidcivics.org/">significant efforts</a> are being made to prioritize the pursuit of a single-shot or “universal” vaccine. One approach has been to take advantage of emerging research showing that if your immune system is presented with multiple versions of the same pathogen, it will tend to <a href="https://doi.org/10.1016/j.celrep.2018.09.029">choose targets that are shared between them</a>. </p>
<p>Presented with a Model T, Ford F-150 and electric Mustang all at once, your immune system will often choose to ignore differences like the hubcaps in favor of similarities like the shape and rubber on the tires. Not only would this interfere with the function of all three vehicles, but it could theoretically interfere with most road-based vehicles – or viral threats such as variants.</p>
<p>Researchers have begun making rapid headway using this approach with the development of <a href="https://doi.org/10.1038/s41591-020-1118-7">complex multi-strain flu vaccines</a> that are performing well in early clinical trials. New studies focused on SARS-CoV-2 <a href="https://doi.org/10.1016/j.ebiom.2022.104341">hope to do the same</a>. Persistent pathogens including <a href="https://doi.org/10.1186/s12985-017-0918-y">influenza</a> and <a href="https://doi.org/10.1038/ni.3158">HIV</a> all suffer from versions of the same antibody-targeting issues. It is possible that this pandemic may serve as a crucible of innovation that leads to the next generation of infectious disease prevention.</p>
<p><em>This is an updated version of an article <a href="https://theconversation.com/immune-interference-why-even-updated-vaccines-could-struggle-to-keep-up-with-emerging-coronavirus-strains-156465">originally published on March 8, 2021</a>.</em></p><img src="https://counter.theconversation.com/content/197878/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Woodruff does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new bivalent boosters against COVID-19 have failed to halt omicron infections. However, new technologies are being developed that pave a way forward.Matthew Woodruff, Instructor of Human Immunology, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1976022023-01-16T23:55:32Z2023-01-16T23:55:32ZFAQ on COVID-19 subvariant XBB.1.5: What is it? Where is it prevalent? How does it differ from Omicron? Does it cause serious illness? How can I protect myself? Why is it nicknamed ‘Kraken’?<figure><img src="https://images.theconversation.com/files/504746/original/file-20230116-14-fkca7k.jpg?ixlib=rb-1.1.0&rect=281%2C32%2C6216%2C3757&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">XBB.1.5 is rapidly spreading across the globe and will likely become the next dominant COVID-19 subvariant.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/faq-on-covid-19-subvariant-xbb-1-5--what-is-it-where-is-it-prevalent-how-does-it-differ-from-omicron-does-it-cause-serious-illness-how-can-i-protect-myself-why-is-it-nicknamed--kraken-" width="100%" height="400"></iframe>
<p>Despite intensive public health efforts to grind the COVID-19 pandemic to a halt, the recent emergence of the highly transmissible, extensively drug-resistant and profoundly immune system-evading XBB.1.5 SARS-CoV-2 subvariant is putting the global community on edge.</p>
<h2>What is XBB.1.5?</h2>
<p>In the naming convention for SARS-CoV-2 lineages, the <a href="https://virological.org/t/pango-lineage-nomenclature-provisional-rules-for-naming-recombinant-lineages/657">prefix “X” denotes a pedigree that arose through genetic recombination</a> between two or more subvariants. </p>
<p>The XBB lineage emerged following natural <a href="https://www.who.int/news/item/27-10-2022-tag-ve-statement-on-omicron-sublineages-bq.1-and-xbb">co-infection of a human host with two Omicron subvariants, namely BA.2.10.1 and BA.2.75</a>. It was <a href="https://doi.org/10.1007/s12291-022-01109-w">first identified by public health authorities in India during summer 2022</a>. XBB.1.5 is a direct descendent, or more accurately, the “fifth grandchild” of the original XBB subvariant.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/504369/original/file-20230113-24-li24wl.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of the genetic lineage of a COVID-19 subvariant" src="https://images.theconversation.com/files/504369/original/file-20230113-24-li24wl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504369/original/file-20230113-24-li24wl.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=355&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504369/original/file-20230113-24-li24wl.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=355&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504369/original/file-20230113-24-li24wl.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=355&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504369/original/file-20230113-24-li24wl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=446&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504369/original/file-20230113-24-li24wl.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=446&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504369/original/file-20230113-24-li24wl.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=446&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Genetic lineage of COVID-19 subvariant XBB.1.5.</span>
<span class="attribution"><span class="source">(Sameer Elsayed)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>How does XBB.1.5 differ from Omicron?</h2>
<p>XBB.1.5 is one of many Omicron subvariants of concern that have appeared on the global pandemic scene since the onset of the <a href="https://www.who.int/news-room/feature-stories/detail/one-year-since-the-emergence-of-omicron">first Omicron wave in November 2021</a>. In contrast to other descendants of the original Omicron variant (known as B.1.1.529), XBB.1.5 is a mosaic subvariant that <a href="https://doi.org/10.1007/s12291-022-01109-w">traces its roots to two Omicron subvariant lineages</a>. </p>
<p>XBB.1.5 is arguably the most genetically rich and <a href="https://www.scientificamerican.com/article/why-covids-xbb-1-5-kraken-variant-is-so-contagious/">most transmissible</a> SARS-CoV-2 Omicron subvariant yet. </p>
<h2>Where is XBB.1.5 prevalent?</h2>
<p><a href="https://www.who.int/docs/default-source/coronaviruse/11jan2023_xbb15_rapid_risk_assessment.pdf">According to the World Health Organization</a>, XBB.1.5 is circulating in at least 38 countries, with the highest prevalence in the United States, where it <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">accounts for approximately 43 per cent of COVID-19 cases nationwide</a>. Within the U.S., there is wide geographic variation in the proportion of cases caused by XBB.1.5, ranging from <a href="https://www.beckershospitalreview.com/public-health/xbb-1-5-prevalence-by-region.html">seven per cent in the Midwest to over 70 per cent in New England</a>. </p>
<p>XBB.1.5 has also been officially reported by governmental agencies in <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/weekly-covid-overview-20230107.pdf">Australia</a>, <a href="https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-sars-cov2-whole-genome-sequencing-epi-summary.pdf">Canada</a>, the <a href="https://www.ecdc.europa.eu/en/news-events/update-sars-cov-2-variants-ecdc-assessment-xbb15-sub-lineage">European Union</a>, <a href="https://www3.nhk.or.jp/nhkworld/en/news/20230112_36/">Japan</a>, <a href="https://www.kuna.net.kw/ArticleDetails.aspx?id=3077268&Language=en">Kuwait</a>, <a href="https://tass.com/world/1561313">Russia</a>, <a href="https://cov-spectrum.org/explore/Singapore/AllSamples/Past6M/variants?nextcladePangoLineage=xbb.1.5*&">Singapore</a>, <a href="https://www.nicd.ac.za/covid-19-update-xbb-1-5-variant/">South Africa</a> and the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1128554/variant-technical-briefing-49-11-january-2023.pdf">United Kingdom</a>. <a href="https://outbreak.info/situation-reports?xmin=2022-07-13&xmax=2023-01-13&loc&pango=XBB.1&selected">Real-time surveillance data</a> reveals that XBB.1.5 is rapidly spreading across the globe and will likely become the next dominant subvariant.</p>
<p>XBB.1.5 has also been detected in municipal wastewater systems in the <a href="https://health.hawaii.gov/coronavirusdisease2019/files/2023/01/Wastewater-Report-01-03-23.pdf">United States</a>, <a href="https://thl.fi/en/web/thlfi-en/-/monitoring-wastewater-for-coronavirus-xbb-sublineage-of-omicron-variant-found-in-wastewater-follow-up-results-coming-in-january?redirect=%2Ffi%2Fajankohtaista%2Ftiedotteet-ja-uutiset%2Fkaikki-uutiset">Europe</a> and other places.</p>
<h2>How likely is XBB.1.5 to cause serious illness?</h2>
<figure class="align-center ">
<img alt="Illustration of five coronaviruses of different colours in a line" src="https://images.theconversation.com/files/504766/original/file-20230116-12-o1ah4n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504766/original/file-20230116-12-o1ah4n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=217&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504766/original/file-20230116-12-o1ah4n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=217&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504766/original/file-20230116-12-o1ah4n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=217&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504766/original/file-20230116-12-o1ah4n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=272&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504766/original/file-20230116-12-o1ah4n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=272&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504766/original/file-20230116-12-o1ah4n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=272&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The XBB lineage emerged following natural co-infection of a human host with two Omicron subvariants, namely BA.2.10.1 and BA.2.75.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>There is limited data about the ability of XBB.1.5 to cause serious illness. According to the <a href="https://www.who.int/docs/default-source/coronaviruse/11jan2023_xbb15_rapid_risk_assessment.pdf">World Health Organization</a>, XBB.1.5 does not have any specific mutations that make it any more dangerous than its ancestral subvariants. </p>
<p>Nonetheless, XBB.1.5 is perceived as being equally capable of causing serious illness in elderly and immunocompromised persons compared to previous Omicron subvariants of concern.</p>
<h2>Are current mRNA vaccines effective against XBB.1.5?</h2>
<p>XBB.1.5 and XBB.1 are the Omicron subvariants with the <a href="https://www.who.int/docs/default-source/coronaviruse/11jan2023_xbb15_rapid_risk_assessment.pdf">greatest immune-evasive properties</a>. Therefore, one of the most contentious issues surrounding XBB.1.5 relates to the degree of protection afforded by currently available mRNA vaccines, including the latest bivalent booster formulations. </p>
<p><a href="https://doi.org/10.1038/s41591-022-02162-x">Researchers from the University of Texas</a> determined that first-generation and bivalent mRNA booster vaccines containing BA.5 result in lacklustre neutralizing antibody responses against XBB.1.5. A report (yet to be peer reviewed) from investigators at the <a href="https://doi.org/10.1101/2022.12.17.22283625">Cleveland Clinic</a> found that bivalent vaccines demonstrate only modest (30 per cent) effectiveness in otherwise healthy non-elderly people when the variants in the vaccine match those circulating in the community. </p>
<p>Furthermore, some experts believe the administration of bivalent boosters for the prevention of COVID-19 illness in otherwise healthy young individuals is <a href="http://doi.org/10.1056/NEJMp2215780">not medically justified</a> nor <a href="https://doi.org/10.1136/jme-2022-108449">cost-effective</a>. </p>
<p>In contrast, <a href="http://doi.org/10.1056/NEJMc2214293">public health experts from Atlanta, Ga. and Stanford, Calif.</a> reported that although the neutralizing antibody activity of bivalent booster vaccines against XBB.1.5 is 12 to 26 times less than antibody activity against the wild-type (original) SARS-CoV-2 virus, bivalent vaccines still perform better than monovalent vaccines against XBB.1.5. </p>
<p>However, <a href="https://doi.org/10.1016/j.cell.2022.12.018">investigators from Columbia University</a> in New York found that neutralizing antibody levels following bivalent boosting were up to 155–fold lower against XBB.1.5 compared to levels against the wild-type virus following monovalent boosting. </p>
<p>This suggests that neither monovalent nor bivalent booster vaccines can be relied upon to provide adequate protection against XBB.1.5.</p>
<h2>How can you protect yourself against XBB.1.5?</h2>
<figure class="align-center ">
<img alt="A blue sign reading 'wearing a mask is recommended,' in French and English" src="https://images.theconversation.com/files/504744/original/file-20230116-18-xo2zgu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504744/original/file-20230116-18-xo2zgu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504744/original/file-20230116-18-xo2zgu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504744/original/file-20230116-18-xo2zgu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504744/original/file-20230116-18-xo2zgu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504744/original/file-20230116-18-xo2zgu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504744/original/file-20230116-18-xo2zgu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Standard infection control precautions including indoor masking, social distancing and frequent handwashing are effective measures against XBB.1.5 and other subvariants of concern.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>The rapid evolution of SARS-CoV-2 continues to pose a challenge for the management of COVID-19 illness using available preventive and therapeutic agents. Of note, all currently available monoclonal antibodies targeting the spike protein of SARS-CoV-2 are <a href="https://doi.org/10.1016/j.cell.2022.12.018">deemed to be ineffective against XBB.1.5</a>. </p>
<p>Antiviral medicines such as remdesivir and Paxlovid may be considered for the treatment of eligible infected patients at high risk of progressing to severe disease.</p>
<p>Standard infection control precautions including indoor masking, social distancing and frequent handwashing are effective measures that can be employed for personal and population protection against XBB.1.5 and other subvariants of concern.</p>
<p>Although bivalent boosters may be considered for elderly, immunocompromised and other risk-averse individuals, their effectiveness in preventing COVID-19 illness due to XBB.1.5 remains uncertain. </p>
<h2>Why is XBB.1.5 nicknamed ‘Kraken’?</h2>
<p><a href="https://www.mountainviewtoday.ca/amp/lifestyle-news/kraken-subvariant-name-beats-alphabet-soup-moniker-for-xbb15-biologist-6351664">Some scientists have coined unofficially-recognized nicknames for XBB.1.5</a> and other SARS-CoV-2 subvariants of concern, arguing that they are easier to remember than generic alphanumeric designations. </p>
<p><a href="https://news.uoguelph.ca/2023/01/biologist-makes-headlines-on-new-covid-subvariant/">The ‘Kraken’ label for XBB.1.5 is currently in vogue</a> on social media sites and news outlets, and the nicknames ‘Gryphon’ and ‘Hippogryph’ have been used to denote the ancestral subvariants XBB and XBB.1, respectively. <a href="https://www.merriam-webster.com/dictionary/kraken">Kraken</a> refers to a mythological Scandinavian sea monster or giant squid, Gryphon (or <a href="https://www.merriam-webster.com/dictionary/griffin">Griffin</a>) refers to a legendary creature that is a hybrid of an eagle and a lion, while Hippogryph (or <a href="https://www.merriam-webster.com/dictionary/hippogriff">Hippogriff</a>) is a fictitious animal hybrid of a Gryphon and a horse. </p>
<p>Notwithstanding their potential utility as memory aids, the use of nicknames or acronyms in formal scientific discussions should be avoided.</p><img src="https://counter.theconversation.com/content/197602/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sameer Elsayed does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The XBB.1.5 subvariant — nicknamed ‘Kraken’ — is arguably the most genetically rich and most transmissible SARS-CoV-2 Omicron subvariant yet.Sameer Elsayed, Professor of Medicine, Pathology & Laboratory Medicine, and Epidemiology & Biostatistics, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1961792022-12-12T13:37:37Z2022-12-12T13:37:37ZChina’s loosened COVID-19 policies – following years of aggressive lockdowns and quarantines – have left the country vulnerable<figure><img src="https://images.theconversation.com/files/500103/original/file-20221209-29029-7l4vwf.jpg?ixlib=rb-1.1.0&rect=0%2C195%2C5202%2C3392&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Chinese government has loosened restrictions designed to limit the spread of COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/epidemic-control-workers-wear-ppe-as-they-walk-to-disinfect-news-photo/1447909402?phrase=china%20zero%20covid%20&adppopup=true">Kevin Frayer/Stringer via Getty Images</a></span></figcaption></figure><p>After nearly three years of aiming to eliminate <a href="https://www.theguardian.com/world/2022/nov/29/china-zero-covid-policy-explained-30-seconds-lockdowns-outbreaks">COVID-19 through</a> mass lockdowns, robust contact tracing programs and international travel bans, the Chinese government has announced it is rolling back the “zero-COVID” policies that helped <a href="https://go.gale.com/ps/i.do?id=GALE%7CA618606601&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00280836&p=HRCA&sw=w&userGroupName=mlin_oweb">suppress the spread of the coronavirus</a> in the country. The Chinese Communist Party <a href="https://www.nytimes.com/2022/12/07/world/asia/china-zero-covid-protests.html">announced these changes</a> on Dec. 7, 2022, as <a href="https://www.nytimes.com/interactive/2021/world/china-covid-cases.html">rates of COVID-19 are on the rise</a> in major cities, following <a href="https://www.nytimes.com/2022/12/07/world/asia/china-zero-covid-protests.html">protests</a> demanding the end of zero-COVID policies. </p>
<p>The situation in China stands in stark contrast to the trajectory of the pandemic in the U.S. SARS-CoV-2 emerged with a bang, but thanks to a strong vaccination effort and the fact that a large portion of U.S. residents have been infected with the coronavirus, COVID-19 cases seem to be reaching somewhat of a steady state and <a href="https://doi.org/10.1056/NEJMp2004361">normal life has mostly resumed</a>.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=YCsTY4sAAAAJ&hl=en&oi=ao">medical anthropologist</a> who studies <a href="https://www.sup.org/books/title/?id=23706">public health trends in China</a> from an epidemiologic and social perspective. </p>
<p>After largely <a href="https://www.nytimes.com/2020/08/23/world/asia/china-coronavirus-normal-life.html">containing the coronavirus in 2020</a>, China began enforcing a strict <a href="https://www.nytimes.com/2022/01/21/world/asia/china-zero-covid-policy.html">zero-COVID policy</a> leading up to the Beijing Olympics in 2022. The result is that China has not followed the standard path of a pandemic where people slowly gain immunity through exposure or vaccination, allowing society to open up over time. Combined with <a href="https://doi.org/10.1136/bmj.n969">questions about the efficacy of China’s vaccines</a> and comparatively low vaccination rates, many public health experts think that China will be hit hard by the coronavirus as the country rapidly <a href="https://www.nytimes.com/2022/12/02/health/china-covid-lockdowns.html">lifts its zero-COVID policy</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A health worker checking a traveller at a checkpoint." src="https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">After the coronavirus first emerged in late 2019, the Chinese government severely limited travel in the region of Wuhan.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChina/5fffda0e9b8841e8923776fefe4a693b/photo?Query=china%20lockdowns%20wuhan&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=261&currentItemNo=9">AP Photo/Ng Han Guan</a></span>
</figcaption>
</figure>
<h2>China’s initial reaction to COVID-19</h2>
<p>Public health campaigns and control of emerging disease in China are entirely reliant on and directed by the government, which promotes health both for the <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0486-6">good of the people and the nation</a>. When COVID-19 emerged, the Chinese government was quick to institute mask-wearing policies and testing regimens, and it <a href="https://www.cnbc.com/2020/04/08/coronavirus-china-ends-lockdown-of-wuhan-city-where-outbreak-started.html">locked down the city of Wuhan and the surrounding region</a> where the coronavirus originated. With only the aid of these <a href="https://doi.org/10.1016/S0140-6736(20)31278-2">nonpharmaceutical interventions</a>, the Chinese government was very successful in containing the spread of COVID-19 after the initial wave hit Wuhan. </p>
<p>From the time China started recording cases in late December 2019, until the government ended its initial period of lockdown in April 2020, <a href="https://www.cnbc.com/2020/04/08/coronavirus-china-ends-lockdown-of-wuhan-city-where-outbreak-started.html">the government documented </a> 82,000 cases of COVID-19 and just over 3,300 deaths. Though not officially called a zero-COVID policy at the time, the control measures were born out of a goal of <a href="https://doi.org/10.2471%2FBLT.20.254045">eliminating COVID-19</a> from the country. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line of people waiting to be swabbed for COVID-19." src="https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In the months leading up to the 2022 Beijing Olympics, China began ramping up zero-COVID measures, including mandatory testing requirements.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChina/f24fab8b8eae4ee4a90c714caadbf960/photo?Query=china%20zero%20covid&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=796&currentItemNo=230">AP Photo/Mark Schiefelbein</a></span>
</figcaption>
</figure>
<h2>Ramping up zero-COVID</h2>
<p>Life returned to normal in China after the initial wave of COVID-19 ravaged Wuhan. For most of 2020 and the first half of 2021, Chinese people were <a href="https://www.theguardian.com/world/2022/nov/29/china-zero-covid-policy-explained-30-seconds-lockdowns-outbreaks">out and about</a> in shopping malls, restaurants and bars. </p>
<p>During this same period, the coronavirus was rampaging across the U.S, Europe and other regions of the world, leading many health experts to say that the lockdowns in China, though brutal, were <a href="https://go.gale.com/ps/i.do?id=GALE%7CA618606601&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00280836&p=HRCA&sw=w&userGroupName=mlin_oweb">successful</a>. Between May 2020 and August 2021, people in China saw COVID-19 as a <a href="https://www.newyorker.com/news/news-desk/what-chinese-people-think-of-their-governments-zero-covid-policy">distant threat</a> and supported the government’s actions. </p>
<p>The situation changed in August 2021 when the Chinese government officially adopted what it calls the “<a href="https://www.ijbs.com/v18p5314.htm">Dynamic zero-COVID</a>” strategy to combat the new delta variant. This strict prevention policy included provisions for mass lockdowns <a href="https://doi.org/10.1016/S2213-2600(22)00142-4">aimed at eliminating</a> the disease in a particular region, even if just a small number of cases were found. </p>
<p>China <a href="https://www.newsweek.com/omicron-march-beijing-strains-china-zero-covid-policy-before-2022-olympics-1667828">ramped up enforcement of the policy</a> as the 2022 Winter Olympics approached. A <a href="https://www.theguardian.com/world/2021/nov/02/china-locks-down-shanghai-disneyland-and-tests-34000-visitors-after-single-covid-case">single case</a> could trigger a massive lockdown where the government would severely limit people’s movement and enforce quarantines, as occurred several times in Shanghai Disney. In some instances, people were held in stores or office buildings for <a href="https://www.nytimes.com/2022/01/21/world/asia/china-zero-covid-policy.html">several days</a> after exposure to an infected person. </p>
<p>Summer and fall 2022 were relatively quiet, with only around 1,000 confirmed infections per day. But since early November 2022, COVID-19 cases in China <a href="https://www.nytimes.com/interactive/2021/world/china-covid-cases.html">have climbed steadily</a>, with more than <a href="https://www.nytimes.com/interactive/2021/world/china-covid-cases.html">35,000 new cases detected per day</a> in the first week of December. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chinese president Xi Jinping with people in masks behind him." src="https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Following a wave of protests in late November and early December, the Chinese Communist Party announced that it would roll back some of the strictest travel limitations and quarantine requirements.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChina/1ca47c62c5f94606bc1a2586088c1d71/photo?Query=xi%20jinping%20zero%20covid%20&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=76&currentItemNo=47">Jack Taylor/Pool Photo via AP</a></span>
</figcaption>
</figure>
<h2>What happens next?</h2>
<p>As of early December, COVID-19 rates in China were still relatively <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">low compared to many places, including the U.S.</a>. But China faces some unique challenges thanks to low levels of immunity in the population and a disease control strategy that prioritized nonpharmaceutical interventions like mask-wearing, social distancing and <a href="https://www.nytimes.com/2022/06/14/business/china-covid-testing.html">frequent testing over vaccine administration</a>.</p>
<p>To date, 90% of the population in China <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">has been vaccinated</a>. Older people have been more reluctant, though, and only <a href="https://www.cnbc.com/2022/11/29/china-says-covid-vaccination-rates-for-seniors-has-climbed-over-the-last-two-weeks.html">66% of those over 80</a> have received two doses of a vaccine. A further concern arises from studies indicating that China’s vaccines may <a href="https://doi.org/10.1136/bmj.n969">not be as effective as the mRNA vaccines</a> used in the West. So far, China has <a href="https://www.cnn.com/2021/12/13/china/china-western-mrna-vaccine-mic-intl-hnk/index.html">not been willing to import</a> and administer Western mRNA vaccines. </p>
<p>In addition to concerns over vaccination, the zero-COVID policy has, to a large extent, successfully suppressed the coronavirus in China. The result is that since most people have not been exposed to the virus, they have not had a chance to develop immunity. This has likely <a href="https://www.theatlantic.com/health/archive/2022/12/china-zero-covid-wave-immunity-vaccines/672375/?utm_source=substack&utm_medium=email">left the country very susceptible</a> to a large outbreak. </p>
<p>There is also a social dimension to the problems facing China today. <a href="https://www.cbsnews.com/news/china-lockdowns-zero-covid-policy/">Recurring lockdowns</a> over the past year have damaged the economy and lessened <a href="https://www.nytimes.com/2022/12/03/opinion/china-covid-protests.html?smid=nytcore-ios-share&referringSource=articleShare">peoples’ patience</a> with restrictive policies. Despite government efforts to <a href="https://www.theguardian.com/world/2022/nov/28/china-censors-maskless-crowd-footage-in-world-cup-broadcasts">limit access to outside information</a>, people in China are learning that most other countries are functioning normally. Maintaining stringent zero-COVID policies has become increasingly difficult, as they <a href="https://www.nytimes.com/2022/12/01/opinion/china-covid-protests.html">wear on a populace</a> that wants life to return to normal.</p>
<p>The Dec. 7 announcement to ease COVID-19 restrictions is a continuation of a trend a few weeks in the making, but has been seen by many as a <a href="https://www.nytimes.com/2022/12/07/world/asia/china-zero-covid-protests.html">response to the widespread protests</a>. Testing centers <a href="https://www.nytimes.com/2022/12/01/world/asia/china-covid-protests-restrictions.html?utm_source=substack&utm_medium=email">are closing</a> and infected people are now allowed to <a href="https://www.reuters.com/world/china/china-allow-some-positive-covid-19-cases-quarantine-home-sources-2022-12-01/?mc_cid=b8f3c7dbfb&mc_eid=d60d414cea&utm_source=substack&utm_medium=email">quarantine at home</a> for the first time since the pandemic began. The digital health passes, issued to people who tested negative through daily PCR tests, are <a href="https://www.washingtonpost.com/world/2022/12/07/china-covid-easing-restrictions/">also no longer required</a> to enter public places. </p>
<p>In much of the world, COVID-19 has followed that <a href="https://www.jstor.org/stable/20025233">natural trajectory</a> of a pandemic. The story is different in China. The relaxation of zero-COVID policies may bring China more in line with the rest of the world in terms of what the people there can do, but the virus also gets a chance to run its natural course now that government actions will not suppress the spread. It is likely that in the coming months, the Chinese people will face the pain and suffering that many other places experienced in 2020 and 2021.</p><img src="https://counter.theconversation.com/content/196179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elanah Uretsky does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Strict lockdowns, quarantines and testing have prevented many people in China from catching COVID-19. With concerns over Chinese vaccine efficacy and uptake, China may be facing a looming COVID-19 surge.Elanah Uretsky, Associate Professor of International and Global Studies, Brandeis UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1936102022-12-11T13:32:42Z2022-12-11T13:32:42ZBeyond vaccine hesitancy: Understanding systemic barriers to getting vaccinated<figure><img src="https://images.theconversation.com/files/500127/original/file-20221209-40125-cwoufi.jpeg?ixlib=rb-1.1.0&rect=17%2C448%2C3796%2C3037&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Throughout the pandemic, much discussion about COVID-19 transmission focused on individual-level decisions, making it easy to blame the unvaccinated.</span> <span class="attribution"><span class="source">(Pixabay)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/beyond-vaccine-hesitancy--understanding-systemic-barriers-to-getting-vaccinated" width="100%" height="400"></iframe>
<p>The term “vaccine hesitancy” was in wide use years before the World Health Organization (WHO) declared COVID-19 a pandemic. The term focuses on individual-level attitudes toward vaccines. Throughout the pandemic, much <a href="https://doi.org/10.1371/journal.pone.0261942">popular</a> and <a href="https://doi.org/10.1016/j.puhe.2021.02.025">scholarly discussion</a> about COVID-19 transmission focused on individual-level decisions, making it easy to <a href="https://doi.org/10.1016%2Fj.socscimed.2022.114699">blame the unvaccinated</a>. </p>
<p>By focusing on individual decisions, it is easy to overlook other reasons for suboptimal vaccine uptake. These include <a href="https://theconversation.com/politicizing-covid-19-vaccination-efforts-has-fuelled-vaccine-hesitancy-175416">politicization</a>, <a href="https://doi.org/10.2196%2F26874">distrust of the health system due to systemic racism</a>, <a href="https://itpcglobal.org/wp-content/uploads/2022/08/Mapping-Access-Gaps-in-COVID-19.pdf">social inequities, and barriers to access and acceptance</a>. </p>
<p>The perspective that health is the result of only individual behaviours falsely disconnects well-being from important factors like systemic <a href="https://doi.org/10.1016/j.socscimed.2020.113559">social inequities</a>, community well-being and environmental health (such as <a href="https://www.who.int/health-topics/one-health#tab=tab_1">One Health</a>). The <a href="https://doi.org/10.1080/13669877.2020.1756382">focus on individual decisions</a> also reinforces widespread social norms and <a href="https://doi.org/10.1080/09581591003797129">sanctions (such as the stigmatization of the unvaccinated)</a>, which <a href="https://doi.org/10.1080/09581596.2010.520692">make individuals personally responsible</a> for keeping themselves healthy, including getting vaccinated to protect others. </p>
<p>Although there have been efforts across Canada to improve COVID-19 vaccine accessibility and acceptability among underserved populations, the success of these efforts is <a href="https://doi.org/10.1080/21645515.2022.2129827">isolated to specific communities</a> and <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/952716/s0979-factors-influencing-vaccine-uptake-minority-ethnic-groups.pdf">ongoing efforts are needed</a> to reduce inequities. As a result, many individuals who are blamed for being unvaccinated are often also denied equal access to health care and vaccination services, and credible information about vaccines from trusted sources.</p>
<p>We are a group of researchers whose work explores <a href="https://doi.org/10.1371/journal.pone.0071106">inequities</a> in vaccination <a href="https://doi.org/10.1016/j.socscimed.2022.115400">intentions</a>, <a href="https://doi.org/10.1080/21645515.2022.2129827">access</a> and <a href="https://doi.org/10.17269/s41997-022-00641-9">uptake</a> among <a href="https://doi.org/10.1101/2022.04.11.22273644">underserved populations</a>, as well as public health <a href="https://doi.org/10.1080/21645515.2022.2145822">communications</a> and <a href="https://doi.org/10.1080/13698575.2021.1994933">inequities resulting from pandemic responses</a>. We also research <a href="https://doi.org/10.1016/j.vaccine.2022.10.058">vaccine hesitancy</a>, <a href="https://doi.org/10.1016/j.vaccine.2022.11.056">public health communications</a> and the use of vaccine <a href="https://doi.org/10.2196/41012">information and misinformation</a> to show how social inequities shape vaccine uptake.</p>
<h2>What is vaccine hesitancy?</h2>
<figure class="align-center ">
<img alt="People entering a vaccination clinic" src="https://images.theconversation.com/files/500128/original/file-20221209-29029-ih1uju.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500128/original/file-20221209-29029-ih1uju.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500128/original/file-20221209-29029-ih1uju.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500128/original/file-20221209-29029-ih1uju.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500128/original/file-20221209-29029-ih1uju.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500128/original/file-20221209-29029-ih1uju.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500128/original/file-20221209-29029-ih1uju.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Convenience of vaccination includes availability, location accessibility and affordability of vaccination, understandability of vaccine information and appeal of vaccine services.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jeff McIntosh</span></span>
</figcaption>
</figure>
<p>The Strategic Advisory Group of Experts (SAGE) on Immunization at the WHO defines vaccine hesitancy as a “<a href="https://doi.org/10.1016/j.vaccine.2015.04.036">delay in acceptance or refusal of vaccination despite availability of vaccine services</a>” for various reasons, including convenience. Convenience refers to the absence of barriers to accessing and accepting vaccines. This includes availability, location accessibility, affordability of vaccination, understandability of vaccine information and appeal of vaccine services. </p>
<p>Systemic social issues affect vaccine access and acceptability. Yet, <a href="https://doi.org/10.1016/j.vaccine.2017.08.004">the term vaccine hesitancy often overlooks these, and reduces the multiple factors that affect vaccine uptake</a> to individual-level decisions. Researchers have also <a href="https://doi.org/10.1038/d41586-022-00495-8">critiqued the focus on vaccine hesitancy</a> because it distracts from the responsibility of government institutions to <a href="https://doi.org/10.1016/j.vaccine.2022.10.058">ensure vaccines are accessible</a> and acceptable to the population.</p>
<h2>Social inequities create barriers to vaccination</h2>
<p>Pre-pandemic research shows <a href="https://doi.org/10.4161/hv.24427">substantial barriers to getting vaccinated exist</a>, especially for certain populations. These include racialized and <a href="https://doi.org/10.1371/journal.pone.0071106">Indigenous Peoples</a>, people with disabilities, people living in rural and remote areas, and those with low income. For example, a recent review of studies about barriers to adult vaccination listed access <a href="https://doi.org/10.1177/17151635221090212">among the most frequently reported barriers</a>.</p>
<p>In Canada and internationally, the uptake of COVID-19 vaccines has been much higher than for other <a href="https://www150.statcan.gc.ca/n1/pub/82-003-x/2010004/article/11348-eng.htm">pandemic</a> and routine vaccines. Yet, it has been harder for those with fewer resources to get vaccinated. </p>
<p><a href="http://dx.doi.org/10.1080/21645515.2022.2129827">Participants in our research</a> identified many barriers to getting vaccinated in Spring 2021 when COVID-19 vaccines first became widely available across Canada. These barriers include technology access, language requirements, accessible transportation and childcare, <a href="https://doi.org/10.17269/s41997-022-00621-z">gaps in accommodations for disability</a> or health conditions, rigid work schedules and feeling unsafe. </p>
<figure class="align-center ">
<img alt="A vial of vaccine and a pile of syringes" src="https://images.theconversation.com/files/499587/original/file-20221207-4043-o3hgzd.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499587/original/file-20221207-4043-o3hgzd.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499587/original/file-20221207-4043-o3hgzd.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499587/original/file-20221207-4043-o3hgzd.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499587/original/file-20221207-4043-o3hgzd.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499587/original/file-20221207-4043-o3hgzd.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499587/original/file-20221207-4043-o3hgzd.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Uptake of COVID-19 vaccines has been much higher than for routine vaccines or other pandemic vaccines (such as H1N1 flu).</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
</figcaption>
</figure>
<p>Similar barriers have been previously recognized with <a href="https://doi.org/10.1016/j.vaccine.2015.07.004">routine childhood vaccines, adult vaccines</a> and seasonal <a href="https://doi.org/10.1177/17151635221090212">vaccines</a>. </p>
<p>For racialized and Indigenous populations, whom Canada’s National Advisory Committee on Immunization identified as being at <a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/guidance-prioritization-key-populations-covid-19-vaccination.html">increased risk</a> of severe illness from <a href="https://doi.org/10.1503/cmaj.202353">COVID-19 disease</a>, major <a href="https://doi.org/10.1080/17441692.2021.1912809">barriers to accepting COVID-19 vaccines</a> also include <a href="https://doi.org/10.1186/s12939-021-01410-9">contemporary</a> and <a href="https://doi.org/10.1503/cmaj.210112">historical</a> medical racism, disregard and mistreatment.</p>
<h2>Improving vaccine access and acceptance</h2>
<p>Throughout the pandemic, local non-profit, community and Indigenous organizations tailored vaccine rollouts for the people they serve. </p>
<p>For example, urban Indigenous health service providers sought <a href="https://doi.org/10.1503/cmaj.212147">to improve the accessibility</a> of culturally appropriate care for First Nations, Métis and Inuit communities, including people without shelter. However, some still noted lower uptake than in non-Indigenous populations. </p>
<p><a href="https://nafc.ca/programs/covid-19/task-group?lang=en">Across Canada</a>, <a href="https://www.millbrookband.com/new-events/2022/2/2/covid-19-vaccine-clinic">First Nations</a>, <a href="https://doi.org/10.17269/s41997-021-00603-7">Métis</a>, <a href="https://covid19.tunngavik.com/initiatives/covid-19-walk-in-vaccination-clinic/">Inuit</a> and <a href="https://bcaafc.com/help/covid-19/">Indigenous-led</a> initiatives provided culturally and linguistically appropriate <a href="https://www.mmf.mb.ca/covid-19-news/mmf-finally-able-to-offer-covid-19-vaccine-rollout-for-metis-citizens-12-and-up">clinics</a>, <a href="https://metisnationsk.com/2020/03/13/metis-nation-saskatchewan-updates-on-response-to-covid-19/">information</a> and wellness support. </p>
<p>Similarly, local organizations worked to improve vaccine accessibility for diverse peoples, including <a href="https://calgaryherald.com/news/local-news/how-calgarys-upper-northeast-achieved-canadas-best-covid-19-vaccine-rates">newcomers</a>, <a href="https://www.ctvnews.ca/health/coronavirus/good-public-health-policy-the-success-of-vaccine-clinics-for-black-racialized-canadians-1.5416822">racialized populations</a> and <a href="https://www.abilitiesmanitoba.org/news/article/4/abilities-manitoba-partners-with-community-to-provide-mobile-vaccination-options">people with disabilities</a>. </p>
<p>Provincial health authorities also worked to <a href="https://www.thestar.com/politics/provincial/2021/07/08/ontario-shifting-focus-to-better-target-those-not-vaccinated-against-covid-19.html?source=newsletter&utm_content=a01&utm_source=ts_sa&utm_medium=email&utm_email=D96C98BF127F325914880BBB38F86FF0&utm_campaign=vaccine_rollout_61599">diversify vaccination services</a>, providing <a href="https://novascotia.ca/news/release/?id=20210316006">mobile</a>, <a href="https://cisss-outaouais.gouv.qc.ca/language/en/covid19-en/covid-19-vaccination/">walk-in</a>, <a href="https://globalnews.ca/video/8461358/cars-line-up-for-drive-through-vaccine-clinic-in-kingston-ont">drive-through</a> and <a href="https://www.pvnccdsb.on.ca/durham-health-department-offering-pop-up-vaccination-clinics-in-local-schools/">pop-up</a> clinics. Federal, provincial and territorial governments also provided pandemic and vaccine information in <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/awareness-resources.html">multiple languages</a> to improve accessibility. </p>
<p>However, many of these efforts were initiated after mass vaccine clinics opened to the general public. This made it harder for populations that were recommended for vaccination early in rollouts to access the first available doses of COVID-19 vaccines. </p>
<figure class="align-center ">
<img alt="People walk past a blue storefront with a yellow Vaccine Clinic sign" src="https://images.theconversation.com/files/500130/original/file-20221209-25181-1qhnxv.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500130/original/file-20221209-25181-1qhnxv.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500130/original/file-20221209-25181-1qhnxv.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500130/original/file-20221209-25181-1qhnxv.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500130/original/file-20221209-25181-1qhnxv.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500130/original/file-20221209-25181-1qhnxv.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500130/original/file-20221209-25181-1qhnxv.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People walk past a vaccine clinic during the COVID-19 pandemic in Mississauga, Ont. in April 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>Although these initiatives improved vaccination accessibility for some underserved communities later in the rollout, <a href="https://doi.org/10.1080/21645515.2022.2129827">barriers to vaccination</a> remained high for many throughout the initial rollout, even for people who <a href="https://doi.org/10.1016/j.socscimed.2022.115400">wanted to be vaccinated</a>. </p>
<h2>Addressing barriers</h2>
<p>The overemphasis of research and public discussion on vaccine hesitancy makes systemic barriers to getting vaccinated invisible to the public. Instead, individuals are blamed for not getting vaccinated, even when access to vaccines is not equitable.</p>
<p>Without resolving barriers to vaccine access and acceptability, efforts solely focused on reducing vaccine hesitancy will not optimize vaccine uptake. Vaccine programs must be intentionally designed for those with the greatest barriers, starting with the initial rollout. </p>
<p>To improve vaccine access and trust, rollouts must occur in a contextualized way and in partnership with organizations that have community trust and experience working to improve access to health care and social justice. As modelled by local non-profit, community and Indigenous organizations, vaccine programs must be embedded in wider efforts to improve social equality and access to health care.</p><img src="https://counter.theconversation.com/content/193610/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Terra Manca currently receives funding from the Social Sciences and Humanities Research Council in the form of an Insight Development Grant for a study into how responsibility for risk mitigation, parenting, and family caregiving was assigned during the pandemic. She has previously received funding from IWK Health and the Canadian Immunization Research Network for research into how emotions and gender shape understandings of vaccination in pregnancy. </span></em></p><p class="fine-print"><em><span>Shannon MacDonald has received research operating funds from the Canadian Institutes of Health Research (CIHR), the Canadian Immunization Research Network (CIRN), and the Alberta Ministry of Health. All funds are directed toward research activities, with Dr. MacDonald receiving no financial remuneration.</span></em></p><p class="fine-print"><em><span>S. Michelle Driedger receives funding from the Canadian Institutes of Health Research for two COVID-19 projects. One project focuses on public understanding of the pandemic through public health communication concerning the virus, and protective behaviours that people can adopt to stay safe, including attitudes toward COVID-19 vaccines. The other project focuses specifically on Red River Métis experiences with the pandemic, including policies in Manitoba that excluded early access to COVID-19 vaccines in the first few months of the rollout and how this may have influenced vaccine uptake in that population group. She also received funding from the Canadian Immunization Research Network to conduct an evaluation of public health web-based communication with citizens in British Columbia, Manitoba and Ontario.</span></em></p><p class="fine-print"><em><span>Emmanuel Akwasi Marfo and Laura Aylsworth do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Systemic social issues affect vaccine access and acceptability. Yet, the term ‘vaccine hesitancy’ overlooks this, reducing the multiple factors that affect vaccine uptake to individual-level choices.Terra Manca, Research Associate, Faculty of Nursing, University of Alberta, Dalhousie UniversityEmmanuel Akwasi Marfo, Assistant researcher, Faculty of Nursing, University of AlbertaLaura Aylsworth, Research Assistant, Faculty of Nursing, University of AlbertaShannon E. MacDonald, Associate Professor, Faculty of Nursing, University of AlbertaS. Michelle Driedger, Professor, Department of Community Health Sciences, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1947262022-11-20T15:22:34Z2022-11-20T15:22:34ZWith COVID, flu and RSV circulating, it’s time to follow the evidence: Return to mask mandates<figure><img src="https://images.theconversation.com/files/495816/original/file-20221117-13-u0jyep.JPG?ixlib=rb-1.1.0&rect=0%2C10%2C3190%2C2069&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ontario Premier Doug Ford and Health Minister Sylvia Jones in conversation at Queen's Park, the day after Ontario’s chief medical officer of health ‘strongly recommended’ mask wearing.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Chris Young</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/with-covid--flu-and-rsv-circulating--it-s-time-to-follow-the-evidence--return-to-mask-mandates" width="100%" height="400"></iframe>
<p>The number of children and babies with respiratory illnesses currently <a href="https://globalnews.ca/news/9273442/mcmaster-childrens-hospital-patient-crisis-grows/">exceeds the capacity of our health system</a> to care for them. More adult Canadians will die directly of COVID-19 this year <a href="https://public.tableau.com/app/profile/bill.comeau/viz/CanadaCovid19_16636261617930/Dashboard1">than died last year or in 2020</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar graph showing deaths from COVID in Canada" src="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=260&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=260&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=260&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=326&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=326&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=326&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">COVID deaths in 2022 outnumber those in 2020 or 2021.</span>
<span class="attribution"><span class="source">(Bill Comeau)</span></span>
</figcaption>
</figure>
<p>Eight per cent of vaccinated people with COVID infections that don’t require hospitalization <a href="https://doi.org/10.1038/s41591-022-01840-0">end up with long COVID</a>, with each subsequent infection <a href="https://doi.org/10.1038/s41591-022-02051-3">repeating the risk</a>. COVID increases the risk of <a href="https://doi.org/10.1038/s41591-022-01689-3">cardiovascular</a> <a href="https://doi.org/10.1016/S0140-6736(22)01214-4">and</a> <a href="https://www.ecdc.europa.eu/sites/default/files/documents/Prevalence-post-COVID-19-condition-symptoms.pdf">other health</a> <a href="https://doi.org/10.1038/s41591-022-01840-0">problems</a>, enough to cause a stark rise in <a href="https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm">excess deaths</a> and to <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr023.pdf">shorten life expectancy</a>.</p>
<p>In 2020, when adult intensive care units were at risk of being overwhelmed, we wore masks and accepted restrictions. With pediatric intensive care now at risk, will leaders follow the evidence and tell us to mask up? While federal officials and <a href="https://www.cbc.ca/news/canada/toronto/ontario-dr-kieran-moore-announcement-1.6650571">several provinces are now recommending masks in all indoor public settings</a> — although <a href="https://toronto.ctvnews.ca/ontario-s-top-doctor-goes-against-own-advice-while-maskless-at-toronto-party-1.6159050">Ontario’s Chief Medical Officer of Health Kieran Moore was seen without one at a party</a> — <a href="https://www.ctvnews.ca/canada/what-provinces-and-territories-are-saying-about-mask-mandates-as-covid-19-rsv-flu-cases-rise-1.6157262">there are no returns to mandates for the public yet</a>.</p>
<h2>Wear the best mask available</h2>
<p>We now know that <a href="https://doi.org/10.1073/pnas.2014564118">masks prevent the spread of respiratory diseases</a>; some better than others. </p>
<figure class="align-right ">
<img alt="A young woman wearing a white face masks with overhead ties" src="https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Vitacore CaN99 respirator with overhead elastic; N95s, CaN99 and FFP3 typically provide greater than 90 per cent filtration without formal fit testing.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The most effective masks, and the only ones recognized as respiratory protection by formal standards, are respirator masks: N95s, CaN99s, FFP3s and reusable elastomeric respirators. In workplaces, respirators are fit-tested to the individual, resulting in greater than 99 per cent protection. </p>
<p>Even without fit testing, respirator masks prevent <a href="https://doi.org/10.1093/annhyg/meq085">more than</a> <a href="https://doi.org/10.1371/journal.pone.0245688">90 per cent</a> <a href="https://doi.org/10.1097/MD.0000000000023709">of particles</a> smaller than one micron from reaching the wearer (submicron particles, the smallest among <a href="https://doi.org/10.1016%2FS2213-2600(20)30323-4">those thought</a> <a href="https://doi.org/10.1080/23744235.2022.2140822">to be</a> <a href="https://doi.org/10.1038/s41564-021-01047-y">relevant</a>).</p>
<p>Respirator masks are relatively expensive — typically a few dollars each — but thanks to Canadian manufacturers, they are <a href="https://www.clothmasks.org/">available</a> and there are no longer concerns about supply chains for front-line workers. They can be safely <a href="https://www.clothmasks.org/extended-use">reused, with good retention of their filtration</a>. New designs are comfortable and fit most faces. </p>
<figure class="align-left ">
<img alt="A young woman wearing a black face mask with ear loops" src="https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A KN95/KF94 mask with ear loops typically provides about 70 per cent filtration.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>N95s are secured with overhead attachments, providing a good seal at the edges. KN95s and KF94s have excellent filtration material, but their ear loops do not provide as secure a seal, and <a href="https://doi.org/10.1371/journal.pone.0258191">their filtration</a> is <a href="https://doi.org/10.1371/journal.pone.0245688">around 70 per cent</a>. A certified medical mask with a well-fitted cloth mask over it, preferably with overhead ties, provides <a href="https://doi.org/10.1038/s41591-022-01840-0">comparable</a> <a href="https://doi.org/10.1016/j.ajic.2021.10.041">filtration</a> at lower cost.</p>
<figure class="align-right ">
<img alt="A young woman wearing a cloth face mask over a surgical mask" src="https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A well-fitting cloth mask over a certified medical mask typically produces about 70 per cent filtration.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Certified Level 1 medical masks alone do not fit well, which affects their filtration ability because unfiltered air passes around the edges with every breath. In tests on humans, these have <a href="https://doi.org/10.1371/journal.pone.0264090">typically </a><a href="https://doi.org/10.1371/journal.pone.0245688">filtered </a><a href="https://doi.org/10.1001/jamainternmed.2020.8168">at around 50 per cent</a>, similar to <a href="https://doi.org/10.1016/j.mayocp.2020.07.020">well-designed</a> <a href="https://doi.org/10.1371/journal.pone.0264090">two-layer cotton cloth masks, ideally with overhead ties</a>; both are around 50 per cent.</p>
<p>Poorly fitting <a href="https://doi.org/10.1016/j.ajic.2021.10.041">cloth masks</a> and non-certified procedure masks are likely worse than 50 per cent, but better than nothing. The World Health Organization advises: “<a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks">Make wearing a mask a normal part of being around other people</a>,” to which we would add: wear the best mask available.</p>
<figure class="align-left ">
<img alt="A young woman wearing a blue surgical face mask" src="https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=514&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=514&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=514&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=646&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=646&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=646&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Level 1 certified mask provides filtration around 50 per cent because of visible gaps and poor fit. To test fit, breathe out rapidly and feel for air leaks around the mask with your hands.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The filtration data above are mirrored by epidemiologic data showing that <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">protection correlates with mask type</a>. In studies of source control (prevention of contamination of the air by respiratory particles), the same hierarchy of efficiency is seen, with N95s at the top. N95s with exhalation valves are an exception and should not be used to prevent spread of respiratory diseases.</p>
<p><a href="https://doi.org/10.1136/bmj-2021-068302">Masks protect </a><a href="https://doi.org/10.1073/pnas.2014564118">against COVID-19</a> and other respiratory infections. They are also an <a href="https://doi.org/10.7326/M20-6625">ideal tool to counter COVID variants</a>, as well as <a href="https://theconversation.com/influenza-and-covid-19-whats-in-store-for-the-fall-winter-respiratory-virus-season-193076">RSV and influenza</a>. Working on basic physical principles — <a href="https://doi.org/10.7326/M20-6625">impaction, sedimentation and diffusion</a> — they protect regardless of the variant or strain. </p>
<p>Staying home when sick is helpful, but many people are infectious <a href="https://doi.org/10.1186/s12879-022-07440-0">before they have symptoms, or never have symptoms</a>. Wearing a mask to prevent infected particles from reaching the environment is basic pollution management: control is best at the source. </p>
<p>Wearing a mask to protect the individual, once controversial, is now settled by <a href="https://www.clothmasks.org/mask-hierarchy">filtration science</a> and <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">epidemiology</a>. The impact of mask mandates in countries where spontaneous mask wearing was low was repeatedly demonstrated, proving that masks protect us all.</p>
<h2>Why people aren’t wearing masks</h2>
<p>Why aren’t people wearing masks? Some remember the <a href="https://doi.org/10.1111/1467-9566.13525">inconsistency of the advice</a> early in the pandemic. Masks may be conflated with closures and capacity restrictions and the resulting hardships. Whatever the reason — <a href="https://www.theguardian.com/world/2021/oct/26/the-great-cover-up-why-the-uk-stopped-wearing-face-masks">stigma, peer pressure or concern about virtue signalling</a> — countries outside Asia do not have a mask-wearing culture. </p>
<figure class="align-center ">
<img alt="Infographic summarizing the literature on filtration properties of respirators and masks." src="https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=776&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=776&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=776&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=976&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=976&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=976&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Infographic summarizing the literature on filtration properties of respirators and masks.</span>
<span class="attribution"><span class="source">(Shiblul Hasan)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Under these circumstances, it will likely take more than strong recommendations to achieve the <a href="https://doi.org/10.1073/pnas.2014564118">high uptake of mask use that will be most effective</a> in reducing transmission of respiratory viruses. Masks protect individuals, imperfectly. Mask mandates (or high voluntary use of masks) protect populations.</p>
<p>Bringing back mask mandates with unequivocal signalling from governments about the effectiveness of both masks and mask mandates would be the best immediate response to our current crisis. <a href="https://doi.org/10.1038/s41398-022-01814-3">Confidence that mask-wearing is effective correlates geographically with willingness to wear a mask</a>: in time, we hope knowledge will change culture. Strong communication from political and public health leadership would increase community understanding that the minor inconvenience of wearing a mask in public indoor spaces is justified by the death and disability prevented. </p>
<p>In North America, the strategy of using masks according to personal judgment has predictably failed, the strategy of strongly recommending masks is unproven, and it’s too late to experiment. Mask mandates, however, are backed by strong evidence of effectiveness in <a href="https://www.nber.org/papers/w27891">both Canada</a> and the <a href="https://doi.org/10.1377/hlthaff.2020.00818">United States</a>. </p>
<p>Mask mandates are less damaging to a recovering economy than physical distancing and capacity limits, and less damaging to learning than a return to remote schooling.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two line graphs showing relationship between school openings, mask use and community COVID 19 cases and deaths" src="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=313&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=313&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=313&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The relationship between mode of school opening (remote, hybrid and in-person) and mask use at school with community cases and deaths, based on county-level data in the U.S.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1073/pnas.21034201">(Chernozhukov et al, PNAS 2021:118;e2103420118)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Schools and universities represent a particularly important opportunity. COVID spreads between children in schools <a href="https://doi.org/10.1073/pnas.2103420118">to infect the whole population; this is mitigated by mask wearing</a>. After Massachusetts lifted its mask mandate, school boards did so at different times, creating a natural experiment: <a href="https://doi.org/10.1056/NEJMoa2211029">transmission was higher among students and staff where mandates were lifted</a> compared with where they were still in place. </p>
<p>There is <a href="https://web.archive.org/web/20220826213955/https:/healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Do-face-masks-interfere-with-language-development.aspx">no convincing</a> <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html">evidence</a> to date that masks reduce social or language skills. Decreasing spread in schools would increase learning by reducing student and teacher sick days and preserving in-person instruction. Keeping children in schools <a href="https://www.washingtonpost.com/business/2022/11/15/work-absences-childcare/">keeps parents at work</a>.</p>
<p>Mask mandates will not produce a rapid fix of our current problems with respiratory viruses. Indicators will lag by weeks. Until we have a <a href="https://doi.org/10.1038/s41586-022-05398-2">whole-of-society approach</a> that recognizes that <a href="https://doi.org/10.1016/S0140-6736(21)00869-2">COVID is airborne</a>, mask mandates offer us the best immediate opportunity to preserve our health-care system, mitigate death and disability from respiratory viruses, support the economy and safely maintain social contacts in our private lives. </p>
<p><em>Rebecca Rudman, co-founder of the Windsor Essex Sewing Force and member of McMaster’s Cloth Mask Knowledge Exchange, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/194726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Clase is editor-in-chief of clothmasks.org and a member of the Cloth Mask Knowledge Exchange, a research and knowledge translation group that includes industry stakeholders. Industry stakeholders contribute to the Cloth Mask Knowledge Exchange by contributing to grant funding, and through in-kind contributions of time and expertise. Industry stakeholders make masks and distribute polypropylene and other fabrics. They may potentially benefit from this article. She is a member of McMaster's Centre of Excellence in Protective Equipment and Materials. Catherine has received consultation, advisory board membership or research funding from the Ontario Ministry of Health, Sanofi, Pfizer, Leo Pharma, Astellas, Janssen, Amgen, Boehringer-Ingelheim and Baxter. In 2018 she co-chaired a KDIGO potassium controversies conference sponsored at arm's length by Fresenius Medical Care, AstraZeneca, Vifor Fresenius Medical Care, Relypsa, Bayer HealthCare and Boehringer Ingelheim. Catherine Clase receives funding from CIHR, and is a member of the Green Party, the American Society of Nephrology, the Canadian Society of Nephrology, the American Association of Textile Chemists and Colorists and ASTM International.</span></em></p><p class="fine-print"><em><span>Charles-Francois de Lannoy receives funding from the Natural Sciences and Engineering Research Council (NSERC) of Canada, the Global Water Futures (GWF) Research organization, Ontario Centres of Excellence (OCE), Federal Economic Development Agency for Southern Ontario (FedDev), Canadian Foundation for Innovation (CFI), the French Embassy, and McMaster University. He has received funding in partnership with Pall Water, Trojan Technologies, Hatch Ltd., and PW Fabrication. He has engaged in various research projects and testing/validation of facemasks for several private companies in Ontario. He is affiliated with the Cloth Mask Knowledge Exchange as an expert advisor.</span></em></p><p class="fine-print"><em><span>Ken G. Drouillard receives funding from Natural Sciences and Engineering Research Council (NSERC) of Canada, Environment and Climate Change Canada, Ontario Ministry of Environment, Conservation and Parks and Mitacs. He is affiliated with the WE-Spark Health Institute, Detroit River Canadian Cleanup Committee, International Association of Great Lakes Research, Editor of Bulletin of Environmental Contamination and Toxicology and science advisor for Windsor-Essex Sewing Force. </span></em></p>In 2020, with adult ICUs at risk of being overwhelmed, we wore masks and accepted restrictions. Now pediatric intensive care is at risk. Will leaders follow the evidence and tell us to mask up?Catherine Clase, Professor of Medicine, Epidemiologist, Physician, McMaster UniversityCharles-Francois de Lannoy, Associate Professor, Chemical Engineering, McMaster UniversityKen G. Drouillard, Professor, Great Lakes Institute for Environmental Research, School of the Environment, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1930762022-11-10T18:49:58Z2022-11-10T18:49:58ZInfluenza and COVID-19: What’s in store for the fall/winter respiratory virus season?<figure><img src="https://images.theconversation.com/files/493682/original/file-20221106-1597-j4udyc.jpg?ixlib=rb-1.1.0&rect=309%2C0%2C4264%2C3238&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Model of an influenza virus. Flu season is expected to make a big comeback this year.</span> <span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/influenza-and-covid-19--what-s-in-store-for-the-fall-winter-respiratory-virus-season" width="100%" height="400"></iframe>
<p>Public health experts in the Northern Hemisphere are <a href="https://www.cbc.ca/news/canada/hamilton/2022-flu-season-intense-1.6616707">predicting a fall/winter respiratory virus season</a> for the ages — one that highlights the importance of global surveillance efforts and vaccines as tools in the fight against influenza (flu) and COVID-19. </p>
<h2>Making sense of COVID-19’s impact on seasonal flu</h2>
<p>Prior to the COVID-19 pandemic, the annual respiratory virus season in northern and southern climates was an epidemic of sorts, one that was characterized by a rapid uptick in the rate of influenza (flu) and of influenza-like illness beginning in mid-fall, peaking in mid-winter and winding down in mid-spring. </p>
<p>The previously predictable pattern of influenza activity in the global North and South has become somewhat unpredictable in post-pandemic seasons. In the United States, approximately 36 million infections, 390,000 hospitalizations and 25,000 deaths due to flu were <a href="https://www.cdc.gov/flu/about/burden/past-seasons.html">reported during the 2019-20 season</a>. </p>
<p>In contrast, minimal influenza activity was noted in 2020-21 while the 2021-22 season saw a four-fold decline in activity compared to pre-pandemic seasons.</p>
<p>Implementation of strict public health measures during the COVID-19 pandemic was instrumental in reducing the incidence of flu and flu-like illnesses during the past two respiratory virus seasons in both hemispheres. However, the <a href="https://doi.org/10.1016/S2214-109X(22)00358-8">relaxation of these measures</a> is expected to promote a tidal wave of respiratory virus infections in the weeks to come. </p>
<p>These infections include <a href="https://doi.org/10.1016%2Fj.ijid.2022.08.002">influenza</a>, <a href="https://covid19.healthdata.org/global?view=cumulative-deaths&tab=trend">SARS-CoV-2</a> and <a href="https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html">Respiratory Syncytial Virus (RSV)</a>, which often <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/palivizumab-respiratory-syncitial-virus-infection-infants.html">affects children</a>.</p>
<h2>Influenza in the Southern Hemisphere</h2>
<figure class="align-center ">
<img alt="Four red circular spots on a blue background." src="https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=495&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=495&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=495&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=622&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=622&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=622&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of influenza B virus particles.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Despite the impact of COVID-19 on global health and the almost negligible level of seasonal influenza activity over the past two years, the Southern Hemisphere experienced a major shift in influenza activity during the 2022 respiratory virus season. </p>
<p>In <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7143a1.htm?s_cid=mm7143a1_w">Chile</a>, the season began with a burst of influenza B activity in January, followed by a relative lull in March and April, and then a surge in influenza A that peaked in June. In contrast, <a href="https://www.health.gov.au/sites/default/files/documents/2022/10/aisr-fortnightly-report-no-7-20-june-to-3-july-2022.pdf">Australia’s flu season</a> started in March, had a record peak in June, and was dominated throughout by influenza A.</p>
<h2>What’s in store for fall and winter?</h2>
<p>Unlike seasonal influenza, COVID-19 primarily behaves as a pandemic virus, with simultaneous, high-level viral transmission in all parts of the globe. COVID-19 activity may be “seasonal” in some respects, with higher rates of transmission during the fall and winter months when people are indoors more often than not and, consequentially, less socially-distanced. </p>
<p>The 2022 Southern Hemisphere experience serves as a harbinger for what to expect during the 2022-23 respiratory virus season in northern climates. </p>
<p>In the North, the respiratory virus season is already off to an early and blazing start, particularly in the <a href="https://www.cdc.gov/flu/weekly/index.htm">U.S.</a> and <a href="https://www.canada.ca/en/public-health/services/diseases/flu-influenza/influenza-surveillance/weekly-influenza-reports.html">Canada</a>, and appears destined to wreak havoc on <a href="https://www.thestar.com/news/canada/2022/11/04/doctors-nurses-advocates-call-on-governments-to-address-health-care-crisis.html">health-care systems that are already struggling</a> from the impact of COVID-19. </p>
<h2>The importance of influenza vaccination</h2>
<figure class="align-right ">
<img alt="Green circular spots with black markings on a blue background." src="https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of H1N1 influenza virus particles.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Vaccination is one of the most effective public health interventions in our battle against influenza and COVID-19. Recommendations on the composition of flu vaccines are made biannually by the World Health Organization (WHO) several months in advance of the forthcoming respiratory virus season in each respective hemisphere. </p>
<p>However, licensing of influenza vaccines generally falls under national jurisdictions. Similar vaccine formulations are approved for use in the <a href="https://www.cdc.gov/flu/professionals/acip/2022-2023/acip-table.htm">U.S.</a>, <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2022-2023.html">Canada</a>, <a href="https://www.gov.uk/government/publications/flu-vaccines-for-the-current-season/flu-vaccines-for-the-2022-to-2023-season">United Kingdom</a> and other northern countries, and are now widely available. </p>
<p><a href="https://www.who.int/news/item/25-02-2022-recommendations-announced-for-influenza-vaccine-composition-for-the-2022-2023-northern-hemisphere-influenza-season">Flu vaccine composition</a> for the 2022-23 respiratory virus season in northern latitudes is based on surveillance of circulating influenza virus strains during the most recent respiratory virus season in the Southern Hemisphere. The WHO has recommended both quadrivalent vaccines (containing four strains) and trivalent vaccines (containing three strains), with no preference given to either formulation. </p>
<p>The quadrivalent vaccine contains two <a href="https://www.mcgill.ca/oss/article/health/what-does-it-mean-when-vaccine-contains-inactivated-virus">inactivated strains</a> of influenza A (H1N1 and H3N2) and two inactivated strains of influenza B. The trivalent vaccine is similar with the exception of having a single inactivated strain of influenza B.</p>
<h2>How effective are flu shots?</h2>
<figure class="align-center ">
<img alt="Gloved hands giving an injection in someone's shoulder" src="https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">You can get the flu jab concurrently with COVID-19 vaccine.</span>
<span class="attribution"><span class="source">(AP Photo/Rogelio V. Solis)</span></span>
</figcaption>
</figure>
<p>Vaccine-mediated protection against influenza infection, severe illness and death has immense public health ramifications, yet is often misunderstood. <a href="http://doi.org/10.1183/16000617.0258-2020">Vaccine effectiveness</a> varies from one respiratory virus season to another and <a href="https://www.cdc.gov/flu/vaccines-work/effectivenessqa.htm#:%7E:text=In%20addition%20to%20virus%20factors,the%20benefits%20received%20from%20vaccination.">hinges on several factors</a>, including the degree of vaccine mismatch with circulating strains, the use of high-dose versus standard-dose vaccines, prior influenza illness or vaccination, age, general health status, and public health measures such as social distancing, medical mask use, and travel restrictions.</p>
<p>Flu vaccines tend to confer a <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">greater degree of protection against influenza B and influenza A H1N1 subtypes</a>, with a lower degree of effectiveness against the influenza A H3N2 subtype. </p>
<p><a href="https://doi.org/10.1093/cid/ciab462">Research</a> has shown that the effectiveness of standard-dose flu vaccines in preventing severe influenza illness during the 2019-20 U.S. respiratory virus season was highest in young adults (60 per cent), relatively low in middle-aged adults (20 per cent) and modest or negligible in the elderly. </p>
<p>High-dose vaccines improve effectiveness to 30 per cent in the elderly. Therefore, people 65 years of age or older should receive a high-dose quadrivalent vaccine. Flu shots should be complemented by other infection control precautions including social distancing, indoor masking and frequent handwashing.</p>
<h2>Do I really need a flu shot?</h2>
<p>You can get a <a href="https://www.cdc.gov/flu/prevent/coadministration.htm">flu shot concurrently with a COVID-19 shot</a>. </p>
<p>Influenza vaccines are considered safe and effective in virtually all individuals, despite the <a href="https://www.scientificamerican.com/article/flu-shots-may-not-protect-the-elderly-or-the-very-young/">lack of robust evidence of protection in very young children and the elderly</a>. Their use is akin to protection from wearing seatbelts; you may not necessarily be involved in an accident but if you are, the chances of survival and protection from serious injury are higher with their use than without. </p>
<p>During the <a href="https://www.cdc.gov/flu/prevent/flushot.htm">2019-20 respiratory virus season in the U.S</a>, influenza vaccination prevented over 100,000 hospitalizations and over 6,000 deaths. Given the expected burden of influenza illness and the ongoing COVID-19 pandemic, the benefits of vaccination will likely be greater during the current respiratory viral season compared to those in the past few years.</p>
<h2>What is the role of COVID-19 boosters?</h2>
<figure class="align-right ">
<img alt="Orange masses studded with small green dots." src="https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=515&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=515&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=515&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=647&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=647&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=647&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of the Omicron strain of SARS-CoV-2 virus particles (coloured green) on a human cell.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>For COVID-19, the <a href="https://doi.org/10.1136/bmj-2022-072141">effectiveness of a two-dose primary vaccine series plus a single booster</a> in preventing hospitalization is close to 90 per cent but gradually drops to around 65 per cent over the course of four to five months after the last vaccine dose. Bivalent vaccine boosters may serve as a means of <a href="https://doi.org/10.1016/S1473-3099(22)00692-2">preserving vaccine-induced immunity</a> against newer variants of SARS-CoV-2. </p>
<p>COVID-19 vaccines remain part of an effective strategy to counter the next wave of infection. The latest <a href="https://secure.medicalletter.org/TML-article-1660c">bivalent vaccines</a> manufactured by Pfizer and Moderna are recommended as boosters for individuals with at least two primary COVID-19 vaccinations. </p>
<p>The bivalent vaccines are believed to be more effective against the dominant BA.4 and BA.5 Omicron subvariants of SARS-CoV-2 than the original mRNA vaccines, but <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/summary-national-advisory-committee-immunization-november-3-2022-recommendations-use-moderna-spikevax-bivalent-mrna-50-mcg-covid-19-booster-vaccine-adults.html">equal in effectiveness to first-generation bivalent vaccines</a> that target the original strain and the BA.1 Omicron subvariant. The <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-and-pfizer-biontech-bivalent-covid-19-vaccines">U.S.</a>, <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/summary-national-advisory-committee-immunization-november-3-2022-recommendations-use-moderna-spikevax-bivalent-mrna-50-mcg-covid-19-booster-vaccine-adults.html">Canada</a> and <a href="https://www.ema.europa.eu/en/news/comirnaty-spikevax-ema-recommendations-extra-doses-boosters">Europe</a> have slightly different age-based and time-based eligibility criteria for these boosters. </p>
<p>Influenza and COVID-19 are expected to make headway during the current respiratory virus season in northern climates. Vaccination in conjunction with personal protective measures are the best means of staying healthy.</p><img src="https://counter.theconversation.com/content/193076/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sameer Elsayed does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Flu and COVID-19 are expected to make headway during the current respiratory virus season. The best way to stay healthy is vaccination in conjunction with personal protective measures.Sameer Elsayed, Professor of Medicine, Pathology & Laboratory Medicine, and Epidemiology & Biostatistics, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1925972022-10-30T12:21:24Z2022-10-30T12:21:24ZHow COVID-19 damages lungs: The virus attacks mitochondria, continuing an ancient battle that began in the primordial soup<figure><img src="https://images.theconversation.com/files/492284/original/file-20221028-37683-z5drng.jpeg?ixlib=rb-1.1.0&rect=18%2C9%2C2011%2C1578&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Red mitochondria in airway cells become coated with green SARS-COV-2 proteins after viral infection: Researchers discovered that the virus that causes COVID-19 damages lungs by attacking mitochondria.</span> <span class="attribution"><span class="source">(Stephen Archer)</span>, <span class="license">Author provided</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-covid-19-damages-lungs--the-virus-attacks-mitochondria--continuing-an-ancient-battle-that-began-in-the-primordial-soup" width="100%" height="400"></iframe>
<p>Viruses and bacteria have a very long history. Because viruses can’t reproduce without a host, they’ve been attacking bacteria for millions of years. Some of those <a href="https://doi.org/10.1016/0022-5193(67)90079-3">bacteria eventually became mitochondria</a>, synergistically adapting to life within eukaryotic cells (cells that have a nucleus containing chromosomes). </p>
<p>Ultimately, mitochondria became the powerhouses within all human cells. </p>
<p>Fast-forward to the rise of novel coronaviruses like SARS-CoV-2, and the <a href="https://coronavirus.jhu.edu/map.html">global spread of COVID-19</a>. <a href="http://doi.org/10.1056/NEJMoa2002032">Approximately five per cent of people infected with SARS-CoV-2 suffer respiratory failure (low blood oxygen)</a> requiring hospitalization. <a href="https://resources-covid19canada.hub.arcgis.com">In Canada about 1.1 per cent of infected patients (almost 46,000 people) have died</a>. </p>
<p>This is the story of how a team, assembled during the pandemic, recognized the mechanism by which these viruses were causing lung injury and lowering oxygen levels in patients: It is a throwback to the primitive war between viruses and bacteria — more specifically, between this novel virus and the evolutionary offspring of bacteria, our mitochondria.</p>
<p>SARS-CoV-2 is the third novel coronavirus to cause human outbreaks in the 21st century, following <a href="https://www.who.int/health-topics/severe-acute-respiratory-syndrome#tab=tab_1">SARS-CoV in 2003</a> and <a href="https://www.who.int/health-topics/middle-east-respiratory-syndrome-coronavirus-mers#tab=tab_1">MERS-CoV in 2012</a>. We need to better understand how coronaviruses cause lung injury to prepare for the next pandemic.</p>
<h2>How COVID-19 affects lungs</h2>
<p>People with severe COVID-19 pneumonia often arrive at the hospital with unusually low oxygen levels. They have two unusual features distinct from patients with other types of pneumonia:</p>
<ul>
<li>First, they suffer widespread injury to their lower airway (the alveoli, which is where oxygen is taken up). </li>
<li>Second, they shunt blood to unventilated areas of the lung, which is called ventilation-perfusion mismatch. This means blood is going to parts of the lung where it won’t get sufficiently oxygenated.</li>
</ul>
<p>Together, these abnormalities lower blood oxygen. However, the cause of these abnormalities was unknown. In 2020, our team of 20 researchers at three Canadian universities set about to unravel this mystery. <a href="https://doi.org/10.1161/circulationaha.120.047915">We proposed that SARS-CoV-2 worsened COVID-19 pneumonia by targeting mitochondria in airway epithelial cells (the cells that line the airways) and pulmonary artery smooth muscle cells</a>. </p>
<p>We already knew that mitochondria are not just the powerhouse of the cell, but also its main consumers and <a href="https://doi.org/10.1056/nejmra050002">sensors of oxygen</a>. Mitochondria control the process of programmed cell death (called apoptosis), and they regulate the distribution of blood flow in the lung by a mechanism called hypoxic pulmonary vasoconstriction. </p>
<p>This mechanism has an important function. It directs blood away from areas of pneumonia to better ventilated lobes of the lung, which optimizes oxygen-uptake. By damaging the mitochondria in the smooth muscle cells of the pulmonary artery, the virus allows blood flow to continue into areas of pneumonia, which also lowers oxygen levels. </p>
<p>It appeared plausible that SARS-CoV-2 was damaging mitochondria. The results of this damage — an increase in apoptosis in airway epithelial cells, and loss of hypoxic pulmonary vasoconstriction — were making lung injury and hypoxemia (low blood oxygen) worse. </p>
<p>Our discovery, <a href="https://doi.org/10.1016/j.redox.2022.102508">published in <em>Redox Biology</em></a>, explains how SARS-CoV-2, the coronavirus that causes COVID-19 pneumonia, reduces blood oxygen levels. </p>
<p>We show that SARS-CoV-2 kills airway epithelial cells by damaging their mitochondria. This results in fluid accumulation in the lower airways, interfering with oxygen uptake. We also show that SARS-CoV-2 damages mitochondria in the pulmonary artery smooth muscle cells, which inhibits hypoxic pulmonary vasoconstriction and lowers oxygen levels. </p>
<h2>Attacking mitochondria</h2>
<p>Coronaviruses damage mitochondria in two ways: by regulating mitochondria-related gene expression, and by direct protein-protein interactions. When SARS-CoV-2 infects a cell, it hijacks the host’s protein synthesis machinery to make new virus copies. However, these <a href="http://doi.org/10.1038/s41586-020-2286-9">viral proteins also target host proteins, causing them to malfunction</a>. We soon learned that many of the host cellular proteins targeted by SARS-CoV-2 were in the mitochondria. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490891/original/file-20221020-25-rozyzy.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cartoon with three panels: a coronavirus shooting arrows at mitochondria and spitting them in two; lungs and contrasting healthy and damaged lung cells; an oxygen meter with the needle in the red zone; and a human silhouette showing airways" src="https://images.theconversation.com/files/490891/original/file-20221020-25-rozyzy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490891/original/file-20221020-25-rozyzy.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490891/original/file-20221020-25-rozyzy.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490891/original/file-20221020-25-rozyzy.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490891/original/file-20221020-25-rozyzy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490891/original/file-20221020-25-rozyzy.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490891/original/file-20221020-25-rozyzy.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">How SARS-CoV-2 targets mitochondria to kill lung cells and prevent oxygen sensing.</span>
<span class="attribution"><span class="source">(drawn by Brooke Ring)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Viral proteins fragment the mitochondria, depriving cells of energy and interfering with their oxygen-sensing capability. The viral attack on mitochondria starts within hours of infection, turning on genes that break the mitochondria into pieces (called mitochondrial fission) and make their membranes leaky (an early step in apoptosis called mitochondrial depolarization). </p>
<p>In our experiments, we didn’t need to use a replicating virus to damage the mitochondria — simply introducing single SARS-CoV-2 proteins was enough to cause these adverse effects. This mitochondrial damage also occurred with other coronaviruses that we studied. </p>
<p>We are now developing drugs that may one day counteract COVID-19 by blocking mitochondrial fission and apoptosis, or by preserving hypoxic pulmonary vasoconstriction. Our drug discovery efforts have already enabled us to identify <a href="https://doi.org/10.1096/fj.201901467r">a promising mitochondrial fission inhibitor, called Drpitor1a</a>. </p>
<p>Our team’s infectious diseases expert, Gerald Evans, notes that this discovery also has the potential to help us understand Long COVID. “The predominant features of that condition — fatigue and neurologic dysfunction — could be due to the lingering effects of mitochondrial damage caused by SARS-CoV-2 infection,” he explains.</p>
<h2>The ongoing evolutionary battle</h2>
<p>This research also has an interesting evolutionary angle. Considering that <a href="https://doi.org/10.1016/0022-5193(67)90079-3">mitochondria were once bacteria, before being adopted by cells back in the primordial soup</a>, our findings reveal an Alien versus Predator scenario in which viruses are attacking “bacteria.”</p>
<p>Bacteria are regularly attacked by viruses, called bacteriophages, that need a host to replicate in. The bacteria in turn fight back, using an ancient form of immune system called the CRISPR-cas system, that chops up the viruses’ genetic material. Humans have recently exploited this CRISPR-cas system for <a href="https://www.synthego.com/blog/gene-editing-nobel-prize">a Nobel Prize-winning gene editing discovery</a>. </p>
<p>The ongoing competition between bacteria and viruses is a very old one; and recall that our mitochondria were once bacteria. So perhaps it’s not surprising at all that SARS-CoV-2 attacks our mitochondria as part of the COVID-19 syndrome.</p>
<h2>Pandemic pivot</h2>
<p>The original team members on this project are heart and lung researchers with expertise in mitochondrial biology. In early 2020 we pivoted to apply that in another field — virology — in an effort to make a small contribution to the COVID-19 puzzle. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/492257/original/file-20221028-27-7vme8l.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A grid of photographs of 25 scientists, and the three collaborating institutions (Queen's University, the Vaccine and Infectious Disease Organization (VIDO) and University of Toronto)" src="https://images.theconversation.com/files/492257/original/file-20221028-27-7vme8l.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492257/original/file-20221028-27-7vme8l.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=342&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492257/original/file-20221028-27-7vme8l.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=342&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492257/original/file-20221028-27-7vme8l.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=342&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492257/original/file-20221028-27-7vme8l.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=429&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492257/original/file-20221028-27-7vme8l.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=429&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492257/original/file-20221028-27-7vme8l.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=429&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The COVID team: The face of research. The diverse team includes members who came to Canada from India, Iran, England, Brazil, Iraq, China and Taiwan to pursue research here.</span>
<span class="attribution"><span class="source">(Stephen Archer)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="https://youtu.be/cJlAsFoTWLg">The diverse team we put together also brought expertise</a> in mitochondrial biology, cardiopulmonary physiology, SARS-CoV-2, <a href="https://www.phgfoundation.org/blog/what-is-transcriptomics">transcriptomics</a>, synthetic chemistry, molecular imaging and infectious diseases. </p>
<p>Our discovery owes a lot to our virology collaborators. Early in the pandemic, University of Toronto virologist Gary Levy offered us a mouse coronavirus (MHV-1) to work with, which we used to make a model of COVID-19 pneumonia. Che Colpitts, a virologist at Queen’s University, helped us study the mitochondrial injury caused by another human beta coronavirus, HCoV-OC43. </p>
<p>Finally, Arinjay Banerjee and his expert SARS-CoV-2 virology team at <a href="https://www.vido.org">Vaccine and Infectious Disease Organization (VIDO)</a> in Saskatoon performed key studies of human SARS-CoV-2 in airway epithelial cells. VIDO is one of the few Canadian centres equipped to handle the highly infectious SARS-CoV-2 virus. </p>
<p>Our team’s super-resolution microscopy expert, Jeff Mewburn, notes the specific challenges the team had to contend with.</p>
<p>“Having to follow numerous and extensive COVID-19 protocols, they were still able to exhibit incredible flexibility to retool and refocus our laboratory specifically on the study of coronavirus infection and its effects on cellular/mitochondrial functions, so very relevant to our global situation,” he said.</p>
<p>Our discovery will hopefully be translated into new medicines to counter future pandemics.</p><img src="https://counter.theconversation.com/content/192597/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen L Archer receives funding from the Canadian Institutes of Health Research for research on COVID-19. Dr Archer is convector on a patent for small molecule inhibitors of mitochondrial fission.</span></em></p>COVID-19 causes lung injury and lowers oxygen levels in patients because the SARS-CoV-2 virus attacks cells’ mitochondria. This attack is a throwback to a primitive war between viruses and bacteria.Stephen L Archer, Professor, Head of Department of Medicine, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1906902022-10-03T14:59:29Z2022-10-03T14:59:29ZSome coronaviruses kill, while others cause a common cold. We are getting closer to knowing why<figure><img src="https://images.theconversation.com/files/487040/original/file-20220928-20-v0xkqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some human coronaviruses cause seasonal colds or other mild symptoms. Others can be severe and even fatal.</span> <span class="attribution"><span class="source">Jdidi wassim/SOPA Images/LightRocket via Getty Images</span></span></figcaption></figure><p>It’s hard to imagine a time when “coronavirus” wasn’t a household word. But for a long time, this family of viruses had merited very little attention. Believed to be ubiquitous among <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543176/">animals and avian species</a>, the <a href="https://pubmed.ncbi.nlm.nih.gov/4158999/">first coronavirus to infect and cause disease in humans</a> was only isolated and identified in the 1960s. </p>
<p>Seven human coronaviruses <a href="https://www.nature.com/articles/s41579-020-00468-6">have been identified</a> since then.</p>
<p>Most cause only relatively minor health concerns: the common cold and seasonal respiratory infections that come around every year. But the 2003 outbreak in China and other parts of Asia of <a href="https://www.cdc.gov/sars/about/fs-sars.html">severe acute respiratory syndrome</a> (SARS), caused by SARS-CoV (now renamed as SARS-CoV-1), propelled the virus onto the global stage. Coronaviruses gained further infamy when, in 2012, cases of the much more severe <a href="https://www.mayoclinic.org/diseases-conditions/sars/expert-answers/what-is-mers-cov/faq-20094747nk">Middle East respiratory syndrome</a> (MERS) were identified in Saudi Arabia. </p>
<p>Both outbreaks were relatively contained. Not surprisingly, the concern over coronavirus diseases largely faded from the minds of ordinary people. The same was true for virologists, who focused their time and funding on more pressing viruses. Then in late 2019 came SARS-CoV-2, the causative agent of COVID-19. </p>
<p>Fortunately, some researchers had retained an interest in coronaviruses. After all, viruses can mutate and reappear, causing new outbreaks. One such cohort, ourselves among them, works at the University of the Western Cape in South Africa. Our laboratory had, among other things, been studying some of the structural proteins that are the building blocks of coronaviruses. These proteins - named spike, nucleocapsid, membrane, and envelope proteins - have different roles, but are essential to how coronaviruses reproduce, spread and cause disease.</p>
<p>In our <a href="https://www.mdpi.com/1999-4915/14/8/1707">most recent paper</a>, we examined what possibly sets the human coronaviruses that cause SARS, MERS and COVID-19 apart from the other human coronaviruses that cause milder diseases like seasonal colds. The answer, we argue, lies with the envelope protein.</p>
<h2>Shedding light on the E protein</h2>
<p>The envelope protein is possibly the most enigmatic and least-studied in the coronavirus-suite, owing to its small size and the difficulty of studying it in laboratory settings. In May 2019, two of us published a <a href="https://virologyj.biomedcentral.com/articles/10.1186/s12985-019-1182-0">review paper</a> on what was known about the envelope protein at the time.</p>
<p>The paper has racked up nearly 2,000 citations, most coming after the outbreak of COVID-19 – a testament less to our foresight than to the critical and previously understated role the envelope protein plays in human coronaviruses.</p>
<p>Even before the COVID-19 outbreak, based on what we had learnt from the SARS and MERS outbreaks, we were convinced that this protein – once written off as a “<a href="https://pubmed.ncbi.nlm.nih.gov/17530462/">minor component</a>” of the virus – was key to the development of disease. It is critical, for instance, in the final assembly of the virus, forming the envelope or wrapping that covers it when all its constituent components come together. </p>
<p>It also plays a role in the virus’s budding, when it exits from the host cell; and in the process known as pathogenesis, or the development and progression of the infection. </p>
<p>And it may hold a clue to either the <a href="https://doi.org/10.1371/journal.ppat.1004320">severity</a> or <a href="https://www.nature.com/articles/s41422-021-00519-4">relative mildness</a> of the disease. </p>
<p>Our <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2020.02086/full">ongoing</a> <a href="https://www.mdpi.com/1999-4915/13/8/1457">research</a> is beginning to suggest that the structure of the envelope protein may determine the severity of a coronavirus disease, or the difference between a blocked nose on the one hand, and collapsed lungs on the other. </p>
<h2>The sting in the protein’s “tail”</h2>
<p>This led us to our <a href="https://www.mdpi.com/1999-4915/14/8/1707">most recent paper</a>. We collaborated with structural bioinformatics expert Ruben Cloete, of the <a href="https://www.sanbi.ac.za/">South African National Bioinformatics Institute</a> at the University of the Western Cape, to develop full-length, 3D models of the envelope proteins of five human coronaviruses: SARS-CoV-1 and -2, and MERS-CoV (responsible for the severe SARS, COVID-19 and MERS diseases); and HCoV-229E and HCoV-NL63, responsible for milder diseases. For this work, we relied on a modelling program known as <a href="https://salilab.org/modeller/">MODELLER</a>, allowing us to explore the proteins in some detail.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/487472/original/file-20220930-19-6msqnn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487472/original/file-20220930-19-6msqnn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=495&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487472/original/file-20220930-19-6msqnn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=495&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487472/original/file-20220930-19-6msqnn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=495&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487472/original/file-20220930-19-6msqnn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=622&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487472/original/file-20220930-19-6msqnn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=622&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487472/original/file-20220930-19-6msqnn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=622&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">3D models of the envelope (E) protein for the human coronaviruses that cause SARS (SARS-CoV-1), COVID-19 (SARS-CoV-2), MERS (MERS-CoV), and the more seasonal common colds (HCoV-229E and HCoV-NL63).</span>
<span class="attribution"><span class="source">Authors supplied</span></span>
</figcaption>
</figure>
<p>We then used a web server, HADDOCK2.4, <a href="https://wenmr.science.uu.nl/haddock2.4/">to simulate</a> how the envelope protein interacts with the human PALS-1 protein – an interaction already shown to be critical with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2982091/">SARS-CoV-1</a>. Each of the envelope proteins could bind to the PALS-1 protein, but the coronaviruses causing SARS, MERS and COVID-19 appeared to bind more stably to PALS-1. </p>
<p>The answers, we believe, may lie in the conformation or shape of what’s known as the PDZ-binding motif, or PBM, which sits at the tail-end of the envelope protein. This PBM - essentially a distinctive sequence on a protein - acts like a one-of-a-kind key to a very specific lock (known as the PDZ domain) on a host cell protein. This ‘key’ allows the viral protein to interact with the host protein, making the disease worse.</p>
<p>We found that the more flexible, extended coil of the PBM of the coronaviruses behind SARS, MERS and COVID-19 viruses may well be what differentiates them from the more rigid PBM of the coronaviruses that cause milder diseases.</p>
<h2>Inner workings</h2>
<p>It is yet too early to draw definitive conclusions, as these findings will have to be confirmed with more studies – in the laboratory and in living organisms. </p>
<p>But it does shine some light on the inner workings of these coronaviruses and the still-enigmatic envelope protein. In so doing it could offer opportunities for the development of essential life-saving treatments and vaccines.</p><img src="https://counter.theconversation.com/content/190690/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dewald Schoeman received funding from National Research Foundation and the Poliomyelitis Research Foundation. </span></em></p><p class="fine-print"><em><span>Burtram C. Fielding receives funding from the National Research Foundation. </span></em></p><p class="fine-print"><em><span>Ruben Cloete receives funding from the Department of Higher Education and Training. </span></em></p>The enigmatic envelope protein seems to hold the key to understanding why some human coronaviruses cause more severe disease than others.Dewald Schoeman, PhD Candidate, Molecular Biology and Virology, University of the Western CapeBurtram C. Fielding, Dean Faculty of Natural Sciences and Professor, University of the Western CapeRuben Cloete, Lecturer in Bioinformatics, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1841662022-09-30T03:35:06Z2022-09-30T03:35:06ZNot just a joke: we scoured TikTok for anti-Asian humour during the pandemic, and found too many disappointing memes<figure><img src="https://images.theconversation.com/files/487222/original/file-20220929-16-yoa8yv.jpeg?ixlib=rb-1.1.0&rect=13%2C441%2C1849%2C2354&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Viviana Rishe/Unsplash</span></span></figcaption></figure><p>We live in deeply unequal societies where certain groups, such as racial and sexual minorities, continue to experience structural oppression. Humour targeted at these groups can cause individual harm through its <a href="https://www.unswlawjournal.unsw.edu.au/article/anti-vilification-laws-and-public-racism-in-australia-mapping-the-gaps-between-the-harms-occasioned-and-the-remedies-provided/">cumulative</a> effects, and contribute to broader social harms too.</p>
<p>Much of our social interaction today takes place online. So it makes sense that significant attention is paid to issues such as online <a href="https://theconversation.com/a-better-way-to-regulate-online-hate-speech-require-social-media-companies-to-bear-a-duty-of-care-to-users-163808">hate speech</a>, <a href="https://theconversation.com/tinder-fails-to-protect-women-from-abuse-but-when-we-brush-off-dick-pics-as-a-laugh-so-do-we-147909">harassment</a> and <a href="https://theconversation.com/why-is-it-so-hard-to-stop-covid-19-misinformation-spreading-on-social-media-134396">misinformation</a>.</p>
<p>However, a more challenging problem is the conduct of users who aren’t necessarily <em>trying</em> to harm others, but still participate online in ways that <a href="https://ir.lib.uwo.ca/commpub/12/">can do so</a>. For example, TikTok users have participated in viral parody challenges that trivialise <a href="https://www.popbuzz.com/internet/tiktok/arrested-challenge-trend-police-videos/">police brutality</a>, <a href="https://www.teenvogue.com/story/tiktok-fake-mugshots-challenge">domestic violence</a> and even <a href="https://www.teenvogue.com/story/holocaust-tiktok-challenge-backlash">the Holocaust</a>.</p>
<p>The COVID-19 health crisis pushed digital platforms to <a href="https://abcnews.go.com/Technology/social-media-companies-partnering-health-authorities-combat-misinformation/story?id=69389222">curb the spread</a> of misinformation, but it seems they did less to minimise <a href="https://asia.nikkei.com/Business/Technology/Social-media-chiefs-grilled-in-US-Congress-over-anti-Asian-content">anti-Asian content</a> – despite <a href="https://www.nytimes.com/2020/03/23/us/chinese-coronavirus-racist-attacks.html">signs</a> the pandemic was being “<a href="https://www.tandfonline.com/doi/full/10.1080/09502386.2021.1905678">racialised</a>”.</p>
<p>In our research, <a href="https://www.cogitatiopress.com/mediaandcommunication/article/view/5154">we investigated</a> how the “humorous” racist stereotyping of people of Asian descent emerged on TikTok during the pandemic, and how such behaviour should be addressed.</p>
<h2>TikTok and racial humour</h2>
<p>TikTok has become hugely popular across generations. Its “use this sound” feature allows users to remix audio from other videos, making it a unique platform to study racist stereotyping. </p>
<p>For our research we collected TikTok videos posted from January to June in 2020, with the hashtag #coronavirus, and other hashtags relevant to our research (such as “#asian” and “#funny”, for example).</p>
<p>We also included videos tagged with keywords related to China (#china, #chinacoronavirus, #wuhan) and with #Australia, to potentially collect examples from within the country (which has a history of <a href="https://www.tandfonline.com/doi/abs/10.1080/07256868.2014.899948">anti-Asian racism</a>).</p>
<p>Once we removed duplicates, unavailable videos, and videos in a language other than English, we obtained a dataset of 639 TikTok videos. After closely analysing these, we found 93 videos displayed examples of racist humour.</p>
<h2>‘Yellow peril’ memes</h2>
<p>Among the videos were “yellow peril” memes. These were about people or objects being “contaminated” with coronavirus by extension of their connection to China, or other Asian countries. The “<a href="https://www.politybooks.com/bookdetail?book_slug=asian-americans-and-the-media-media-and-minorities--9780745642734">yellow peril</a>” trope dehumanises people from Asian countries by posing them as a threat to Western countries.</p>
<p>Three types of “yellow peril” memes were noticed in our sample:</p>
<ol>
<li>memes targeting people of Asian descent as being the cause of coronavirus spreading</li>
<li>memes where people react in horror or disgust when they receive packages or goods from China </li>
<li>memes that blame the coronavirus on practices such as eating wild animals. </li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/asian-american-mothers-confront-multiple-crises-of-pandemic-anti-asian-hate-and-caregiving-179162">Asian American mothers confront multiple crises of pandemic, anti-Asian hate and caregiving</a>
</strong>
</em>
</p>
<hr>
<h2>“Digital yellowface” parodies</h2>
<p>We also found a form of “digital yellowface”. In these videos users applied the “use this sound” feature to parody Asian accents in English or say “Asian sounding words” by speaking gibberish, or words like “Subaru” (the Japanese car brand) in an exaggerated way.</p>
<p>Some users dramatised their face to further embody the offensive caricature they were trying to portray.</p>
<p>Scholars researching racist stereotyping online have <a href="https://www.google.com.au/books/edition/White_Negroes/pOW2DwAAQBAJ?hl=en&gbpv=1&printsec=frontcover">warned</a> that “certain dialects, vocal ranges, and vernacular are deemed noisy, improper, or hyperemotional by association with blackness”. </p>
<p>During COVID-19, non-Asian users appropriated “Asian sounds” on TikTok in a similar way. They portrayed people of Asian descent as irrational or overly emotional, reducing an entire racial group to a mere caricature. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/487021/original/file-20220928-17-s2i3ld.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Still from Breakfast at Tiffany's with Mickey Rooney's racist portrayal of 'Mr Yunioshi'" src="https://images.theconversation.com/files/487021/original/file-20220928-17-s2i3ld.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487021/original/file-20220928-17-s2i3ld.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=339&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487021/original/file-20220928-17-s2i3ld.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=339&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487021/original/file-20220928-17-s2i3ld.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=339&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487021/original/file-20220928-17-s2i3ld.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=426&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487021/original/file-20220928-17-s2i3ld.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=426&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487021/original/file-20220928-17-s2i3ld.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=426&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Actor Mickey Rooney did ‘yellowface’ in the 1961 film Breakfast at Tiffany’s – a depiction that’s now rightly considered very racist.</span>
<span class="attribution"><span class="source">Wiki Commons</span></span>
</figcaption>
</figure>
<h2>What has TikTok done?</h2>
<p>TikTok has enabled users to willingly or unwillingly contribute to racist discourse that dehumanised Chinese people, and other Asian people, over the course of the pandemic. </p>
<p>We are not claiming a direct causal link between this racist stereotyping and real-world violence. But research has shown attaching an illness to an historically marginalised group has immediate and longer-term <a href="https://utpjournals.press/doi/10.3138/topia.16.23">negative social effects</a> in societies.</p>
<p>Although TikTok <a href="https://newsroom.tiktok.com/en-ie/tiktok-joins-the-code-conduct-on-countering-illegal-hate-speech-online">joined</a> the European Commission’s Code of Conduct on Countering Illegal Hate Speech Online in 2020, its policies still do not provide a detailed explanation of when humour can have the capacity to harm. </p>
<p>To improve the moderation of harmful humour, TikTok could modify its community guidelines and reporting processes to acknowledge the way humour targeted at historically-marginalised groups can have severe consequences.</p>
<p>This would be similar to Facebook’s expansion of its hate speech policy in 2020 to include <a href="https://www.theverge.com/2020/8/11/21363890/facebook-blackface-antisemitic-stereotypes-ban-misinformation">harmful stereotypes</a> (which came after the platform consulted with advocacy groups and experts).</p>
<p>TikTok’s moderation of racialised harmful humour doesn’t necessarily have to entail takedowns and user bans. There are several other <a href="https://repository.law.umich.edu/mtlr/vol28/iss1/2/">remedies</a> available. The platform could:</p>
<ul>
<li>educate users by tagging or labelling dubious or potentially harmful content</li>
<li>reduce the visibility of content through algorithmic demotion</li>
<li>restricting engagement functionalities on “humorous” content that’s likely to cause harm.</li>
</ul>
<p>One thing’s for sure: we can no longer excuse racism under the guise of humour. Beyond individuals, social media platforms have a responsibility to make sure they address racist humour, since it can and does cause <a href="https://www.youtube.com/watch?v=_w4J9XRMhpE&ab_channel=ABC7">real harm</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-corn-how-the-online-viral-corn-kid-is-on-a-well-worn-path-to-fame-in-the-child-influencer-industry-189974">It’s corn! How the online viral ‘Corn Kid’ is on a well-worn path to fame in the child influencer industry</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://theconversation.com/au/topics/social-media-and-society-125586" target="_blank"><img src="https://images.theconversation.com/files/479539/original/file-20220817-20-g5jxhm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=144&fit=crop&dpr=1" width="100%"></a></p><img src="https://counter.theconversation.com/content/184166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Anti-Asian memes spread on TikTok during the pandemic, and the potential for harm is real. It’s about time platforms scrutinised such ‘humour’ more closely.Ariadna Matamoros-Fernández, Senior Lecturer in Digital Media at the School of Communication, Queensland University of TechnologyAleesha Rodriguez, Research Fellow at Australian Research Council Centre of Excellence for the Digital Child, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1902562022-09-23T03:03:59Z2022-09-23T03:03:59ZAfrican newspapers can be anti-African too: what my research found<figure><img src="https://images.theconversation.com/files/485562/original/file-20220920-19-awmqty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ebola news was the top story in Nigeria in early August 2014.</span> <span class="attribution"><span class="source">Photo by Mohammed Elshamy/Anadolu Agency/Getty Images</span></span></figcaption></figure><p>Following the recent outbreak of <a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html">monkeypox in Europe and North America</a> the international news media were accused of <a href="https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2022/may/20220522_PR_Monkeypox">bias in their reporting</a>. The accusation is that media outlets perpetuated negative stereotypes by, for example, portraying monkeypox as a disease that affects only African people, or people of African descent. </p>
<p>The accusations stem from editorial decisions to use stock images of Africans, people of African descent, or people living in Africa, when reporting an outbreak that predominantly affected countries in the global north. </p>
<p>The Foreign Press Association, Africa <a href="https://twitter.com/fpa_africa/status/1527990596044001282">said</a> these types of reports showed a “glaring lack of dignity afforded to black and brown-skinned victims of disease outbreaks.” </p>
<p>Numerous pieces of research have shown that western media <a href="https://www.jstor.org/stable/490566">misrepresent Africa</a> when reporting on diseases, and portray the west as superior and Africa as inferior. </p>
<p>My findings, in a <a href="https://link.springer.com/chapter/10.1007/978-3-030-95100-9_10#DOI">recently published paper</a>, show that African publications can be just as guilty of this. I looked at media coverage of the 2014 Ebola outbreak as well as the COVID-19 2020 pandemic in two newspapers – the South African daily, the <a href="https://www.sowetanlive.co.za/">Sowetan</a> and the Nigerian daily broadsheet, the <a href="https://dailytrust.com/">Daily Trust</a>. Both papers reported on both outbreaks.</p>
<p>I also reviewed literature that looked at news reports on diseases such as HIV and AIDS as well as cancer.</p>
<p>My research showed that the reporting misrepresented Africa, and portrayed Africans as inferior and dangerous. In doing this, they perpetuated an ideology of othering that emphasises the west as superior and Africa as inferior.</p>
<h2>The analysis</h2>
<p>I looked at the language used in these newspapers, as well as the volume of coverage by subject matter and by country. I considered close to 200 news reports on the 2014 Ebola outbreak and the 2020 coronavirus outbreak published by the Daily Trust and the Sowetan. They are among the most widely read and distributed in <a href="https://content.app-sources.com/s/49873730264296551/uploads/Novus_Group_Documents_/South_African_Print_Media_Landscape_Report_-_July_2021-9316612.pdf">their respective countries</a>. </p>
<p>I chose to focus on two 31-day periods: 1 August 2014 to 31 August 2014 for Ebola and 23 March 2020 to 23 April 2020 for the COVID-19 pandemic. These periods were chosen because they marked significant developments in the Ebola and coronavirus outbreaks. My focus was on how language and images were used.</p>
<p>I quantified the coverage: first in terms of continents and then on a country-by-country basis. </p>
<p>Figure 1 shows the number of news reports on the 2014 Ebola and 2020 coronavirus outbreaks at continental level. Figure 2 breaks this down further and shows which countries received the most coverage in the publications and period considered. </p>
<iframe title="News reports by continent" aria-label="Stacked Bars" id="datawrapper-chart-JPLHj" src="https://datawrapper.dwcdn.net/JPLHj/1/" scrolling="no" frameborder="0" style="width: 0; min-width: 100% !important; border: none;" height="292" width="100%"></iframe>
<p>When it came to the 2020 coronavirus outbreak, three of the four most reported on countries were western countries – America, Italy and England. All had very high rates of infection and death. The fourth most mentioned country was China, where the outbreak originated. </p>
<iframe title="News reports by country" aria-label="Grouped Bars" id="datawrapper-chart-Y8O2H" src="https://datawrapper.dwcdn.net/Y8O2H/3/" scrolling="no" frameborder="0" style="width: 0; min-width: 100% !important; border: none;" height="525" width="100%"></iframe>
<p>While this could have been expected, the contrast with Africa is marked because individual countries weren’t mentioned even though the continent overall received a great deal of coverage. The conclusion is that for these publications, developments in individual African countries were not prioritised to the same degree as developments in individual western states.</p>
<p>Next I analysed the headlines and the body of the articles to understand how words were used. The framework I used, <a href="https://sk.sagepub.com/books/ideology">known as the ideological square</a>, is rooted in a view of language-use as something that advances ideology, particularly in how it includes and esteems through references to “us” and excludes or disparages through reference to “them”. </p>
<p>This “us vs them” perspective is commonly known as <a href="https://discourses.org/wp-content/uploads/2022/06/Teun-A.-van-Dijk-1991-Racism-And-the-Press.pdf">othering or otherness</a>. </p>
<p>Language that alludes to “us” is associated with favourable properties, while language that alludes to “them” is associated with negative properties.</p>
<p>I found examples of this in news reports on specific individuals who were infected or died due to either of these two viruses. The tendency was to emphasise the humanity and positive traits of affected western individuals while either anonymising or writing negatively about African individuals. This was particularly evident in news reports on Ebola.</p>
<p>Take the reporting on the first European Ebola victim <a href="https://www.pressreader.com/nigeria/daily-trust/20140808/281702612862873">as reported</a> in The Daily Trust.</p>
<blockquote>
<p>The first European infected by a strain of Ebola that has killed more than 932 people in West Africa, Spanish priest Miguel Pajares, was stable in Madrid.</p>
</blockquote>
<p>The infected person is named, and the report goes as far as to tell us he is a priest, a role that carries positive connotations. </p>
<p>But reporting on the first Ebola victim in Nigeria used words like <a href="https://www.pressreader.com/nigeria/daily-trust/20140813/281483569537959/textview">“importer” and “suspect”</a>.</p>
<p>My research showed other differences too. For example, when it came to the coronavirus, the <a href="https://www.news24.com/news24/analysis/fact-check-africa-didnt-fare-better-during-covid-than-rest-of-the-world-20220906">fact</a> that African countries kept deaths and infections to a minimum was de-emphasised. Instead, the emphasis was on the donations western countries were making to African countries.</p>
<p>When it came to the economic impact of the coronavirus outbreak, the reports emphasised <a href="https://www.pressreader.com/nigeria/daily-trust/20200324/page/8">pessimistic forecasts</a> on how African countries would be affected.</p>
<p>Finally, when it came to domestic developments in different countries, the emphasis was on what was going right in western countries and what was going wrong in African countries. An example was that there were no news reports on the public outcry against government lockdown in western nations. But <a href="https://www.bbc.com/news/world-africa-52268320">there</a> were <a href="https://mg.co.za/article/2020-04-08-is-lockdown-wrong-for-africa/">several about African countries</a>.</p>
<h2>Insights</h2>
<p>The outbreak of a disease, whether local or global, is not merely a public health matter. It is also a health communication issue, as people need information to help them respond. Established information sources, such as newspapers, become critical in shaping how the public understands and responds to the crisis.</p>
<p>But media sources play another role too – they frame how issues are seen. My research confirmed that the coverage perpetuated the “us versus them” ideology. The articles reflected negative self-representation of the African continent and positive other-representation of western countries in the same way as western newspapers often do.</p><img src="https://counter.theconversation.com/content/190256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sisanda Nkoala is a past grant recipient of funding from the National Research Foundation</span></em></p>African media also emphasise the west as superior and Africa as inferior.Sisanda Nkoala, Senior Lecturer, Cape Peninsula University of TechnologyLicensed as Creative Commons – attribution, no derivatives.