tag:theconversation.com,2011:/uk/topics/epidemiology-1854/articlesEpidemiology – The Conversation2024-03-07T21:28:26Ztag:theconversation.com,2011:article/2218262024-03-07T21:28:26Z2024-03-07T21:28:26ZWhy ‘One Health’ needs more social sciences: Pandemic prevention depends on behaviour as well as biology<p>On March 11, 2024, <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">it will be four years since the World Health Organization characterized the SARS-CoV-2 outbreak as a pandemic</a>. And while COVID-19 continues to impact people globally, it is only the most recent in a long history of pandemics with likely origins in animals. Examples include <a href="https://www.cdc.gov/plague/transmission/index.html">plague</a>, which usually spreads from rodents to humans via infected fleas, and the 2009 <a href="https://www.cdc.gov/h1n1flu/general_info.htm">H1N1 flu</a>, also known as swine flu due to its <a href="https://doi.org/10.7554/eLife.16777">origins in pigs</a>. </p>
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<img alt="Purple spikes covered with a mossy yellow-green substance" src="https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.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">
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<span class="caption">Microscopic view of Yersinia pestis bacteria, which causes bubonic plague, in a flea.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>Given the animal origins of past pandemics, as well as the many recent cases of disease in people linked to animals — such as <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON497">anthrax</a>, <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON506">Middle East respiratory syndrome</a> and <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON504">avian influenza virus</a> — it is very likely that the next pandemic will again originate in animals. </p>
<p>In fact, <a href="https://doi.org/10.3390%2Fmicroorganisms8091405">over 60 per cent of emerging infectious diseases in people originate in animals. Among these, more than 70 per cent are associated with wildlife</a>. Our close interactions with animals and our shared environment is a major factor for why and how these pathogens spill over. </p>
<h2>Pandemic prevention</h2>
<p>Recognizing our interconnected health, there have been increased calls for <a href="https://doi.org/10.1016/S0140-6736(24)00066-7">primary pandemic prevention</a>, which focuses on reducing the chance of an outbreak occurring by preventing the spread of pathogens from animals to people.</p>
<p>One framework for primary pandemic prevention is called “One Health.” One Health recognizes the close links among human, animal and environmental health, whereby promoting health in one part of this triad promotes the health of all. </p>
<p>While this concept of interconnected health has gained awareness in western science in the past century, it is not new. Instead, it is a reflection of what <a href="https://doi.org/10.1126/science.abe2401">Indigenous Peoples have known and practised for millennia</a>. </p>
<h2>One Health</h2>
<p>Global recognition of One Health has been steadily increasing. For example, the formation of the <a href="https://globalohc.org/what-is-one-health">Quadripartite</a> — which consists of global organizations including the <a href="https://www.fao.org/home/en">Food and Agriculture Organization of the United Nations</a>, the <a href="https://www.unep.org/">United Nations Environment Programme</a>, the World Health Organization, and the <a href="https://www.woah.org/en/home/">World Organisation for Animal Health</a> — has been focused on mobilizing One Health. The Quadripartite is advised by the <a href="https://www.who.int/groups/one-health-high-level-expert-panel/members">One Health High Level Expert Panel</a>. </p>
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<img alt="Gloved hands injecting a cow" src="https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.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">
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<span class="caption">A veterinarian vaccinates cattle against disease. Understanding farmers’ barriers to vaccinating livestock is key to successful disease prevention.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Yet despite the interdisciplinary nature of One Health, many initiatives are still falling short. Discussions and decisions about One Health issues are often dominated by veterinary and human health sciences, sidelining the social sciences <a href="https://doi.org/10.1016/j.socscimed.2014.09.048">despite the crucial role</a> of disciplines like psychology, sociology, and communications in understanding human behaviour. </p>
<p>Social science researchers aim to understand people — their perceptions and concerns, their histories, their socio-political, cultural and environmental contexts, and their knowledge — with a view to understanding how structural disparities affect personal and societal behaviour, health and political power.</p>
<p>In interdisciplinary fields such as One Health, this understanding is paramount. One Health interventions include measures such as the vaccination of livestock to prevent spillover events to people, such as <a href="https://doi.org/10.1038/s41541-023-00769-w">Rift Valley fever</a>, which can affect both animals and humans. </p>
<p>The success of these interventions hinges not only on vaccine efficacy, but also on societal factors. For example, social scientists uncover <a href="https://doi.org/10.1371%2Fjournal.pone.0256684">barriers faced by farmers in accessing livestock vaccination services</a>. This ultimately improves access and ensures widespread livestock immunization, and therefore contributes to the primary prevention of future pandemics.</p>
<h2>Recognizing intersections</h2>
<p>Another key factor contributing to the successful implementation of One Health interventions is understanding gender dynamics in society. Often women bear the disproportionate caregiving burden, which impacts their access to health care for themselves and their livestock. Gender roles and responsibilities may also decide who interacts closely with animals, affecting possible disease exposure risks as well as <a href="https://doi.org/10.1080/13552074.2015.1096041">narrowing down the target group for educational efforts</a>. </p>
<p>Recognizing these intersections is crucial for developing inclusive and effective interventions.</p>
<p>And while animals may be the potential source of a future pandemic, it is also important to recognize the important positive contributions wildlife have made to our health and well-being, including their roles in the economy and <a href="https://www.indigenousfoodsystems.org/food-sovereignty">food security</a>, as well as their cultural significance. </p>
<p>The perception that animals are a threat to humans can lead to heightened public fears and apprehensions about wildlife, potentially reducing <a href="https://doi.org/10.1093/ilar.51.3.255">support for wildlife conservation</a>. </p>
<p>Addressing this issue requires a deeper understanding of public perceptions, values, priorities and behaviours — emphasizing the <a href="https://doi.org/10.7589/2014-01-004">necessity of integrating social science</a> in the development of informed, relevant and sustainable surveillance of potential infectious disease in wildlife and conservation programs. </p>
<h2>An interdisciplinary approach to pandemic prevention</h2>
<p>Even beyond the role of social science in understanding the complex systems in which health risks occur, social science can also bridge communication gaps between researchers, policymakers and communities. By integrating social science into One Health approaches, we ensure that initiatives are not only scientifically sound, but also socially and culturally acceptable, appropriate and equitable for all rights holders involved.</p>
<p>A movement towards a true, interdisciplinary and holistic approach to primary pandemic prevention will need a proactive approach to health and well-being instead of a reactive one. It will also require us to critically examine our current health systems to identify innovative solutions to ensure its resilience. </p>
<p>We need to mobilize information and understanding across knowledge systems and elevate the critical role of social sciences to meaningfully integrate One Health into primary pandemic prevention in Canada.</p><img src="https://counter.theconversation.com/content/221826/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kaylee Byers receives funding from the Public Health Agency of Canada to strengthen communications and knowledge mobilization of One Health issues. </span></em></p><p class="fine-print"><em><span>Sarah Robinson receives funding from the Public Health Agency of Canada to strengthen communications and knowledge mobilization of One Health issues.</span></em></p><p class="fine-print"><em><span>Lara Hollmann and Salome A. Bukachi 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>Pandemics often have animal origins, so prevention is often dominated by health and veterinary sciences. However, social sciences’ role in understanding human behaviour is also crucial to prevention.Kaylee Byers, Assistant Professor, Faculty of Health Sciences; Senior Scientist, Pacific Institute on Pathogens, Pandemics and Society, Simon Fraser UniversityLara Hollmann, Research Fellow, Pacific Institute on Pathogens, Pandemics and Society, Simon Fraser UniversitySalome A. Bukachi, Associate professor, Institute of Anthropology, Gender and African Studies, University of NairobiSarah Robinson, Postdoctoral Fellow, Pacific Institute on Pathogens, Pandemics and Society, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2194892024-01-15T20:13:26Z2024-01-15T20:13:26ZIs economic growth good for our health?<figure><img src="https://images.theconversation.com/files/569373/original/file-20240115-45156-73jxzx.jpg?ixlib=rb-1.1.0&rect=281%2C140%2C6428%2C4255&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Given how wealth contributes to health on the personal, individual level, the case for economic growth being good for us might seem intuitive.</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/is-economic-growth-good-for-our-health" width="100%" height="400"></iframe>
<p>Is <a href="https://www.investopedia.com/terms/e/economicgrowth.asp">economic growth</a> good for us? Put another way, we know that growing the economy is good for business and for creating jobs. But does it help everyone in society? One way to answer this question is to explore what it does for population health. </p>
<p>Our health is one of the most important aspects of our lives, considering how it affects our everyday comfort and ability to survive. Given how wealth contributes to health <a href="https://doi.org/10.1177/0022146510383498">on the personal, individual level</a>, the case for economic growth might seem intuitive. </p>
<p>However the picture gets murkier when looking at income <em>per capita</em>, where people both rich and poor depend upon a fluctuating economy. </p>
<p>There are also problems of interpretation. Most financial advice includes the disclaimer that the past does not predict the future. The <a href="https://doi.org/10.1093/jhmas/jrr076">same may be true</a> of the relationship between growth and population health. </p>
<h2>Economics and life expectancy</h2>
<p>There is a reliable <a href="https://doi.org/10.1111/ssqu.12638"><em>historical</em> correlation</a> between economic prosperity and trends in life expectancy, which is enough for many scholars to suggest that growth is generally a good thing. However, this is not to say that we can expect continued improvements in health whenever we see economic growth. </p>
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<img alt="Miniature human figures walking on a bar graph" src="https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&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">Long-term historical trends show a very strong correlation between economic growth and increasing life expectancy.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p><a href="https://doi.org/10.1007/s42650-023-00072-y">As I argue in a recent paper</a>, a lot of this has to do with how governments understand growth: its purpose, how to get it, what to do with it once it happens.</p>
<p>As a political sociologist and epidemiologist, I understand health as a fundamentally political problem. I am not alone in this; scholars have connected politics to population health <a href="https://doi.org/10.1093/epirev/mxp002">since ancient times</a>. Nor is this an outmoded idea. Far from it. As of the time of this writing, after searching for the terms “politics” and “health” it seems Google has stopped counting at two billion hits.</p>
<h2>Politics and economics</h2>
<p>Economic growth is also a political subject — the inevitable talking point for candidates on the campaign trail. The problem is that too many scholars have come forward with concerns that growth can be <em>bad</em> for our health. </p>
<p>A <a href="https://doi.org/10.4324/9780203994320">classic sociological study published in 1897</a> found that suicide rates spike after sudden improvements in a society’s economic prosperity. <a href="https://doi.org/10.1016/S0167-6296(03)00041-9">Similar observations</a> come a century later, linking growth with an increase in poor health outcomes. There is also evidence that economic growth <a href="https://doi.org/10.1093/bmb/ldh005">harms public health</a> when governments do not plan for it carefully. </p>
<p>And then there is the story as economists tell it. A prevailing economic theory has supported <a href="https://www.investopedia.com/ask/answers/032415/what-are-some-ways-economic-growth-can-be-achieved.asp">tax cuts, trimming budgets, deregulation and other business-friendly policies</a>, but more and more economists are <a href="https://www.nytimes.com/2009/09/06/magazine/06Economic-t.html">recognizing that these tactics</a> can harm societies and <a href="https://www.imf.org/external/pubs/ft/fandd/2016/06/ostry.htm">even pose obstacles to growth</a>. </p>
<p>How, then, can these misgivings be harmonized with the long-term historical trends, which show a very strong correlation between economic growth and increasing life expectancy? This was the question I set out to answer in my recent research.</p>
<p>The answer to whether or not economic growth improves population health seems to be, “It depends.” More precisely, it’s a <em>qualified</em> yes: economic growth promotes health in <em>some</em> respects, for <em>some</em> countries, and <em>only in conjunction with other life-saving priorities</em>. </p>
<h2>Priorities and population health</h2>
<p>Arguably, many growing societies happen to be the same ones that <a href="https://doi.org/10.1111/padr.12141">invested in education</a> and other beneficial infrastructures, which explains the correlation with health. </p>
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<img alt="Group of graduates standing in a row wearing caps and gowns holding diplomas" src="https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.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">
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<span class="caption">Arguably, many growing societies happen to be the same ones that invested in education and other beneficial infrastructures, which explains the correlation with health.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>By the same token we cannot expect better health to come from economic growth if the pursuit of growth ends up <a href="https://doi.org/10.1016/j.socscimed.2010.04.002">increasing income inequality</a>. Nor can we expect better health after slashing budgets allocated to key priorities such as education or health care. </p>
<p>Greece, for example, learned a hard lesson about austerity when its cuts to health-care programs for drug users resulted in a <a href="https://doi.org/10.1016/S0140-6736(13)62291-6">steep increase in HIV infections</a>.</p>
<p>And then there is the issue of how health is defined. When looking beyond life expectancy, other patterns emerge. </p>
<p>Medical research has found that economic development worsens cancer rates for example. <a href="https://doi.org/10.1016/j.ecolecon.2017.11.031">One recent study</a> links economic prosperity to higher incidence of most major cancer types. The authors suspect this may be an issue of industrialization, and they have a point. The rise of modern industry came with the innovation of <a href="https://doi.org/10.1016/j.biopha.2007.10.006">innumerable toxic substances</a>, many of which are suspected carcinogens. </p>
<h2>A better way to grow</h2>
<p>Such findings prompt the question of whether there is a better way to grow. For many researchers, the answer is obvious and the case for it clear: Yes. Absolutely.</p>
<p>The takeaway here would seem to be that growth <em>can</em> be good for health. However, it should by design benefit the ordinary citizens it presumes to serve. I and other researchers (including prominent economists like <a href="https://doi.org/10.1016/S0140-6736(99)90363-X">Amartya Sen</a>) agree that systems for education, health care and welfare, which support the everyday Jane, are the very <a href="http://dx.doi.org/10.1080/1464988032000051487">engines of growth</a>. This is because they enhance workforce capability and local purchasing power. They also promote health. </p>
<p>Investing in the systems that support populations — their earnings capability, their quality of life — appear to result in both growth and health. However, neglecting these priorities may well result in neither outcome.</p><img src="https://counter.theconversation.com/content/219489/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew C. Patterson 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 historical correlation between economic prosperity and increased life expectancy might suggest that growth is generally a good thing. However, other evidence points to the downside of growth.Andrew C. Patterson, Assistant Professor of Sociology, MacEwan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168382023-11-22T14:35:36Z2023-11-22T14:35:36ZPatients’ beliefs about illness matter: the case of elephantiasis in rural Ghana<p>Would you take medication for an illness you didn’t believe you had? Or if you disagreed with healthcare workers about the cause of your condition? </p>
<p>This is the dilemma of many people who live in areas of Ghana where a mosquito-borne disease called <a href="https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis#:%7E:text=Lymphatic%20filariasis%2C%20commonly%20known%20as,damage%20to%20the%20lymphatic%20system">lymphatic filariasis</a>, often referred to as elephantiasis, continues to spread. </p>
<p>Lymphatic filariasis, or LF as it is commonly known, is a neglected tropical disease which spreads through repeated bites by parasite-carrying mosquitoes. This infection results in the painful and debilitating swelling of legs, arms and genitals, and increases vulnerability to injury and secondary infections. </p>
<p>Although little known, lymphatic filariasis is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246437">significant</a>
and <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30323-5/fulltext">under-addressed</a> global cause of disability. According to the World Health Organization at least<a href="https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis"> 51 million</a> people are infected with lymphatic filariasis. </p>
<p>The World Health Organization’s <a href="https://www.who.int/teams/control-of-neglected-tropical-diseases/lymphatic-filariasis/global-programme-to-eliminate-lymphatic-filariasis">Global Programme for Elimination of Lymphatic Filariasis</a> has greatly reduced the burden of the disease through preventive mass drug campaigns, mosquito control, veterinary public health and sanitation and hygiene measures.</p>
<p>Despite this concerted effort, however, lymphatic filariasis continues to be endemic and require mass drug administration in <a href="https://academic.oup.com/inthealth/article/13/Supplement_1/S22/6043665">31</a> African countries. The challenges to eradicating it are not well understood, and may hinge on better understanding how people with this disease view their condition. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/why-its-hard-to-end-elephantiasis-a-debilitating-disease-spread-by-mosquitoes-166627">Why it's hard to end elephantiasis, a debilitating disease spread by mosquitoes</a>
</strong>
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<p>Our research team brings together specialists in epidemiology, public health and human rights. In our recently published paper in <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002476">PLOS Global Public Health</a> we take a different approach to the conventional medical focus that dominates research and interventions for this disease. </p>
<p>We examined the local perceptions and beliefs about the disease
and the personal experiences of those living with it in three rural communities in Ghana’s Ahanta West district. This coastal district in Ghana’s Western Region has a high rate of lymphatic filariasis infection and many people living with advanced stages of the disease. </p>
<p>Members of our research team had worked in this area for more than a decade, establishing the trust relationships that made this research possible.</p>
<p>Our findings may help provide insight into why lymphatic filariasis persists in certain settings and how best to tackle it.</p>
<h2>Cold, rain and curses</h2>
<p>We found that only <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002476">18%</a> of respondents understood lymphatic filariasis as a disease. Fewer than 7% believed it to be a disease spread by mosquitoes. </p>
<p>Instead, people held a range of alternative beliefs attributing the condition to other sources, including spiritual causes (curses, witchcraft, evil spirits), cold or rainy weather, and other illnesses. In subsequent interviews, people described how, from their perspective, they encountered the disease. </p>
<p>One person explained, “When you are cold, then your leg gets swollen.” </p>
<p>Another noted, “There are some who just get jealous of and develop hatred for people for just walking and going about their normal duties and decide that they do not want this person or that person to progress, hence they buy the disease for them spiritually.” They added, “I strongly believe and have the conviction that someone bought mine for me spiritually.”</p>
<p>In contrast with these beliefs, which show very limited overlap with medical explanations, nearly half (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709921">45.8%</a>) of respondents reported receiving information about the disease from healthcare workers or drug campaigns. </p>
<p>These findings suggest we need to learn more about local beliefs in health and wellbeing in order to achieve more effective communication with patients. </p>
<p>Our research also demonstrates lymphatic filariasis is not only a medical condition, but also a social and economic one. </p>
<h2>Ashamed and stigmatised</h2>
<p>Almost <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002476">80%</a> of respondents reported feeling ashamed or stigmatised by their condition. Some said it restricted their social lives and their willingness to go out in public. </p>
<p>Infection also limited the ability to earn a living. More than a third (<a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002476">36.2%</a>) said they could no longer work due to their condition. Many reported a need to depend on others for financial support. </p>
<p>Among those surveyed less than 3% reported that they were “doing well”. </p>
<p>These findings show an urgent need to address the unmet social, mental health and economic impacts of lymphatic filariasis.</p>
<h2>What needs to be done</h2>
<p>Drug campaigns are important but cannot be done in isolation. Existing research shows us that these <a href="https://academic.oup.com/inthealth/article/13/Supplement_1/S55/6043672">are more successful when offered in a broader context of care</a>. </p>
<p>Healthcare workers must be trained to avoid stigmatising patients. But eliminating stigma is not a simple task, nor can it be left to healthcare workers alone.</p>
<p>Further research is needed to better understand local beliefs about lymphatic filariasis, and to understand how stigma affects patients’ access to treatment and quality of life. This must include the strong links between the disease and poverty. </p>
<p>Lymphatic filariasis follows <a href="https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1">the “social gradient”</a>. Those who are poorest are most likely to be affected. Factors associated with poverty increase the chances of being infected and of developing complications. These factors include poor quality housing, limited access to methods of prevention (mosquito nets, good quality footwear), difficulty getting medical care, living in remote rural communities, and working as subsistence farmers.</p>
<p>The disease also pushes poor people <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10170-8">further into poverty</a> as it progresses.</p>
<p>As the number of people affected by it decreases, those who are left behind are more and more likely to be isolated, marginalised, stigmatised and impoverished. </p>
<p>As we argue in a <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781003207672-15/examining-research-positionality-understanding-self-first-step-transnational-research-colleen-mcmillan-alexander-kwarteng-kristi-kenyon-mary-asirifi">recent book chapter</a>, these factors underscore the need for interdisciplinary research teams who are able to address lymphatic filariasis holistically. We need an approach that merges healthcare, health promotion, health systems, spiritual beliefs, social and cultural context, gender dynamics and economic impact. </p>
<p>We must put people with lymphatic filariasis – and their dignity – at the centre of research.</p><img src="https://counter.theconversation.com/content/216838/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristi Heather Kenyon receives funding from the Canadian Institutes for Health Research.</span></em></p><p class="fine-print"><em><span>Alexander Kwarteng receives funding from the Canadian Institutes of Health Research</span></em></p><p class="fine-print"><em><span>Dr Colleen McMillan receives funding from the Canadian Institutes of Health Research. </span></em></p><p class="fine-print"><em><span>Mary Asirifi works for MacEwan University. She receives funding from CIHR. </span></em></p><p class="fine-print"><em><span>Regiane Garcia receives funding from Canadian Health Institutes Research</span></em></p>In rural Ghana, only 18% of patients believe elephantiasis is a disease. Some others think it is caused by curses or even rain. Only by understanding local beliefs can it be treated effectively.Kristi Heather Kenyon, Associate Professor, Human Rights, University of WinnipegAlexander Kwarteng, Senior Lecturer in Immunology of Infectious Diseases, Kwame Nkrumah University of Science and Technology (KNUST)Colleen McMillan, Scientific Co-Director and Associate Professor, University of WaterlooMary Asirifi, Assistant Professor, Department of Nursing Foundations, MacEwan UniversityRegiane Garcia, Research Associate, focus on health rights, laws and policies, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2151352023-11-20T13:16:27Z2023-11-20T13:16:27ZPooling multiple models during COVID-19 pandemic provided more reliable projections about an uncertain future<figure><img src="https://images.theconversation.com/files/559148/original/file-20231113-21-81g8j.jpg?ixlib=rb-1.1.0&rect=11%2C383%2C3479%2C2610&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The sum is greater than the parts when researchers build an ensemble from multiple coordinated but independent models.</span> <span class="attribution"><span class="source">Matteo Chinazzi</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>How can anyone decide on the best course of action in a world full of unknowns?</p>
<p>There are few better examples of this challenge than the COVID-19 pandemic, when officials fervently compared potential outcomes as they weighed options like whether to implement lockdowns or require masks in schools. The main tools they used to compare these futures were epidemic models.</p>
<p>But often, models included numerous unstated assumptions and considered only one scenario – for instance, <a href="https://doi.org/10.7326/M20-1565">that lockdowns would continue</a>. Chosen scenarios were rarely consistent across models. All this variability made it difficult to compare models, because it’s unclear whether the differences between them were due to different starting assumptions or scientific disagreement.</p>
<p>In response, we came together with colleagues to found the <a href="https://covid19scenariomodelinghub.org">U.S. COVID-19 Scenario Modeling Hub</a> in December 2020. We provide real-time, long-term projections in the U.S. for use by federal agencies such as the Centers for Disease Control and Prevention, local health authorities and the public. We work directly with public health officials to identify which possible futures, or scenarios, would be most helpful to consider as they set policy, and we convene multiple independent modeling teams to make projections of public health outcomes for each scenario. Crucially, having multiple teams address the same question allows us to better envision what could possibly happen in the future.</p>
<p>Since its inception, the Scenario Modeling Hub has generated 17 rounds of projections of COVID-19 cases, hospitalizations and deaths in the U.S. across varying stages of the pandemic. In a recent study published in the journal Nature Communications, we looked back at all these projections and <a href="https://doi.org/10.1038/s41467-023-42680-x">evaluated how well they matched the reality</a> that unfolded. This work provided insights about when and what kinds of model projections are most trustworthy – and most importantly supported our strategy of combining multiple models into one ensemble.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557558/original/file-20231103-19-f0po1g.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="line graph that ends in multiple colored options on the right" src="https://images.theconversation.com/files/557558/original/file-20231103-19-f0po1g.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557558/original/file-20231103-19-f0po1g.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=200&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557558/original/file-20231103-19-f0po1g.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=200&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557558/original/file-20231103-19-f0po1g.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=200&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557558/original/file-20231103-19-f0po1g.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=251&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557558/original/file-20231103-19-f0po1g.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=251&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557558/original/file-20231103-19-f0po1g.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=251&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Collecting projections from multiple independent models provides a fuller picture of possible futures − as in this graph of potential hospitalizations − and allows researchers to generate an ensemble.</span>
<span class="attribution"><span class="source">COVID-19 Scenario Modeling Hub</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Multiple models are better than just one</h2>
<p>A founding principle of our Scenario Modeling Hub is that multiple models are more reliable than one.</p>
<p>From tomorrow’s temperature on your weather app to predictions of interest rates in the next few months, you likely use the combined results of multiple models all the time. Especially in times like the COVID-19 pandemic when uncertainty abounds, <a href="https://doi.org/10.1016/0169-2070(89)90012-5">combining projections from multiple models into an ensemble</a> provides a fuller picture of what could happen in the future. Ensembles have become ubiquitous in many fields, primarily because <a href="https://doi.org/10.1016/S1574-0706(05)01004-9">they work</a>.</p>
<p><iframe id="3xdrr" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/3xdrr/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Our analysis of this approach with COVID-19 models resoundingly showed the strong performance of the Scenario Modeling Hub ensemble. Not only did the <a href="https://doi.org/10.1038/s41467-023-42680-x">ensemble give us more accurate predictions</a> of what could happen in the future overall, it was substantially more consistent than any individual model throughout the different stages of the pandemic. When one model failed, another performed well, and by taking into account results from all of these varying models, the ensemble emerged as more accurate and more reliable.</p>
<p>Researchers have previously shown performance benefits of ensembles for short-term forecasts of <a href="https://doi.org/10.1038/s41598-018-36361-9">influenza</a>, <a href="https://doi.org/10.1073/pnas.1909865116">dengue</a> and <a href="https://doi.org/10.1073/pnas.2113561119">SARS-CoV-2</a>. But our recent study is one of the first times researchers have tested this effect for long-term projections of alternative scenarios. </p>
<h2>A ‘hub’ makes multimodel projections possible</h2>
<p>While scientists know combining multiple models into an ensemble improves predictions, it can be tricky to put an ensemble together. For example, in order for an ensemble to be meaningful, model outputs and key assumptions need to be standardized. If one model assumes a new COVID-19 variant will gain steam and another model does not, they will come up with vastly different results. Likewise, a model that projects cases and one that projects hospitalizations would not provide comparable results. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/559121/original/file-20231113-22-5b1rrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="people seated around an open conference table with whiteboards" src="https://images.theconversation.com/files/559121/original/file-20231113-22-5b1rrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559121/original/file-20231113-22-5b1rrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=311&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559121/original/file-20231113-22-5b1rrh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=311&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559121/original/file-20231113-22-5b1rrh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=311&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559121/original/file-20231113-22-5b1rrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=391&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559121/original/file-20231113-22-5b1rrh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=391&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559121/original/file-20231113-22-5b1rrh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=391&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Meeting frequently helps multiple modeling teams stay on the same page.</span>
<span class="attribution"><span class="source">Matteo Chinazzi</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Many of these challenges are overcome by <a href="https://doi.org/10.2105/AJPH.2022.306831">convening as a “hub.”</a> Our modeling teams meet weekly to make sure we’re all on the same page about the scenarios we model. This way, any differences in what individual models project are the result of things researchers truly do not know. Retaining this scientific disagreement is essential; the success of the Scenario Modeling Hub ensemble arises because each modeling team takes a different approach.</p>
<p>At our hub we work together to <a href="https://www.medrxiv.org/content/10.1101/2023.10.11.23296887v1">design our scenarios strategically</a> and in close collaboration with public health officials. By projecting outcomes under specific scenarios, we can estimate the impact of particular interventions, like vaccination.</p>
<p>For example, a scenario with higher vaccine uptake can be compared with a scenario with current vaccination rates to understand how many lives could potentially be saved. Our projections have informed recommendations of <a href="https://doi.org/10.1016/j.lana.2022.100398">COVID-19 vaccines for children</a> and bivalent boosters for all age groups, both in <a href="http://dx.doi.org/10.15585/mmwr.mm7145a2">2022</a> and <a href="http://dx.doi.org/10.15585/mmwr.mm7224a3">2023</a>. </p>
<p>In other cases, we design scenarios to explore the effects of important unknowns, such as the impact of a new variant – <a href="https://doi.org/10.7554/eLife.73584">known</a> or <a href="https://doi.org/10.1016/j.lana.2022.100398">hypothetical</a>. These types of scenarios can help individuals and institutions know what they might be up against in the future and plan accordingly.</p>
<p>Although the hub process requires substantial time and resources, our results showed that the effort has clear payoffs: The information we generate together is more reliable than the information we could generate alone. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/559966/original/file-20231116-17-51u1pb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman filling out a form with a COVID vaccine sign in the foreground" src="https://images.theconversation.com/files/559966/original/file-20231116-17-51u1pb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559966/original/file-20231116-17-51u1pb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559966/original/file-20231116-17-51u1pb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559966/original/file-20231116-17-51u1pb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559966/original/file-20231116-17-51u1pb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559966/original/file-20231116-17-51u1pb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559966/original/file-20231116-17-51u1pb.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">What models suggest are likely futures can inform real-world decisions, such as when to run a vaccine clinic.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-fills-out-a-registration-form-to-receive-a-dose-of-a-news-photo/1250226576">Eric Lee for The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<h2>Past reliability, confidence for future</h2>
<p>Because Scenario Modeling Hub projections can inform real public health decisions, it is essential that we provide the best possible information. Holding ourselves accountable in retrospective evaluations not only allows us to identify places where the models and the scenarios can be improved, but also helps us build trust with the people who rely on our projections.</p>
<p>Our hub has expanded to produce <a href="https://fluscenariomodelinghub.org">scenario projections for influenza</a>, and we are introducing projections of respiratory syncytial virus, or RSV. And encouragingly, other groups abroad, <a href="https://covid19scenariohub.eu">particularly in the EU</a>, are replicating our setup.</p>
<p>Scientists around the world can take the hub-based approach that we’ve shown improves reliability during the COVID-19 pandemic and use it to support a comprehensive public health response to important pathogen threats.</p><img src="https://counter.theconversation.com/content/215135/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Howerton is funded by the US National Science Foundation to support this work. </span></em></p><p class="fine-print"><em><span>Justin Lessler receives funding from the US CDC and the NIH to support this work. He has also served as an expert witness on cases where the likely length of the pandemic was of issue. </span></em></p><p class="fine-print"><em><span>Cecile Viboud 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>Policymakers rely on models during uncertain times to figure out how their choices could affect the future. Over the pandemic, an ensemble of many COVID-19 models outperformed any one alone.Emily Howerton, Postdoctoral Scholar in Biology, Penn StateCecile Viboud, Senior Research Scientist, National Institutes of HealthJustin Lessler, Professor of Epidemiology, University of North Carolina at Chapel HillLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168202023-11-10T01:03:36Z2023-11-10T01:03:36ZWe’re in a new COVID wave. What can we expect this time?<figure><img src="https://images.theconversation.com/files/558289/original/file-20231108-21-f5uskt.jpg?ixlib=rb-1.1.0&rect=65%2C139%2C5398%2C3497&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/young-woman-face-mask-walking-through-1685691631">Shutterstock</a></span></figcaption></figure><p>Australia is now into its <a href="https://www.abc.net.au/news/2023-11-02/nsw-sydney-covid-christmas-fresh-wave/103051190">next COVID wave</a>. We’ve seen hints of this for a while. Case numbers and indicators of severe disease began rising in Victoria in August. But it has taken several months for a consistent pattern to emerge across Australia. </p>
<p>Now we see evidence of this new wave via <a href="https://www.health.vic.gov.au/sites/default/files/2023-11/victorian-covid-19-surveillance-report-03-november-2023.pdf">wastewater surveillance</a> for traces of SARS-CoV-2, the virus that causes COVID. We also see <a href="https://www.health.gov.au/topics/covid-19/weekly-reporting">rises</a> in COVID-related hospital admissions and antiviral prescriptions. Compared to past waves, this one has built up slowly and over a longer period.</p>
<p>Here’s what we know about this new wave and what to expect over the coming weeks.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-covid-inquiry-has-been-announced-but-is-covid-still-a-thing-do-i-need-a-booster-213469">A COVID inquiry has been announced. But is COVID still a thing? Do I need a booster?</a>
</strong>
</em>
</p>
<hr>
<h2>How do we know we’re in a new COVID wave?</h2>
<p>In earlier waves, when more people were testing for COVID and reporting their results, we were more confident case numbers were a reasonable reflection of how COVID was tracking.</p>
<p>However, now, a more useful indicator for COVID nationally is to look at trends in the number of prescriptions for the antiviral medications ritonavir (Paxlovid) and molnupiravir (Lagevrio) on the Pharmaceutical Benefits Scheme (PBS). </p>
<p>In the graph below, which is drawn from <a href="https://www.health.gov.au/topics/covid-19/weekly-reporting">national prescribing data</a>, you can clearly see script numbers rising.</p>
<p><iframe id="3d26e" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/3d26e/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>When will we hit the peak?</h2>
<p>It has become more difficult to predict the size and timing of the peak. Reduced access to COVID testing and fewer requirements or opportunities to report test results, combined with the slow growth rate for this wave, give a wider range of possibilities. </p>
<p>The wave is also likely to differ between states and territories, as some got off to a later start. </p>
<p>However, given the wave’s slow growth rate and further increases in hybrid immunity (immunity from both vaccination and infection) over 2023, it’s reasonable to expect this to be the smallest Omicron wave so far. </p>
<p>We also expect it will be over by early in the summer holiday period. That’s when rates of community contact decline significantly, as work and school contacts are much reduced. That means fewer opportunities for the virus to spread between networks of family and friends.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ah-memories-of-2020-why-its-important-to-remember-our-covid-holidays-good-or-bad-150061">Ah, memories of 2020. Why it's important to remember our COVID holidays, good or bad</a>
</strong>
</em>
</p>
<hr>
<h2>Why now?</h2>
<p>It’s unlikely this latest COVID wave stems from changes in behaviour. People are generally out and about, fewer people are wearing masks in public. But we don’t see any dramatic shifts in this type of behaviour in 2023 compared with 2022.</p>
<p>It’s not a seasonal cause, given respiratory viruses tend to spread better in winter, when we’re cooped up indoors with others.</p>
<p>It’s unlikely it’s our <a href="https://www.medrxiv.org/content/10.1101/2023.08.26.23294679v1">waning immunity</a> from infection or vaccination that’s prompting these successive waves.</p>
<p>Instead, we’re seeing the result of a constantly mutating virus. Successful SARS-CoV-2 variants are gradually acquiring mutations. Some of these changes reduce the ability of existing antibodies to bind to and neutralise the virus. So it appears it’s still the “immune escape” variants that are behind these latest waves.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/with-a-covid-variant-soup-looming-new-zealand-urgently-needs-another-round-of-vaccine-boosters-193616">With a COVID 'variant soup' looming, New Zealand urgently needs another round of vaccine boosters</a>
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</em>
</p>
<hr>
<h2>Which variants are to blame?</h2>
<p>The primary viral lineage in Australia this year has been XBB. Over the past six months, its two most influential mutations have been:</p>
<ul>
<li><p>the F456L mutation that led to the rise of EG.5.1, also known as Eris</p></li>
<li><p>more recently, the paired “FLip” mutations F456L+L455F. We see these in offspring of Eris and in much-less closely related lineages. This is a clear sign these mutations help the virus spread better.</p></li>
</ul>
<p>Both the single and paired mutations make existing antibodies less effective at blocking SARS-CoV-2 from binding to critical receptors on our cells. This increases our susceptibility to infection.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1689763022573916169"}"></div></p>
<p>The novel BA.2.86 lineage – colloquially known as Pirola – was first reported in Denmark in August and has many unique mutations. It has not been influential so far in this wave in Australia. But it has continued to evolve. And we may see it play a much bigger role in Australia in 2024.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-evasive-and-transmissible-is-the-newest-omicron-offshoot-ba-2-86-that-causes-covid-19-4-questions-answered-212453">How evasive and transmissible is the newest omicron offshoot, BA.2.86, that causes COVID-19? 4 questions answered</a>
</strong>
</em>
</p>
<hr>
<h2>Who is most at risk during this COVID wave?</h2>
<p>Since the start of the pandemic, rates of COVID-related death and severe disease have greatly declined. That’s due to <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00801-5/fulltext">widespread</a> vaccination and hybrid immunity, and a major change in the Omicron variant that’s made the virus less-likely to <a href="https://pubmed.ncbi.nlm.nih.gov/35104837/">infect the lung</a>.</p>
<p>However, provisional statistics show there have been about <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">3,000</a> registered COVID deaths in Australia from January to July 2023.</p>
<p>Older people and those with weaker immune systems are expected to remain at <a href="https://www.sciencedirect.com/science/article/pii/S2468266723000798">greatest risk</a> of developing severe COVID during this current wave.</p>
<p>This is the rationale for the Australian Technical Advisory Group on Immunisation’s (ATAGI) September <a href="https://www.health.gov.au/news/atagi-update-on-the-covid-19-vaccination-program">recommendation</a> for people aged 75 or older to get boosted if more than six months had passed since their last vaccine dose. </p>
<p>ATAGI also recommended people aged 65-74, and people 18 years and over with severe immunocompromising conditions, consider having another booster.</p>
<p>But, by the end of October 2023, <a href="https://www.health.gov.au/sites/default/files/2023-10/covid-19-vaccine-rollout-update-27-october-2023.pdf">it was estimated</a> only one-quarter of Australians aged 65-74, one-third of people aged 75 or over and fewer than half (45%) of people in aged care had received a COVID vaccine in the past six months.</p>
<figure class="align-center ">
<img alt="Woman receives vaccination" src="https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=313&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=313&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.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">
<figcaption>
<span class="caption">People with immunocompromising conditions should get boosted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-wearing-protective-face-mask-getting-1966499908">Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/millions-of-australians-still-havent-had-their-covid-boosters-what-message-could-convince-them-now-190482">Millions of Australians still haven't had their COVID boosters. What message could convince them now?</a>
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</em>
</p>
<hr>
<h2>Which vaccines are available?</h2>
<p>Currently available bivalent vaccines protect against the original ancestral strain of SARS-CoV-2 (now extinct) plus the newer BA.1 or BA.4/5 variants. These bivalent vaccines also protect us against <a href="https://assets.publishing.service.gov.uk/media/6527f0bfaea2d0000d219c69/vaccine-surveillance-report-2023-week-41.pdf">severe disease</a> from the Omicron variants circulating now, such as XBB.</p>
<p>But we can expect newer monovalent XBB.1.5 vaccines soon, now the Therapeutic Goods Administration has <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">approved them</a>. These are expected to provide <a href="https://www.medrxiv.org/content/10.1101/2023.10.04.23296545v1.full.pdf">better protection</a> against newer Omicron variants than the currently available <a href="https://www.sciencedirect.com/science/article/pii/S2213260023003065">bivalent vaccines</a>.</p>
<p>In the meantime, boosting with any available COVID vaccine will provide <a href="https://assets.publishing.service.gov.uk/media/6527f0bfaea2d0000d219c69/vaccine-surveillance-report-2023-week-41.pdf">good protection</a> for vulnerable people.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">CDC greenlights two updated COVID-19 vaccines, but how will they fare against the latest variants? 5 questions answered</a>
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</em>
</p>
<hr>
<h2>What might we expect from COVID in 2024?</h2>
<p>The Northern Hemisphere appears to have settled into an approximate seasonal pattern of COVID infections in 2023 and it’s plausible Australia will follow suit. </p>
<p>If so, we should plan for overlapping seasonal epidemics of our three most important respiratory viruses: SARS-CoV-2, influenza and respiratory syncytial virus (RSV). So hospitals may need to plan ahead for larger peaks in admissions.</p>
<p>Hopefully, new <a href="https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/rsv.html">vaccines for RSV</a>, and more broadly protective <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-progress-toward-universal-vaccines">flu and COVID vaccines</a> to be developed over the next decade, should help.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-is-everywhere-right-now-what-parents-need-to-know-about-respiratory-syncytial-virus-208855">RSV is everywhere right now. What parents need to know about respiratory syncytial virus</a>
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<img src="https://counter.theconversation.com/content/216820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Wood receives funding from NSW Health and the National Health and Medical Research Council for projects on COVID-19. He has previously received funding from the federal government as part of COVID responses in 2020-21 and from WHO Western Pacific Regional Office in 2020. He is a current member of the Australian Technical Advisory Committee on Immunisation.</span></em></p><p class="fine-print"><em><span>Bette Liu receives funding from the Australian National Health and Medical Research Council and Australian Government. </span></em></p><p class="fine-print"><em><span>Katie Flanagan receives funding from the National Health and Medical Research Council, Medical Research Future Fund, Bill and Melinda Gates Foundation and Clifford Craig Foundation. She is involved in research projects studying the impact of COVID-19 vaccine boosters. She is a member of the Australian Technical Advisory Group on Immunisation and President of the Australasian Society for Infectious Diseases.</span></em></p><p class="fine-print"><em><span>Stuart Turville receives funding from the Australian National Health and Medical Research Council, Medical Research Future Fund and Covid grants (Round 2 Covid grant and VIIM vaccine group) awarded from the NSW state government.</span></em></p>This is expected to be the smallest Omicron wave so far. But eligible older and vulnerable people are still recommended to have a booster.James Wood, Professor, epidemiological modelling of infectious diseases, UNSW SydneyBette Liu, Associate Professor and NHMRC Career Development Fellow, UNSW SydneyKatie Louise Flanagan, Infectious Diseases Specialist and Clinical Professor, University of TasmaniaStuart Turville, Associate Professor, Immunovirology and Pathogenesis Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2153012023-10-16T12:48:25Z2023-10-16T12:48:25ZWho tracked UK COVID infections the best at the height of the pandemic? A new study provides the answer<p>At the height of the COVID pandemic everybody, from health ministers to Joe public, wanted to know two things: how many infected people are there in the country? And is this number going up or down?</p>
<p>There were many sources for these figures, from the Office for National Statistics to the Zoe app. We wanted to know which of these methods was the most reliable during the first two years of the pandemic. Our results have just been published in <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00219-0/fulltext">The Lancet Public Health</a>.</p>
<p>In judging the effectiveness of the various surveillance methods, we looked at three criteria. First, to what degree did the method reflect whether cases were rising or falling? Second, how accurate was it in giving estimates of the actual infection numbers? And, third, was the data available swiftly enough for control measures, such as enhanced contact tracing, to be rapidly put in place? </p>
<p>The gold standard surveillance was the Office for National Statistics (ONS) COVID survey. This tested a random sample of people every two weeks and reported both the number of <a href="https://theconversation.com/the-ons-has-published-its-final-covid-infection-survey-heres-why-its-been-such-a-valuable-resource-202589">people likely to test positive</a> and the number of new infections occurring every day. </p>
<p>The other big advantage of the ONS survey is that it picked up all infections, whether or not the person had symptoms (and you probably recall that many people were asymptomatic). But, by the time their results were reported, the data was usually a week or two out of date. Not good if you needed to quickly introduce new control measures. </p>
<p>The ONS survey was also very expensive, as it involved visiting tens of thousands of people each week to take swabs. </p>
<p>The number of new cases reported each day by the Department of Health on the <a href="https://coronavirus.data.gov.uk/">COVID dashboard</a> was much more up to date, being published within a couple of days of the swabs being taken. This data tracked the ONS estimates very closely, though the reported numbers were usually only about 45% of the ONS data. So a little less than half of all infections were being picked up by mass screening.</p>
<p>The <a href="https://zoe.com/learn/category/covid">Zoe app</a> also tracked the ONS survey estimates closely and was a good estimate of whether infections were rising or falling. But, at times, the Zoe estimates were too high. Sometimes, it was also slow at spotting a fall in case numbers. </p>
<p>The Zoe app estimates were periodically adjusted to fit closer to the ONS survey estimates, raising the question of how good it would have been if it wasn’t for the ONS data to calibrate its estimates.</p>
<p>For influenza surveillance, the UK relies heavily on <a href="https://www.gov.uk/government/statistics/national-flu-and-covid-19-surveillance-reports-2023-to-2024-season">GPs</a> reporting people with influenza-like illness. However, for COVID this data source was very poor, not correlating at all with infection counts. </p>
<p>Using data on computer searches such as found in Google Trends has been used to track infectious diseases, especially <a href="https://www.nature.com/articles/nature07634">Google Trends and influenza</a>. Here again, there was very little correlation between infection numbers and Google Trend searches for either “COVID” or “coronavirus”.</p>
<p>The number of people calling NHS 111 with COVID symptoms performed only slightly better. </p>
<p>We also examined use of the <a href="https://111.nhs.uk/">NHS 111 website</a> to identify potential COVID cases, the number of patients suspected of having COVID at <a href="https://www.gov.uk/government/publications/emergency-department-weekly-bulletins-for-2023">emergency departments</a>, and <a href="https://coronavirus.data.gov.uk/details/cases?areaType=nation&areaName=England">hospital admissions</a>. These were all moderately correlated with the ONS estimates. </p>
<p>Hospital admissions data tended to lag about a week behind changes in infection numbers, so did not provide timely information.</p>
<p>Wastewater surveillance, where assumptions are made about infection numbers in the population based on <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00230-8/fulltext">testing sewage for the presence of the virus</a>, received a lot of interest during the COVID pandemic. </p>
<p>Testing of wastewater for <a href="https://theconversation.com/polio-was-recently-detected-in-sewage-in-the-uk-heres-what-else-scientists-look-for-in-our-wastewater-185799">poliovirus has a long history</a>. But for poliovirus, detecting any circulating virus is enough to raise the alarm. For COVID, the question was can wastewater testing indicate how much infection is present in the population? In our analysis, we found that counts in wastewater were moderately correlated with the prevalence of COVID in the population. </p>
<h2>Useful additional insights</h2>
<p>No single surveillance method was ideal in England. But the most timely and consistent approach was reporting the results of routine testing on the COVID dashboard. </p>
<p>Other surveillance methods were unable to improve on this routine approach for timeliness and detection of trends. </p>
<p>Even so, the other approaches provided useful additional insights. For example, the Zoe app provided some of the earliest evidence that <a href="https://health-study.zoe.com/post/is-loss-of-smell-or-taste-a-symptom-of-covid-19">loss of the sense of smell</a> was an important symptom of COVID. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-killed-your-sense-of-smell-heres-how-experts-train-people-to-get-theirs-back-150989">COVID killed your sense of smell? Here's how experts train people to get theirs back</a>
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</em>
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<hr>
<p>The hospital admissions data and emergency department attendance methods provided important information on how the pandemic was affecting health services. NHS 111 call and website data provided useful information early in the pandemic, before other surveillance methods were established. </p>
<p>Although wastewater surveillance did little to increase our understanding of the course of the pandemic in England, this surveillance method may be useful in countries that don’t have easy access to human testing. </p>
<p>Overall, the best indication of the course of the pandemic came not from relying on a single surveillance method but from considering the outputs from all available data sources.</p><img src="https://counter.theconversation.com/content/215301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Hunter consults for the World Health Organization. He receives funding from National Institute for Health Research, the World Health Organization and the European Regional Development Fund.</span></em></p><p class="fine-print"><em><span>Iain Lake receives funding from the UK National Institute for Health and Care Research.</span></em></p>ONS, Zoe app, Google Trends … there were many ways to keep an eye on COVID cases during the pandemic. Here’s how they fared.Paul Hunter, Professor of Medicine, University of East AngliaIain Lake, Professor of Environmental Epidemiology, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2115022023-08-14T07:16:47Z2023-08-14T07:16:47Z‘Stay safe’ – Vale Mary-Louise McLaws, a champion for the power of clear science communication<p>When the COVID pandemic hit, epidemiologist <a href="https://research.unsw.edu.au/people/emeritus-professor-marylouise-mclaws">Professor Emeritus Mary-Louise McLaws AO</a> became the go-to expert for many journalists across the media spectrum. With new research being released daily, access to calm, reliable and knowledgeable experts like Mary-Louise – or “ML” as she was known to her friends – became paramount for them and many Australians.</p>
<p>Her manner was friendly and unassuming for someone so highly regarded in scientific circles. She had a gentle and calm presence on camera and a way of cutting through scientific terms and jargon to get to the heart of what really mattered to viewers, readers and listeners. </p>
<p>Yet she was also not afraid to question whether authorities were making the correct decisions. She expressed concerns that too few measures were being taken to stop the virus spreading <a href="https://theconversation.com/5-tips-for-ventilation-to-reduce-covid-risk-at-home-and-work-151758">through the air</a> and about the <a href="https://www.facebook.com/watch/?v=645971703420401">time it took</a> for rapid antigen tests to become publicly and freely available.</p>
<p>And when Mary-Louise spoke, the audience listened. Yet, she never resorted to hyperbole or exaggeration. When Australians needed someone to explain what at times seemed inexplicable, she knew all the right words. She had a unique way of taking her understanding of diseases such as COVID and being able to tell audiences exactly what they needed to hear.</p>
<p>Mary-Louise passed away on Saturday aged 70, some 18 months after her <a href="https://www.abc.net.au/melbourne/programs/mornings/mary-louise-mclaws-queens-birthday-honour/13926650">diagnosis</a> with brain cancer. We had the privilege of collaborating with Mary-Louise, including on a paper <a href="https://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/1079">published today</a> about communicating health and science to the public. We hope to continue her legacy of building trust in science, even as it unfolds. </p>
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<h2>Unique skills</h2>
<p>A reputable scientist – she spent 36 years in the University of NSW Medicine and Health Faculty – she was able to adeptly translate research findings into language the public could understand. Mary-Louise had the confidence to work with journalists and the media during a public health emergency. Along with countless interviews, she <a href="https://www.abc.net.au/news/2023-08-14/mary-louise-mclaws-remembered-by-health-community/102725732">wrote</a> 180 scientific papers and was made an Officer of the Order of Australia in 2022 for distinguished service to epidemiology and infection prevention. As she <a href="https://www.abc.net.au/melbourne/programs/mornings/mary-louise-mclaws-queens-birthday-honour/13926650">told</a> ABC radio listeners just over a year ago: </p>
<blockquote>
<p>My tone should always be – I’m not political but I will tell you what I think as an epidemiologist and as a global epidemiologist as well and what the [World Health Organization] and others are trying to achieve.</p>
</blockquote>
<p>She was passionate about ensuring scientists and academic researchers develop public engagement and science communication skills to allow them to become influential champions and to rebuild trust in science. </p>
<p>Of her passing, UNSW Chancellor David Gonski <a href="https://newsroom.unsw.edu.au/news/health/vale-mary-louise-mclaws-researcher-and-global-advocate-infectious-diseases-and-public">said</a> </p>
<blockquote>
<p>We mourn the passing of a UNSW academic who was locally grown and became a superstar while remaining tenacious, humble, hardworking and caring. We are grateful for all she did for UNSW and Australia, she will not be forgotten.</p>
</blockquote>
<p>Mary-Louise responded quickly to the media, respecting their deadlines. She often said that journalists have a difficult job to do. When she was diagnosed with a brain tumor, she <a href="https://twitter.com/MarylouiseMcla1/status/1482201662387519492">thanked the media</a> for helping her spread knowledge. </p>
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<p>We hope her legacy will help pave the way for universities to encourage and train their scientists and academics to work confidently with journalists to communicate their research to the public.</p>
<h2>A calm voice</h2>
<p>To the Australian public, Mary-Louise was a calm voice who graced our lounge rooms daily via the ABC, sometimes <a href="https://www.facebook.com/watch/?v=645971703420401">signing off</a> with “stay safe”. She wrote for and spoke to media outlets including <a href="https://theconversation.com/profiles/mary-louise-mclaws-280701/articles">The Conversation</a> before and during the pandemic.</p>
<p>To her colleagues at UNSW, on the WHO Health Emergencies Program Expert Advisory Panel and the NSW COVID Infection Prevention and Control taskforce, she was a credible, well-regarded and respected epidemiologist and infection prevention and control expert and extended her expertise globally with many appointments.</p>
<p>To her students, Mary-Louise was devoted and while she demanded the highest quality of work from her doctoral students, she provided much more than just academic guidance – she was gentle, thought-provoking and always available.</p>
<p>To her friends and family, Mary-Louise was a nurturer, a kind, loving mother and devoted wife. Her Jewish heritage was important to her and she embraced diversity, culture and enjoyed travelling around the world experiencing all that it had to offer.</p>
<p>For all of us feeling her loss, there is some comfort knowing Mary-Louise’s life penetrated so many hearts and that her legacy will continue, forever.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1690700184832069633"}"></div></p><img src="https://counter.theconversation.com/content/211502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jocelyne Basseal is the President for the Australasian Medical Writers Association.</span></em></p><p class="fine-print"><em><span>Sharon Salmon and Sophie Scott 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>A calm voice, a trusted expert, devoted teacher. Epidemiologist Professor Mary-Louise McLaws was passionate about engaging with the mainstream media and communicating what she knew.Jocelyne Basseal, Associate Director, Sydney Infectious Diseases Institute (Sydney ID), Faculty of Medicine and Health, University of SydneySharon Salmon, Honorary Senior Lecturer, UNSW SydneySophie Scott, Associate Professor (Adjunct), Science Communication, University of Notre Dame AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2064932023-06-12T20:01:24Z2023-06-12T20:01:24ZWe’re in another COVID wave. But it’s not like the others<figure><img src="https://images.theconversation.com/files/531031/original/file-20230608-17666-2sh956.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C664&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/woman-public-transport-respirator-on-her-1943475565">Shutterstock</a></span></figcaption></figure><p>Each Omicron wave so far in Australia has had distinguishing features – the sharp rise and fall of BA.1, the widespread transmission among children and families in BA.2, a shift to more infections in older people with BA.5, then the confusing variant mix in the summer wave of 2022-23. </p>
<p>Now Australia is in its fifth Omicron wave, which has been brewing since February. But it has grown so slowly that many people may have not realised it until recent months.</p>
<p>Why has this most recent wave been so drawn out? And what has its real impact been on our health and health systems?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/531048/original/file-20230609-29-c8mspj.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/531048/original/file-20230609-29-c8mspj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531048/original/file-20230609-29-c8mspj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531048/original/file-20230609-29-c8mspj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531048/original/file-20230609-29-c8mspj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531048/original/file-20230609-29-c8mspj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=482&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531048/original/file-20230609-29-c8mspj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=482&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531048/original/file-20230609-29-c8mspj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=482&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Australia’s COVID cases and seven-day rolling average, showing how the latest wave is long and drawn out.</span>
<span class="attribution"><a class="source" href="https://www.health.gov.au/health-alerts/covid-19/weekly-reporting?language=und">health.gov.au</a></span>
</figcaption>
</figure>
<h2>Slower spread, less testing</h2>
<p>With <a href="https://kirby.unsw.edu.au/sites/default/files/COVID19-Blood-Donor-Report-Round4-Nov-Dec-2022.pdf">most people</a> in Australia now having been vaccinated against COVID, infected or both, we expect the virus to spread more slowly through the population.</p>
<p>This means the overall number of infections in the current wave should be fewer than in previous ones. Infections should also occur over a longer period of time.</p>
<p>But we also know people are mixing and socialising more than in previous waves. So it is easier for viruses such as SARS-CoV-2 (the virus that causes COVID) to be transmitted.</p>
<p>While these two factors counter each other, overall we expect to see reduced health impacts compared with previous waves.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/531050/original/file-20230609-15-9lenas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Ambulance driving on tram tracks through Melbourne CBD, trams in background" src="https://images.theconversation.com/files/531050/original/file-20230609-15-9lenas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531050/original/file-20230609-15-9lenas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531050/original/file-20230609-15-9lenas.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531050/original/file-20230609-15-9lenas.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531050/original/file-20230609-15-9lenas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531050/original/file-20230609-15-9lenas.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531050/original/file-20230609-15-9lenas.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">We expect fewer people with COVID going to hospital at this stage of the pandemic.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/melbourne-australia-march-26-2018-ambulance-1057060745">etsir/Shutterstock</a></span>
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<p>We are <a href="https://www.health.gov.au/health-alerts/covid-19/weekly-reporting?language=und">already seeing</a> fewer people with confirmed infections and fewer people who are unwell requiring hospitalisation.</p>
<p>We also know from weekly surveys that people are less likely to test for COVID and report their results at this stage of the pandemic. So reported cases are now a smaller fraction of all infections than in previous waves.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-or-covid-you-can-now-test-for-both-at-home-with-a-single-swab-heres-what-you-need-to-know-204119">Flu or COVID? You can now test for both at home with a single swab. Here's what you need to know</a>
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<h2>New sub-variants are likely the cause</h2>
<p>The slow and drawn out nature of the current wave is most likely due to the sequential emergence and spread of new Omicron sub-variants. The current wave started with <a href="https://theconversation.com/the-kraken-subvariant-xbb-1-5-sounds-scary-but-behind-the-headlines-are-clues-to-where-covids-heading-198158">XBB.1.5</a>, then shifted to XBB.1.9.1 and XBB.1.9.2, then most recently <a href="https://theconversation.com/arcturus-what-to-know-about-the-new-covid-variant-omicron-xbb-1-16-204598">XBB.1.16</a>.</p>
<p>Each sub-variant has been able to spread where the <a href="https://theconversation.com/new-covid-variants-may-be-more-transmissible-but-that-doesnt-mean-the-r0-or-basic-reproduction-number-has-increased-186826">previous one could not</a>. But the competitive advantage of each has been minor. So we have only seen a progressive increase in infections as new sub-variants emerge, rather than the dramatic surges in infections and health impacts associated with previous variants.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1621458548940054530"}"></div></p>
<h2>Are we at the peak of the current wave?</h2>
<p>There is some debate about whether New South Wales has reached the peak of its wave. However, forecasts for most other jurisdictions suggest declines have begun or are imminent.</p>
<p>But as always, there is uncertainty in how the wave will develop, and we cannot exclude the possibility of sustained epidemic activity over a longer period.</p>
<p>Hospitalisations for those infected with COVID may stay elevated for a while longer. This is due both to the lag between infection and hospitalisation and we are seeing a shift in infections to older people as the wave progresses. </p>
<p>Thankfully, we do not expect the health system to come under the pressure from COVID seen during the BA.5 wave in winter 2022. This is good news.</p>
<p>However, for the first time in Australia, the SARS-CoV-2 wave may coincide almost completely with influenza and RSV (respiratory syncytial virus) waves. This certainly appears <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/weekly-covid-overview-20230603.pdf">likely in NSW</a>. The combined impact of these three viruses may be significant.</p>
<p>Looking ahead, this combined threat will need careful attention. Surveillance systems need to be (re-)designed to detect, anticipate and forecast the <a href="https://arxiv.org/abs/2306.01224">combined burden</a> of acute viral respiratory infections.</p>
<p>We expect COVID to contribute to the increased burden of seasonal respiratory diseases over the next few years, and perhaps well beyond.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-need-a-flu-shot-and-a-covid-booster-can-i-get-them-at-the-same-time-204027">I need a flu shot and a COVID booster. Can I get them at the same time?</a>
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</em>
</p>
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<h2>How about future waves?</h2>
<p>Future COVID waves are likely to become much more predictable, and coincide with winter. While this is somewhat speculative, it is consistent with how other respiratory viruses behave.</p>
<p>What might this look like? In the United Kingdom all COVID indicators have seen a <a href="https://coronavirus.data.gov.uk/">major decline</a> after winter. We see similar patterns in other temperate northern hemisphere countries, such as the <a href="https://covid.cdc.gov/covid-data-tracker/#trends_weeklyhospitaladmissions_select_00">United States</a>.</p>
<p>Although there are <a href="https://theconversation.com/deltacron-what-scientists-know-so-far-about-this-new-hybrid-coronavirus-179442">other</a> <a href="https://interactives.stuff.co.nz/2022/covid-19-cases-new-zealand/">contenders</a>, internationally, it is likely that the next wave of COVID will also be caused by a sub-variant of XBB.</p>
<p>Without a clear successor to XBB.1.16 identified at present, a new wave will likely only form as genetic mutations accumulate during the next northern winter. </p>
<p>During that time (our Australian summer) people will travel between Australia and the northern hemisphere, re-importing these newer variants into Australia. As conditions in Australia change (next autumn) and the risk of transmission increases, a new wave may develop, peaking in the winter of 2024.</p>
<h2>Alpha, Delta, Omicron waves</h2>
<p>Of course, we have seen COVID behave very differently to this over the past three years. The Alpha, Delta and then Omicron variants appeared and spread across the globe causing large and often devastating waves. </p>
<p>But they occurred at a fundamentally different period of the pandemic, where small changes in the virus had dramatic consequences for transmission and our health. </p>
<p>Recent changes to the virus have provided far less advantage, suggesting such transformative events are now far less likely.</p>
<p>Still, we should maintain sufficient surveillance to keep an eye on emerging sub-variants (genomics), case numbers and hospitalisations – all essential if we are to protect our health and wellbeing.</p><img src="https://counter.theconversation.com/content/206493/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Wood receives funding from NSW Health and the National Health and Medical Research Council for projects on COVID-19. He has previously received funding from the federal government as part of COVID responses in 2020-21 and from WHO Western Pacific Regional Office in 2020. He is a current member of the Australian Technical Advisory Committee on Immunisation.</span></em></p><p class="fine-print"><em><span>Freya Shearer receives funding from the National Health and Medical Research Council, the Australian Government Departments of Health and Foreign Affairs and Trade, and NSW Health.</span></em></p><p class="fine-print"><em><span>James McCaw receives funding from the Australian Government Departments of Health and Foreign Affairs and Trade, the Australian Research Council and the National Health and Medical Research Council. He is an invited expert member of the Communicable Disease Network of Australia and between January 2020 and May 2022 was an invited expert member of the Australian Health Protection Principal Committee.</span></em></p>Australia is in the middle of its fifth Omicron wave, which has been brewing since February. But it’s been slow and drawn out and the health impacts are very different to earlier waves.James Wood, Professor, epidemiological modelling of infectious diseases, UNSW SydneyFreya Shearer, Research Fellow, Epidemic Decision Support, The University of MelbourneJames McCaw, Professor in Mathematical Biology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2065722023-06-07T12:24:04Z2023-06-07T12:24:04ZThe ugly side of beauty: Chemicals in cosmetics threaten college-age women’s reproductive health<figure><img src="https://images.theconversation.com/files/530352/original/file-20230606-20-19o8gg.jpg?ixlib=rb-1.1.0&rect=1300%2C0%2C3332%2C2010&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many types of makeup contain endocrine-disrupting chemicals.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/two-young-women-sitting-applying-make-up-royalty-free-image/200425913-004">Charles Gullung/The Image Bank via Getty Imagges</a></span></figcaption></figure><p>Walk through the personal care aisles of your local store and you’ll see dozens of products that promise to soften your skin, make you smell better, extend your lashes, decrease wrinkling, tame your curly hair, or even semi-permanently change the color of your lips, hair or skin.</p>
<p>Remember the adage “If it seems too good to be true, it probably is”?</p>
<p>Many of product promises like these are based on chemicals that can also be hazardous to your health, including endocrine-disrupting chemicals that can interfere with <a href="https://doi.org/10.1002/mrd.23541">fertility and reproduction</a>, <a href="https://doi.org/10.1289/ehp.11681">fetal growth</a> and <a href="https://doi.org/10.1289/ehp.1003178">infant development</a>.</p>
<p>That’s a big concern, because these products are heavily marketed to young women in the years before they might consider starting a family.</p>
<p>Recent studies have demonstrated that <a href="https://doi.org/10.1038/s41370-019-0170-1">college-age women</a> use cosmetic products <a href="https://doi.org/10.1016/j.hazadv.2022.100117">at higher rates</a> than other groups. Additionally, many of these young women are unaware of the health risks from frequent use of popular products containing <a href="https://doi.org/10.1186/1752-153X-8-15">contaminants of emerging concern</a>. And finding cleaner alternatives often means paying more. </p>
<figure class="align-center ">
<img alt="A person's hands test colors of lipstick in store in front of a counter filled with cosmetics." src="https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530353/original/file-20230606-15-c60dar.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">Cosmetics designed to be free of endocrine-disrupting chemicals are often more expensive.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/this-picture-taken-on-july-29-2018-shows-jiang-cheng-news-photo/1014162178">Wang Zhao/AFP via Getty Images</a></span>
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<p>As <a href="https://scholar.google.com/citations?view_op=list_works&hl=en&user=tQJksK8AAAAJ">an epidemiologist</a> who has fought my own fertility battles, I study exposure to endocrine-disrupting chemicals found in everyday products, such as cosmetics, shampoos, lotions and plastics. I have been working to raise awareness of the health risks to young people and encourage prudent use of cosmetic products.</p>
<h2>Unregulated and potentially risky</h2>
<p>According to the <a href="https://www.fda.gov/industry/fda-basics-industry/are-all-personal-care-products-regulated-cosmetics">U.S. Food and Drug Administration</a>, the term “cosmetic” can include deodorants, perfumes, lotions, nail polish, shampoos and other hair products, as well as eye, lip and face makeup.</p>
<p>This is important to know, because unless these products are used to treat a condition, such as dandruff or perspiration, they are not federally regulated in the same way drugs are. That leaves it up to cosmetic companies to decide how to communicate product safety.</p>
<p>Personal care products contain many types of chemicals that manufacturers add for specific purposes, including some that can interfere with or disrupt the normal functioning of the endocrine system. For example, they commonly add UV filters like oxybenzone <a href="https://www.cdc.gov/biomonitoring/Benzophenone-3_FactSheet.html">to protect skin from sun damage</a>, phthalates to <a href="https://doi.org/10.1016/j.envres.2011.01.013">enhance fragrance</a>, parabens and triclosan for their <a href="https://www.fda.gov/cosmetics/cosmetic-ingredients/parabens-cosmetics">antimicrobial properties</a>, and per- and polyfluoroalkyl substances, or PFAS, to <a href="https://doi.org/10.1021/acs.estlett.1c00240">enhance durability</a>.</p>
<p><iframe id="0B09y" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/0B09y/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>However, not all of these chemicals are present in all products, so figuring out how to avoid exposure can be complicated. For example, in a <a href="https://doi.org/10.1016/j.talanta.2021.122642">2021 review</a> of studies detecting endocrine-disrupting chemicals in daily-use cosmetic products, phthalates were present in perfumes, shower gels, shampoo and nail polish. Parabens were detected in lotions, creams, shampoos, body wash, face cleansers and lipstick. Triclosan was detected in toothpastes, soaps and other cleansers. And UV filters were present in sunscreens, lotions, toothpaste, and lipstick. </p>
<p>Many of these chemicals can co-occur in products, putting consumers at risk of <a href="https://doi.org/10.1289/ehp.1104052">exposure to multiple chemicals</a> at once, and sometimes without warning, as labels <a href="https://www.fda.gov/cosmetics/cosmetics-labeling-regulations/summary-cosmetics-labeling-requirements">do not always list</a> endocrine-disrupting chemicals among the ingredients.</p>
<h2>Why are chemicals in cosmetics a health risk?</h2>
<p>As you rub cosmetic products onto your skin, breathe in their scent or use them to brush your teeth, <a href="https://www.ewg.org/the-toxic-twelve-chemicals-and-contaminants-in-cosmetics">the chemicals</a> found within can travel throughout your body, targeting your endocrine, nervous and cardiovascular systems.</p>
<p>When these chemicals are endocrine disruptors, such as phthalates, parabens, triclosan <a href="https://theconversation.com/toxic-chemicals-in-cosmetics-and-personal-care-products-remain-in-our-bodies-and-environments-for-a-very-very-long-time-201137">and PFAS</a>, they can mimic naturally produced hormones or block hormone receptors. Their presence can result in abnormal hormone production, secretion or transport throughout the body.</p>
<p>These hormonal changes can lead to reproductive problems, including <a href="https://doi.org/10.1097/01.EDE.0000059950.11836.16">poor sperm quality</a>, <a href="https://doi.org/10.1038/s41370-023-00533-1">miscarriage</a> and <a href="https://doi.org/10.1016/j.envres.2020.110342">endometriosis</a>. They can also lead to <a href="https://doi.org/10.1016/j.envres.2018.05.005">thyroid disruption</a> and <a href="https://doi.org/10.1016/j.envres.2008.08.007">abnormal growth and development</a>.</p>
<p>Neurological conditions such as <a href="https://doi.org/10.3390/ijerph19052849">attention-deficit/hyperactivity disorder (ADHD)</a>, <a href="https://doi.org/10.1016/j.envint.2019.01.023">cognitive impairment</a> and <a href="https://doi.org/10.1016/j.chemosphere.2023.139031">depression</a> have also been linked to chemicals added to cosmetic products. So have cardiovascular issues such as <a href="https://doi.org/10.1007/s11356-018-2367-6">high blood pressure</a>, <a href="https://doi.org/10.1016/j.scitotenv.2022.158218">insulin resistance</a> and <a href="https://doi.org/10.1021/acs.est.2c06488">coronary heart disease</a>.</p>
<p>The level of risk is often difficult to measure and depends in part on the amount of exposure, the type of chemical and how the chemical interacts with the endocrine system. One study of women ages 18-44 in Utah and California found increased exposure to a common phthalate was associated with twice the <a href="https://doi.org/10.1016%2Fj.fertnstert.2013.03.026">odds of developing endometriosis</a>, which can be painful and interfere with pregnancy. In a <a href="https://doi.org/10.1289%2FEHP208">meta-analysis</a> of pregnant women with occupational exposure to endocrine-disrupting chemicals, researchers calculated a 25% increase in the odds of low birth weight when mothers were exposed to more than one type of endocrine-disrupting chemical.</p>
<h2>States are starting to ban these chemicals</h2>
<p>Our <a href="https://doi.org/10.1038/s41370-019-0170-1">study of college-age females</a> found that, on average, young women use eight different personal care products each day that can contain endocrine-disrupting chemicals, but some report as many as 17. This is concerning, as the number of products people use has been <a href="https://doi.org/10.1038/s41370-017-0003-z">linked to higher exposure to endocrine-disrupting chemicals</a>.</p>
<p>Furthermore, 80% of the women we surveyed did not know whether their cosmetic products contained harmful chemicals.</p>
<figure class="align-center ">
<img alt="Two young women in party dresses stand in front of a mirror putting on makeup. The counter in front of them has many types of cosmetics that can contain harmful chemicals." src="https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=753&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=753&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=753&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=947&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=947&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530354/original/file-20230606-7937-uuaww1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=947&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many young women aren’t aware of the risks chemicals in cosmetics can contain.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenage-girls-applying-make-up-in-bathroom-royalty-free-image/200389334-001">Shannon Fagan/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<p>Studies have found significantly higher exposure to phthalates and other chemicals among adolescent girls who <a href="https://doi.org/10.1038/s41370-017-0003-z">wore foundation, blush and mascara</a> than among those who did not. One found that when adolescent girls <a href="https://doi.org/10.1289/ehp.1510514">stopped using products containing endocrine-disrupting chemicals</a>, the concentrations in their urine dropped by as much as 45%.</p>
<p>The <a href="https://www.safecosmetics.org/resources/regulations/">European Union has led</a> the way on regulating the use of these chemicals in cosmetic products, with U.S. policies generally lagging behind, but that’s changing.</p>
<p><a href="https://toxicfreefuture.org/press-room/strongest-law-in-the-u-s-regulating-toxic-chemicals-in-cosmetics-signed-by-washington-state-governor-today/">Washington</a> state recently passed legislation that bans <a href="https://toxicfreefuture.org/toxic-chemicals/pfas-forever-chemicals/">PFAS</a>, <a href="https://toxicfreefuture.org/toxic-chemicals/lead/">lead</a>, <a href="https://toxicfreefuture.org/toxic-chemicals/phthalates/">phthalates</a>, <a href="https://toxicfreefuture.org/toxic-chemicals/formaldehyde/">formaldehyde</a> and other harmful chemicals starting in 2025 and creates new incentives for companies to produce safer products. <a href="https://toxicfreefuture.org/press-room/strongest-law-in-the-u-s-regulating-toxic-chemicals-in-cosmetics-signed-by-washington-state-governor-today/">New York</a> banned mercury, a neurotoxin that can be used as a skin lightener, effective June 1, 2023. <a href="https://www.ewg.org/news-insights/news-release/2023/02/california-bill-would-ban-cosmetics-chemicals-linked-cancer">California</a>, <a href="https://legiscan.com/MN/text/HF458/id/731206">Minnesota</a> and <a href="https://www.jdsupra.com/legalnews/maine-makes-a-bold-move-in-banning-most-3530524/">Maine</a> also have broad restrictions on chemical additives in cosmetics.</p>
<p>While many cosmetic companies offer alternative products without endocrine-disrupting chemicals, they tend to cost more, which can put safer products out of reach of young people. I believe a national ban on the use of harmful chemicals in cosmetic products would be the most equitable means for reducing everyone’s exposure.</p><img src="https://counter.theconversation.com/content/206572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leslie Hart receives funding from The National Institute of Environmental Health Sciences. </span></em></p>Finding cosmetics that are free of hormone- disrupting chemicals often means paying more. An epidemiologist explains the risk, particularly for young women.Leslie Hart, Associate Professor of Public Health, College of CharlestonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2011472023-04-18T12:43:34Z2023-04-18T12:43:34ZIf 1% of COVID-19 cases result in death, does that mean you have a 1% chance of dying if you catch it? A mathematician explains the difference between a population statistic and your personal risk<figure><img src="https://images.theconversation.com/files/521327/original/file-20230417-22-5x3idt.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2078%2C1440&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The risk of dying from COVID-19 varies from person to person.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/covid-19-statistics-graph-royalty-free-image/1347040093">Jasmin Merdan/Moment via Getty Images</a></span></figcaption></figure><p>As of April 2023, <a href="https://covid19.who.int/">about 1% of people</a> who contracted COVID-19 ended up dying. Does that mean you have a 1% chance of dying from COVID-19? </p>
<p>That 1% is what epidemiologists call the <a href="https://www.cdc.gov/foodnet/reports/data/case-fatality.html">case fatality rate</a>, calculated by dividing the number of confirmed COVID-19 deaths by the number of confirmed cases. The case fatality rate is a <a href="https://mathworld.wolfram.com/Statistic.html">statistic</a>, or something that is calculated from a data set. Specifically, it is a type of statistic called a <a href="https://mathworld.wolfram.com/SampleProportion.html">sample proportion</a>, which measures the proportion of data that satisfies some criteria – in this case, the proportion of COVID-19 cases that ended with death.</p>
<p>The goal of calculating a statistic like case fatality rate is normally to estimate an unknown proportion. In this case, if every person in the world were infected with COVID-19, what proportion would die? However, some people also use this statistic as a guide to estimate personal risk as well.</p>
<p>It is natural to think of such a statistic as a <a href="https://mathworld.wolfram.com/Probability.html">probability</a>. For example, popular statements that you are <a href="https://doi.org/10.1080/09546553.2018.1530662">more likely to get struck by lightning</a> than die in a terrorist attack, or <a href="https://www.cleveland19.com/story/38100144/how-likely-are-you-to-die-on-a-plane-these-statistics-may-ease-your-fears/">die driving to work</a> than get killed in a plane crash, are based on statistics. But is it accurate to take these statements literally?</p>
<p>I’m a <a href="https://scholar.google.com/citations?user=qPNQSR5AWokC&hl=en">mathematician who studies probability theory</a>. During the pandemic, I watched health statistics become a national conversation. The public was inundated with ever-changing data as research unfolded in real time, calling attention to specific risk factors such as preexisting conditions or age. However, using these statistics to accurately determine your own personal risk is <a href="https://theconversation.com/its-impossible-to-determine-your-personal-covid-19-risks-and-frustrating-to-try-but-you-can-still-take-action-182287">nearly impossible</a> since it varies so much from person to person and depends on intricate physical and biological processes. </p>
<h2>The mathematics of probability</h2>
<p>In <a href="https://www.britannica.com/science/probability-theory">probability theory</a>, a process is considered random if it has an unpredictable outcome. This unpredictability could simply be due to difficulty in getting the necessary information to accurately predict the outcome. Random processes have observable events that can each be assigned a probability, or the tendency for that process to give that particular result.</p>
<p>A typical example of a random process is flipping a coin. A coin flip has two possible outcomes, each assigned a probability of 50%. Even though most people might think of this process as random, knowing the precise force applied to the coin can allow an observer to <a href="https://www.youtube.com/watch?v=AYnJv68T3MM">predict the outcome</a>. But a coin flip is still considered random since measuring this force is not practical in real-life settings. A slight change can result in a different outcome for the coin flip.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/AYnJv68T3MM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">You could predict the outcome of a coin toss if you had the right information.</span></figcaption>
</figure>
<p>A common way to think about the probability of heads being 50% is that, when a coin is flipped several times, you would expect 50% of those flips to be heads. For a large number of flips, in fact, very close to 50% of the flips will be heads. A mathematical theorem called the <a href="https://www.britannica.com/science/law-of-large-numbers">law of large numbers</a> guarantees this, stating that running proportion of outcomes will get closer and closer to the actual probability when the process is repeated many times. The more you flip the coin, the running percentage of flips that are heads will get closer and closer to 50%, essentially with certainty. This depends on each repeated coin flip happening in essentially identical conditions, though. </p>
<p>The 1% case fatality rate of COVID-19 can be thought of as the running percentage of COVID-19 cases that have resulted in death. It doesn’t represent the true average probability of death, though, since the virus, and the global population’s immunity and behavior, have changed so much over time. The conditions are not constant. </p>
<p>Only if the virus stopped evolving, everyone’s immunity and risk of death were identical and unchanging over time, and there were always people available to become infected, then, by the law of large numbers, would the case fatality rate get closer to the true average probability of death over time.</p>
<h2>A 1% chance of dying?</h2>
<p>The biological process of a disease leading to death is complex and uncertain. It is unpredictable and <a href="https://theconversation.com/cancer-evolution-is-mathematical-how-random-processes-and-epigenetics-can-explain-why-tumor-cells-shape-shift-metastasize-and-resist-treatments-199398">therefore random</a>. Each person has a real physical risk of dying from COVID-19, though this risk varies over time and place and between individuals. So, at best, 1% could be the average probability of death within the population.</p>
<p>Health risks vary among demographic groups, too. For example, elderly individuals have a much <a href="https://www.statnews.com/2020/03/30/what-explains-coronavirus-lethality-for-elderly/">higher risk of death</a> than younger individuals. Tracking COVID-19 infections and how they end for a large number of people that are demographically similar to you would give a better estimate of personal risk. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/521375/original/file-20230417-974-45tk2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pedestrian crosses street in front of cars" src="https://images.theconversation.com/files/521375/original/file-20230417-974-45tk2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521375/original/file-20230417-974-45tk2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521375/original/file-20230417-974-45tk2h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521375/original/file-20230417-974-45tk2h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521375/original/file-20230417-974-45tk2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521375/original/file-20230417-974-45tk2h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521375/original/file-20230417-974-45tk2h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You have a much smaller chance of dying from a car accident if you aren’t near any roads or cars.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/crossing-in-moab-royalty-free-image/1177654681">georgeclerk/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Case fatality rate is a probability, but only when you look at the specific data set it was directly calculated from. If you were to write the outcome of every COVID-19 case in that data set on a strip of paper and randomly select one from a hat, you have a 1% chance of selecting a case that ended in death. Doing this only for cases from a particular group, such as a group of older adults with a higher risk or young children with a lower risk, would cause the percentage to be higher or lower. This is why 1% may not be a great estimate of personal risk for every person across all demographic groups. </p>
<p>We can apply this logic to car accidents. The chance of getting into a car crash on a 1,000-mile road trip is about <a href="https://www.news9.com/story/5e6fca6cf86011d4820c3f2d/what-are-your-chances-of-getting-into-a-car-accident">1 in 366</a>. But if you are never anywhere near roads or cars, then you would have a 0% chance. This is really a probability only in the sense of drawing names from a hat. It also applies unevenly across the population – say, due to differences in driving behavior and local road conditions.</p>
<p>Although a population statistic is not the same thing as a probability, it might be a good estimate of it. But only if everyone in the population is demographically similar enough so that the statistic doesn’t change much when calculated for different subgroups.</p>
<p>The next time you’re confronted with such a population statistic, recognize what it actually is: It’s just the percent of a particular population that satisfies some criteria. Chances are, you’re not average for that population. Your own personal probability could be higher or lower.</p><img src="https://counter.theconversation.com/content/201147/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Stover 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>It’s not entirely accurate to say that you’re more likely to die in a car accident than in a plane crash. Chances are, you’re not the average person.Joseph Stover, Associate Professor of Mathematics, Gonzaga UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2015592023-03-17T03:34:49Z2023-03-17T03:34:49ZAre flu cases already 100 times higher than last year? Here’s what we really know about the 2023 flu season<figure><img src="https://images.theconversation.com/files/515943/original/file-20230316-2171-ewng07.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C661&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/sick-boy-thermometer-laying-bed-mother-450568075">Shutterstock</a></span></figcaption></figure><p>Alarming <a href="https://www.9news.com.au/national/flu-cases-australia-update-warning-vulnerable-numbers-rise-100-fold-last-year/55ccbb1d-9613-4e45-85aa-43c905efc8e6">headlines</a> and media coverage <a href="https://www.sbs.com.au/news/article/the-flu-nearly-disappeared-during-the-pandemic-now-cases-are-soaring-in-australia/a98cybrj8">have said</a> we’ve had 100 times as many influenza cases in the first two months of 2023 compared with the same time the previous year.</p>
<p>The coverage suggested we’re in for a bumper flu season, starting early and your best protection was to get a flu vaccine, when available.</p>
<p>But that scary sounding 100 figure is misleading. Here’s what’s behind the figures and what we can really expect from the 2023 flu season.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/you-cant-get-influenza-from-a-flu-shot-heres-how-it-works-118916">You can't get influenza from a flu shot – here's how it works</a>
</strong>
</em>
</p>
<hr>
<h2>Comparing apples with oranges</h2>
<p>In the first two months of 2023, there were 8,474 laboratory-confirmed cases of influenza. In 2022, over the same period, there were 79 cases.</p>
<p>So it might seem this year’s figures are indeed more than 100 times higher than last year’s. But we shouldn’t be alarmed. That’s because in early 2022, influenza cases were artificially low.</p>
<p>Strict COVID measures <a href="https://www.bmj.com/content/379/bmj.o2998">almost eliminated</a> influenza outbreaks in 2020 and 2021. Shutting international borders, quarantining, social distancing and mask-wearing stopped influenza coming into the country and spreading.</p>
<p>Many COVID restrictions weren’t relaxed until late February/March 2022. So, in January and February of that year there were fewer opportunities for us to mingle and spread the influenza virus. It’s hardly surprising there were few cases then.</p>
<p>In fact, the rate of flu in 2023 is actually very similar to pre-COVID years (that is before 2020).</p>
<p>As always, the reported cases represent just a fraction of the actual influenza cases. That’s because many people do not seek medical care when infected with influenza or their GP doesn’t always test them for it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-when-is-the-flu-really-a-cold-25150">Health Check: when is 'the flu' really a cold?</a>
</strong>
</em>
</p>
<hr>
<h2>How about an earlier flu season?</h2>
<p>Every year, it seems, influenza throws a new curve ball making predictions tricky.</p>
<p>Flu rates in the northern hemisphere <a href="https://www.cnet.com/health/medical/early-signs-point-to-this-years-flu-season-being-the-worst-one-in-years/">largely peaked</a> in December 2022, two months earlier than usual.</p>
<p>But there has been some late-season influenza B activity in the northern hemisphere this year. This is one type of influenza that causes seasonal flu. So travellers arriving/returning from the northern hemisphere have been bringing influenza to Australia for several months.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Travellers pulling roll-along luggage in busy airport" src="https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=522&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=522&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=522&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Travellers from the northern hemisphere may have been bringing the influenza virus with them.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/airport-349845530">Shutterstock</a></span>
</figcaption>
</figure>
<p>So we expect more cases of influenza. Australia may even have an autumn surge. This occurred <a href="https://www.bmj.com/content/379/bmj.o2998">last year</a>, where influenza cases rose sharply in May, and peaked by June. That’s two months earlier than the five-year average pre-COVID.</p>
<p>Before COVID, influenza cases usually began to rise in April/May. This progressed to a full epidemic from June to August, often extending into September, before waning in October.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-covid-and-flurona-what-we-can-and-cant-expect-this-winter-177826">Flu, COVID and flurona: what we can and can’t expect this winter</a>
</strong>
</em>
</p>
<hr>
<h2>So what can we expect in 2023?</h2>
<p>The start, length and severity of influenza seasons vary and are often unpredictable.</p>
<p>Community immunity will be less than in pre-COVID times. That’s because of fewer influenza infections during COVID restrictions plus <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">lower influenza vaccine uptake</a> in recent years.</p>
<p>So the 2023 flu season may be at least moderately severe. This remains speculation. Flu routinely surprises us.</p>
<p>The severity of the coming Australian influenza season will be influenced by the types of influenza that circulate, when the surge starts and when the season peaks. The effectiveness, uptake and timing of vaccinations and the degree of remaining herd immunity will all be important. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-mrna-vaccines-researchers-are-working-on-that-arent-covid-157858">3 mRNA vaccines researchers are working on (that aren't COVID)</a>
</strong>
</em>
</p>
<hr>
<h2>Plan to get vaccinated</h2>
<p>Only about 40% of those eligible were vaccinated against influenza in 2022, according to the <a href="https://www.servicesaustralia.gov.au/australian-immunisation-register">Australian Immunisation Register</a> database. Rates <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">were highest</a> in people aged 65 or older.</p>
<p>However, as we saw an early influenza season in 2022 (peaking in May/June) this meant many Australians were not vaccinated during the early stages of the epidemic.</p>
<p>With this knowledge, it’s important to be vaccinated in April/May before influenza becomes common.</p>
<p>Now is a good time to start preparing to get your flu vaccine. Ask your GP or pharmacist when you can book yourself in.</p>
<p>Vaccination is our best defence against influenza and is recommended from the age of <a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">6 months</a>. Younger infants <a href="https://www.health.gov.au/influenza-vaccination-in-pregnancy">receive protection</a> if their mum was vaccinated during pregnancy.</p>
<p>The 2023 vaccine has been updated to protect against more recently circulating strains. There are also <a href="https://www.health.gov.au/sites/default/files/2023-03/atagi-advice-on-seasonal-influenza-vaccines-in-2023.pdf">different types</a> of influenza vaccine, some more effective in elderly people, some free under the <a href="https://www.health.gov.au/resources/publications/national-immunisation-program-schedule?language=en">National Immunisation Program</a>, some not. Other vaccines are available for people with egg allergies and for small children. It’s best to discuss the vaccine options with your GP or pharmacist.</p><img src="https://counter.theconversation.com/content/201559/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Booy receives funding from and consults to various vaccine companies in Australia. He has been funded by the ARC, NHMRC and industry to do research on influenza. He is a long-standing director of the Immunisation Coalition.</span></em></p><p class="fine-print"><em><span>Ian Barr owns shares in an influenza vaccine producing company, and his centre receives funding from commercial groups for ongoing activities.</span></em></p>We may have an autumn surge in flu cases. So best start planning for your flu shot soon.Robert Booy, Hon Prof, Dept of Child & Adolescent Health, University of SydneyIan Barr, Deputy Director, WHO Collaborating Centre for Reference and Research on InfluenzaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2004942023-02-24T20:48:52Z2023-02-24T20:48:52ZWhat is spillover? Bird flu outbreak underscores need for early detection to prevent the next big pandemic<figure><img src="https://images.theconversation.com/files/512225/original/file-20230224-1884-kmbqrq.jpg?ixlib=rb-1.1.0&rect=170%2C186%2C5231%2C3414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Wild birds like pelicans and ducks are getting infected with – and dying from – a new strain of avian influenza and have spread it to farm animals around the world.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/dead-pelican-is-seen-on-the-beach-in-lima-peru-on-december-news-photo/1245471646?phrase=bird%20flu&adppopup=true">Klebher Vasquez/Anadolu Agency via Getty Images</a></span></figcaption></figure><p>The current epidemic of avian influenza has killed <a href="https://www.cdc.gov/flu/avianflu/data-map-commercial.html">over 58 million birds</a> in the U.S. as of February 2023. Following on the heels of the COVID-19 pandemic, large outbreaks of viruses like bird flu raise the specter of another disease jumping from animals into humans. This process is called spillover.</p>
<p>I’m a veterinarian and a researcher who studies how diseases spread between animals and people. I was on the Colorado State University <a href="https://source.colostate.edu/avian-bird-flu-egg-prices/">veterinary diagnostic team</a> that helped detect some of the earliest cases of H5N1 avian influenza in U.S. birds in 2022. As this year’s outbreak of bird flu grows, people are understandably worried about spillover.</p>
<p>Given that the next potential pandemic will likely originate from animals, it’s important to understand how and why spillover occurs – and what can be done to stop it.</p>
<figure class="align-center ">
<img alt="A cup of water containing viruses inside of it, with a fruit bat, chicken and pig standing on top of it. A drop of water with a new virus is falling toward a person, spreading more virus through coughing." src="https://images.theconversation.com/files/512088/original/file-20230223-1774-77sguf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512088/original/file-20230223-1774-77sguf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=548&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512088/original/file-20230223-1774-77sguf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=548&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512088/original/file-20230223-1774-77sguf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=548&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512088/original/file-20230223-1774-77sguf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=689&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512088/original/file-20230223-1774-77sguf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=689&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512088/original/file-20230223-1774-77sguf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=689&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Viral spillover occurs when a virus spills out from an animal population into people.</span>
<span class="attribution"><span class="source">Treana Mayer/BioRender</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>How spillover works</h2>
<p>Spillover involves any type of disease-causing pathogen, be it a virus, parasite or bacteria, jumping into humans. The pathogen can be something never before seen in people, such as a new <a href="https://doi.org/10.1126/science.aaw7864">Ebola virus carried by bats</a>, or it could be something well known and recurring, like <a href="https://www.theguardian.com/environment/2021/aug/10/why-salmonella-is-a-food-poisoning-killer-that-wont-go-away-in-the-us"><em>Salmonella</em> from farm animals</a>. </p>
<p>The term spillover evokes images of a container of liquid overflowing, and this image is a great metaphor for how the process works.</p>
<p>Imagine water being poured into a cup. If the water level keeps increasing, the water will flow over the rim, and anything nearby could get splashed. In viral spillover, the cup is an animal population, the water is a zoonotic disease capable of spreading from an animal to a person, and humans are the ones standing in the splash zone. </p>
<p>The probability that a spillover will occur depends on many <a href="https://doi.org/10.1038/nrmicro.2017.45">biological and social factors</a>, including the rate and severity of animal infections, environmental pressure on the disease to evolve and the amount of close contact between infected animals and people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/512231/original/file-20230224-1926-7gbjli.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign telling people to wear masks, stay 6 feet apart and wash hands." src="https://images.theconversation.com/files/512231/original/file-20230224-1926-7gbjli.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512231/original/file-20230224-1926-7gbjli.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512231/original/file-20230224-1926-7gbjli.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512231/original/file-20230224-1926-7gbjli.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512231/original/file-20230224-1926-7gbjli.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512231/original/file-20230224-1926-7gbjli.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512231/original/file-20230224-1926-7gbjli.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Epidemiologists estimate that three-quarters of all new infectious human diseases originated in animals.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sign-listing-the-safety-guidelines-of-the-getty-museum-is-news-photo/1233106978?phrase=covid%20closed%20sign%20california&adppopup=true">Valerie Macon/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>Why spillover matters</h2>
<p>While not all animal viruses or other pathogens are capable of spilling over into people, up to <a href="https://doi.org/10.1590%2F1678-4685-GMB-2020-0355">three-quarters of all new human infectious diseases</a> have originated from animals. There’s a good chance the next big pandemic risk will <a href="https://www.mdpi.com/2078-1547/13/2/35">arise from spillover</a>, and the more that’s known about how spillovers occur, the better chance there is at preventing it.</p>
<p>Most spillover research today is focused on <a href="https://doi.org/10.1146/annurev-virology-100120-015057">learning about and preventing viruses</a> – including coronaviruses, like the one that causes COVID-19 and certain viral lineages of avian influenza – from jumping into humans. These <a href="https://doi.org/10.1007%2Fs00018-014-1785-y">viruses mutate very quickly</a>, and random changes in their genetic code could eventually allow them to infect humans.</p>
<p>Spillover events can be <a href="https://doi.org/10.1007%2Fs00018-014-1785-y">hard to detect</a>, flying under the radar without leading to bigger outbreaks. Sometimes a virus that transfers from animals to humans poses no risk to people if the virus is not well adapted to human biology. But the more often this jump occurs, the higher the chances a dangerous pathogen will <a href="https://doi.org/10.1098/rspb.2021.0900">adapt and take off</a>.</p>
<h2>Spillover is becoming more likely</h2>
<p>Epidemiologists are projecting that the risk of spillover from wildlife into humans will increase in coming years, in large part because of the <a href="https://www.theguardian.com/world/2021/jun/04/end-destruction-of-nature-to-stop-future-pandemics-say-scientists">destruction of nature</a> and encroachment of humans into previously wild places. </p>
<p>Because of <a href="https://doi.org/10.1016%2FS2542-5196(21)00031-0">habitat loss, climate change and changes in land use,</a> humanity is collectively jostling the table that is holding up that cup of water. With less stability, spillover becomes more likely as animals are stressed, crowded and on the move.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/512237/original/file-20230224-1648-ddddz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Houses and a farm next to some woods." src="https://images.theconversation.com/files/512237/original/file-20230224-1648-ddddz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512237/original/file-20230224-1648-ddddz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512237/original/file-20230224-1648-ddddz0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512237/original/file-20230224-1648-ddddz0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512237/original/file-20230224-1648-ddddz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512237/original/file-20230224-1648-ddddz0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512237/original/file-20230224-1648-ddddz0.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">As housing and farmland expand into wild places, the risk of spillover increases.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/urban-development-on-the-edge-of-a-farm-field-royalty-free-image/1210310779?phrase=urban%20forest%20interface&adppopup=true">Cavan/Getty Images</a></span>
</figcaption>
</figure>
<p>As development expands into new habitats, wild animals come into closer contact with people – and, importantly, the food supply. The mixing of <a href="https://doi.org/10.1073/pnas.1208059110">wildlife and farm animals</a> greatly amplifies the risk that a disease will jump species and spread like wildfire among farm animals. Poultry across the U.S. are experiencing this now, thanks to a <a href="https://www.cdc.gov/flu/avianflu/avian-flu-summary.htm">new form of avian flu</a> that experts think spread to chicken farms mostly through <a href="https://doi.org/10.3201%2Feid2805.220318">migrating ducks</a>.</p>
<h2>Current risk from bird flu</h2>
<p>The new avian influenza virus is a distant descendant of the original H5N1 strain that has caused <a href="https://asm.org/Articles/2022/July/Avian-Influenza-Past,-Present,-Future">human epidemics of bird flu</a> in the past. Health officials are detecting cases of this new flu virus jumping from <a href="https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/animal-disease-information/avian/avian-influenza/hpai-2022/2022-hpai-mammals">birds to other mammals</a> – like foxes, skunks and bears. </p>
<p>On Feb. 23, 2023, news outlets began reporting a few confirmed infections of people in Cambodia, including one infection leading to the death of an 11-year-old girl. While this new strain of bird flu can infect people in rare situations, it isn’t very good at doing so, because it is <a href="https://www.cdc.gov/flu/avianflu/spotlights/2022-2023/avian-flu-highly-pathogenic.htm">not able to bind to cells in human respiratory tracts</a> very effectively. For now, the Centers for Disease Control and Prevention thinks there is <a href="https://www.cdc.gov/flu/avianflu/spotlights/2022-2023/avian-flu-highly-pathogenic.htm">low risk to the general public</a>.</p>
<p>Active monitoring of wild animals, farm animals and humans will allow health officials to detect the first sign of spillover and help prevent a small viral splash from turning into a large outbreak. Moving forward, researchers and policymakers can take steps to prevent spillover events by preserving nature, keeping wildlife wild and separate from livestock and improving early detection of novel infections in people and animals.</p><img src="https://counter.theconversation.com/content/200494/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Treana Mayer receives funding from the NIH/NCATS Colorado CTSA Grant Number TL1 TR002533. Contents are the authors’ sole responsibility and do not necessarily represent official NIH views.</span></em></p>A biologist who studies how viruses spread from animals to people explains the process of spillover and the risks posed by the new bird flu that has spread across the globe.Treana Mayer, Postdoctoral Fellow in Microbiology, Colorado State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2001532023-02-20T20:11:51Z2023-02-20T20:11:51ZEpigenetic and social factors both predict aging and health – but new research suggests one might be stronger<figure><img src="https://images.theconversation.com/files/510905/original/file-20230217-22-uooeg7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3295%2C2549&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Epigenetics is but one of many factors that influence aging, health and disease.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/clock-and-dna-royalty-free-image/1094434840">bestdesigns/iStock via Getty Images</a></span></figcaption></figure><p>Can we objectively tell how fast we are aging? With a good measure, scientists might be able to change our rate of aging to live longer and healthier lives. Researchers know that some people age faster than others and have been trying to concisely measure the internal physiological changes that lead to deteriorating health with age.</p>
<p>For years, researchers have been using <a href="https://doi.org/10.1093/gerona/gls233">clinical factors</a> normally collected at physicals, like hypertension, cholesterol and weight, as indicators to predict aging. The idea was that these measures could determine whether someone is a fast or slow ager at any point in their life cycle. But more recently, researchers have theorized that there are other biological markers that reflect aging at the <a href="https://doi.org/10.1016%2Fj.cell.2013.05.039">molecular and cellular level</a>. This includes modifications to a person’s genetic material itself, or epigenetics.</p>
<p>While each person has a genetic makeup that largely does not change over their lifetime, chemical changes to their genetic material that occur throughout life can change which genes are turned on or off and lead to more rapid aging. These changes typically involve the addition of methyl groups to DNA and are <a href="https://doi.org/10.1016/j.ssmph.2022.101071">influenced by social</a> and <a href="https://doi.org/10.1186/s13148-022-01286-8">environmental exposures</a>, such as adverse childhood experiences, smoking, pollution and depression.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/GASaqPv0t0g?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The body undergoes many changes as it ages.</span></figcaption>
</figure>
<p>But how well do epigenetic markers predict the important health changes that happen with aging? We are <a href="https://scholar.google.com/citations?hl=en&user=xcXH8QcAAAAJ">social</a> <a href="https://scholar.google.com/citations?user=0aj9ZoEAAAAJ&hl=en">scientists</a> who study how social factors predict aging. Our <a href="https://doi.org/10.1016/j.arr.2020.101136">previous research</a> has shown that factors like education, poverty, race, access to medical care and certain health behaviors can influence aging rates. We are incorporating biological measures like epigenetic age in large population studies to understand how social factors get “under the skin” and affect aging. In our <a href="https://www.pnas.org/cgi/doi/10.1073/pnas.2215840120">recently published study</a>, we found that while epigenetic age does predict certain health outcomes later in life, it does little to explain important differences related to social factors.</p>
<h2>What is epigenetic aging?</h2>
<p>In 2013, geneticist and biostatistician <a href="https://scholar.google.com/citations?user=mEM8q5cAAAAJ&hl=en">Steve Horvath</a> introduced the idea that a person’s rate of aging would be captured by the <a href="https://doi.org/10.1186/gb-2013-14-10-r115">level of methylation</a> in their genome. He also developed ways to measure epigenetic age in terms of years and compare this age to one’s chronological age.</p>
<p>Researchers have since developed <a href="https://doi.org/10.18632/aging.101684">several measures</a> that can more reliably predict health outcomes based on epigenetics. Some have suggested that DNA methylation could potentially be used to summarize the amount and rate of aging with a <a href="https://doi.org/10.7554/eLife.54870">few drops of blood</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/510924/original/file-20230217-18-vamim0.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of DNA methylation" src="https://images.theconversation.com/files/510924/original/file-20230217-18-vamim0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510924/original/file-20230217-18-vamim0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510924/original/file-20230217-18-vamim0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510924/original/file-20230217-18-vamim0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510924/original/file-20230217-18-vamim0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510924/original/file-20230217-18-vamim0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510924/original/file-20230217-18-vamim0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Epigenetics can influence health in a number of ways.</span>
<span class="attribution"><a class="source" href="http://commonfund.nih.gov/epigenomics/figure">National Institutes of Health</a></span>
</figcaption>
</figure>
<h2>Comparing epigenetic and social factors</h2>
<p>It has been unclear how well epigenetic age predicts health outcomes compared to other nongenetic factors like demographics and socioeconomic status. We wanted to see whether epigenetic age, measured by DNA methylation levels in the blood, predicted four aging-related health outcomes: death, chronic disease, physical disability and cognitive dysfunction.</p>
<p>Using data from the <a href="https://hrs.isr.umich.edu/about">Health and Retirement Study</a>, a large, nationally representative sample of Americans over the age of 56, we found that epigenetic age <a href="https://www.pnas.org/cgi/doi/10.1073/pnas.2215840120">predicted all of the health outcomes we examined</a>. Epigentic age most strongly predicted death and morbidity later in life. So overall, people with a higher epigenetic age experienced poorer health.</p>
<p>On the other hand, epigenetic age did not explain why people with certain demographics – such as having less education, smoking, being Black or Hispanic, being obese or having a more difficult childhood – experienced worse health outcomes earlier or more frequently. These social factors were able to predict mortality and morbidity just as well as epigenetics and substantially predicted physical and cognitive functioning better than epigentic age.</p>
<p>Our findings suggest that while DNA methylation is a useful addition to the toolbox to predict health outcomes later in life, other factors such as demographics, socioeconomic status, mental health and health behaviors remain equally, if not more robust, predictors of health.</p>
<h2>Better predicting aging and health</h2>
<p>Epigenetic aging processes like DNA methylation show promise in explaining aging. But there is still a long way to go before researchers fully understand the molecular and cellular mechanisms underlying aging.</p>
<p>Improving our ability to measure both the lifetime social experiences that affect biology and the biological mechanisms that underlie aging could lead not only to better measurements of aging, but to better treatments and disease prevention for those who need it the most.</p><img src="https://counter.theconversation.com/content/200153/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Crimmins receives funding from the National Institute on Aging .
</span></em></p><p class="fine-print"><em><span>Jessica Faul receives funding from the National Institute on Aging.</span></em></p>People don’t all age at the same rate. Untangling the factors that influence health and disease – such as epigenetics, demographics and behavior – could lead to better care for those who need it most.Eileen Crimmins, Professor of Gerontology, University of Southern CaliforniaJessica Faul, Research Associate Professor of Epidemiology, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1981582023-02-02T19:17:34Z2023-02-02T19:17:34ZThe ‘Kraken’ subvariant XBB.1.5 sounds scary. But behind the headlines are clues to where COVID’s heading<figure><img src="https://images.theconversation.com/files/507491/original/file-20230201-13-2aahu8.jpg?ixlib=rb-1.1.0&rect=0%2C43%2C998%2C750&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-illustration/kraken-sea-sunset-1830388856">Anastelfy/Shutterstock</a></span></figcaption></figure><p>The XBB.1.5 subvariant, known informally as “Kraken”, is the latest in a menagerie of Omicron subvariants to dominate the headlines, following <a href="https://theconversation.com/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-197602">increasing detection</a> in the United States and United Kingdom. </p>
<p>But there have been <a href="https://cov-spectrum.org/explore/Australia/AllSamples/Past6M/variants/international-comparison?nextcladePangoLineage=xbb.1.5">few cases</a> of XBB.1.5 in Australia so far. And its nickname – a mythical sea monster – may be causing unnecessary fear.</p>
<p>Yet XBB.1.5 and other subvariants do signal a change in how the virus is mutating. Here’s what this means for Australia and globally.</p>
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Read more:
<a href="https://theconversation.com/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-197602">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'?</a>
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<h2>We’ve had multiple Omicron waves</h2>
<p>From Australia’s first major wave of transmission in the summer of 2021/22 through to late 2022, we have had a series of COVID waves, each dominated by a single Omicron subvariant: BA.1, then BA.2 and then BA.5. </p>
<p>Although each new subvariant has played an important role in driving these waves of transmission, we should expect waves like this even in the absence of new variants.</p>
<p>This cyclical pattern of waves of increased infections alternating with periods of much lower transmission is an expected feature of endemic infections that confer short-term immunity, such as COVID.</p>
<p>This pattern arises because the natural protection we develop against the virus from infection declines or “wanes” over time. Markers of the immune response that protects against initial infection (especially antibodies) can be clearly observed to <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00025-2/fulltext#seccestitle160">decline</a> with time.</p>
<p>Reassuringly though, the protection we develop against severe outcomes is <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(22)00287-7/fulltext#seccestitle150">sustained</a> for much longer.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-there-so-many-new-omicron-sub-variants-like-ba-4-and-ba-5-will-i-be-reinfected-is-the-virus-mutating-faster-182274">Why are there so many new Omicron sub-variants, like BA.4 and BA.5? Will I be reinfected? Is the virus mutating faster?</a>
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<h2>Then there was a shift</h2>
<p>In late 2022, following the rise of BA.5 around the globe, we started to see a shift in the evolution of SARS-CoV-2, the virus that causes COVID.</p>
<p>The result has been an explosion of subvariants, sometimes called a “<a href="https://www.nature.com/articles/d41586-022-03445-6">variant soup</a>”. This has led to the emergence of a plethora of genetically diverse Omicron subvariants: <a href="https://theconversation.com/from-centaurus-to-xbb-your-handy-guide-to-the-latest-covid-subvariants-and-why-some-are-more-worrying-than-others-192945">BA.4.6, BA.2.75, BQ.1, XBB</a>, and on the list goes.</p>
<p>The recent evolution of the virus is markedly different to what we saw earlier in the pandemic. Before this proliferation of subvariants, there were complete shifts from wild-type (the original viral strain) to Alpha, Delta, Omicron and the earlier Omicron subvariants (BA.1, BA.2 and BA.5) – each with substantially different effects on COVID transmission and immune protection.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1590104415033335808"}"></div></p>
<h2>This brings us to XBB.1.5</h2>
<p>XBB.1.5 was first detected in the <a href="https://www.ecdc.europa.eu/en/news-events/update-sars-cov-2-variants-ecdc-assessment-xbb15-sub-lineage">US in October 2022</a>. Since then, it has spread steadily, and has now been detected <a href="https://cov-spectrum.org/explore/World/AllSamples/Past6M/variants/international-comparison?nextcladePangoLineage=xbb.1.5*&">in more than 50 countries</a>. In some countries, such as the UK and US, its share of COVID <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1129169/variant-technical-briefing-49-11-january-2023.pdf">cases</a> is increasing. Although importantly, in the UK the total number of sequenced XBB.1.5 cases remains small and there is uncertainty around these growth estimates at this early stage.</p>
<p>The potential of XBB.1.5 to outcompete other subvariants and take a bigger piece of infection pie is likely driven by its ability to <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2214314?query=featured_coronavirus">evade</a> parts of the immune system that prevent us getting infected. This is due to a <a href="https://www.biorxiv.org/content/10.1101/2023.01.03.522427v2.full">specific mutation</a> that might help it to better enter the human cells it first comes in contact with.</p>
<p>These properties have led to its monstrous social media moniker “<a href="https://www.smh.com.au/politics/federal/kraken-basilisk-and-gryphon-the-push-to-name-omicron-variants-after-monsters-20230116-p5ccso.html">Kraken</a>”. It joins other subvariants given mythical nicknames, including “Centaurus” (BA.2.75) and “Aeterna” (BA.4.6).</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1615138343163162624"}"></div></p>
<p>Some argue these names make these subvariants <a href="https://www.smh.com.au/politics/federal/kraken-basilisk-and-gryphon-the-push-to-name-omicron-variants-after-monsters-20230116-p5ccso.html">easier to remember</a> and more accessible to the general public than the often cumbersome official <a href="https://www.nature.com/articles/s41564-020-0770-5">scientific terms</a> used to describe these subvariants.</p>
<p>However, we must also acknowledge the considerable fear still associated with COVID, which could be exacerbated by attributing such terrifying names to each new form of the virus that emerges.</p>
<p>While a high level of concern may have been appropriate – or even beneficial – during the COVID-zero phase of our response, we now need to look to sustainable policies as we transition out of the emergency phase of our response.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/even-bivalent-updated-covid-19-boosters-struggle-to-prevent-omicron-subvariant-transmission-an-immunologist-discusses-why-new-approaches-are-necessary-197878">Even bivalent updated COVID-19 boosters struggle to prevent omicron subvariant transmission – an immunologist discusses why new approaches are necessary</a>
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</em>
</p>
<hr>
<h2>So how about Australia?</h2>
<p>At the time of writing, only <a href="https://cov-spectrum.org/explore/World/AllSamples/Past6M/variants/international-comparison?nextcladePangoLineage=xbb.1.5*&">29</a> XBB.1.5 sequences have been recorded across Australia, making predictions about its trajectory uncertain.</p>
<p>For XBB.1.5 to become established in Australia, it would have to outcompete a range of established subvariants, including two that appear to be <a href="https://cov-spectrum.org/explore/World/AllSamples/Past6M/variants?nextcladePangoLineage=xbf*&">more common here</a> than overseas: BR.2 and XBF.</p>
<p>In countries in which XBB.1.5 is established and contributing a substantial proportion of samples, such as the US and UK, the number of COVID cases and hospitalisations already appear <a href="https://www.gov.uk/government/statistics/national-flu-and-covid-19-surveillance-reports-2022-to-2023-season">to be</a> <a href="https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions">declining</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/chinas-covid-cases-may-have-hit-900-million-whats-headed-our-way-197896">China's COVID cases may have hit 900 million. What's headed our way?</a>
</strong>
</em>
</p>
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<h2>What can we expect next in Australia?</h2>
<p>We can expect recurrent waves of infection in Australia, even without the emergence of dramatically different variants.</p>
<p>However, the health-care burden of these waves should get progressively <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2118946">less severe</a>, due to high levels of hybrid population immunity (from vaccination, natural infection or both).</p>
<p>XBB.1.5 may come to be the dominant circulating subvariant, although it is very unlikely we will need to introduce restrictive measures to curb transmission.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1619303701990219778"}"></div></p>
<p>As time goes on, it is likely that transmission waves will settle into a somewhat more predictable or cyclical pattern. </p>
<p>For other coronaviruses, this manifests as a winter epidemic every one to two years, and a pattern like this would also fit with the characteristics of COVID. </p>
<p>However, we are not there yet, as subvariants such as XBB.1.5 contribute to transmission waves and the epidemic continues to wax and wane unpredictably.</p>
<h2>What should we do next?</h2>
<p>Given this background of endemic transmission with fluctuating levels of transmission, our public health response needs to focus on sustainable measures, including through optimising population immunity.</p>
<p>This should include focusing on vaccines and medicines to protect the most vulnerable, as well as shifting towards considering how recently a person was last vaccinated rather than just the total number of vaccines, as <a href="https://www.nature.com/articles/d41586-023-00234-7">proposed</a> in the US.</p>
<p>A sustainable response also requires continued investment in surveillance systems to monitor COVID, its evolution and impact.</p><img src="https://counter.theconversation.com/content/198158/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Epidemiological Modelling Unit at the School of Public Health and Preventive Medicine (led by James Trauer) has received funding for COVID-19 research from the NHMRC, the MRFF, the World Health Organization, the Victorian Government Department of Health and Human Services (now the Victorian Department of Health) and the Northern Territory Government.</span></em></p><p class="fine-print"><em><span>Angus Hughes 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>XBB.1.5 and other subvariants do signal a change in how the virus is mutating. Here’s what this means for Australia and globally.James Trauer, Associate Professor, Monash UniversityAngus Hughes, Epidemiologist, Epidemiological Modelling Unit, School of Public Health and Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1975812023-02-01T13:18:46Z2023-02-01T13:18:46ZLung cancer rates have decreased for the Marlboro Man, but have risen steeply for nonsmokers and young women – an oncologist explains why<figure><img src="https://images.theconversation.com/files/507416/original/file-20230131-7915-kzl91k.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Around 20% of women with lung cancer have never smoked.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-coughing-while-sitting-against-wall-at-home-royalty-free-image/1188576496">Mallika Wiriyathitipirn/EyeEm via Getty Images</a></span></figcaption></figure><p>When many people think of an average lung cancer patient, they often imagine an <a href="https://www.statnews.com/2021/01/26/growing-share-of-lung-cancer-turning-up-in-never-smokers">older man smoking</a>. But the face of lung cancer has changed. Over the past 15 years, <a href="https://doi.org/10.1016/j.cllc.2018.03.013">more women, never smokers and younger people</a> are being diagnosed with lung cancer.</p>
<p>In fact, lung cancer is the <a href="https://doi.org/10.3322/caac.21654">leading cause of cancer death among women</a>, and more women die from lung cancer than breast, ovarian and colorectal cancer each year. The American Lung Association reports that while lung cancer rates have risen by 79% for women over the last 44 years, they <a href="https://www.lung.org/about-us/diversity-inclusion/womens-history-month">decreased by 43% for men</a>. And for the first time in history, there are <a href="https://doi.org/10.1056/NEJMoa1715907">more young women than men</a> diagnosed with lung cancer. </p>
<p>As a <a href="https://doctors.umiamihealth.org/provider/Estelamari+Rodriguez/1257821">thoracic oncologist</a> at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System, I have seen many younger women and never smokers walk into my clinic with a new diagnosis of lung cancer. Particularly for never smokers, lung cancer is unexpected for both patients and their doctors, which can often lead to delays in diagnosis. Researchers have described this trend of increasing lung cancer rates among women in <a href="https://doi.org/10.1002/ijc.32809">different parts of the world</a> and are starting to understand why cases are on the rise.</p>
<h2>Lung cancer in women</h2>
<p>The first explanation of why rates of lung cancer in women have increased is that many <a href="https://doi.org/10.1016/j.ccm.2021.04.007">started smoking later than men</a>, pushing back their peak in smoking-related lung cancer diagnoses.</p>
<p>Women also started smoking in the years when filtered cigarettes were most commonly used. This led to an <a href="https://www.cdc.gov/cancer/lung/nonsmokers/index.htm">increased risk of a type of cancer called adenocarcinoma</a> due to the way cigarette filters distribute tobacco smoke to the outer parts of the lungs. Some studies suggest that women are <a href="https://doi.org/10.1001/jama.296.2.180">more susceptible</a> to the carcinogenic effects of exposure to tobacco and cigarette smoke, including second-hand smoke, and may develop lung cancer after fewer years of smoking compared to men.</p>
<p>However, it is important to note that most people diagnosed today with lung cancer are not active smokers. About <a href="https://doi.org/10.1016/j.ccm.2021.04.007">20% of women with lung cancer</a> have never smoked – higher than for men with lung cancer who’ve never smoked.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/yRDDMX8vFrg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An increasing number of lung cancer diagnoses are among people who never smoked.</span></figcaption>
</figure>
<h2>Lung cancer risk factors</h2>
<p>Besides smoking and secondhand smoke, there are <a href="https://www.cancer.org/cancer/lung-cancer/causes-risks-prevention/risk-factors.html">several other lung cancer risk factors</a>. These include a family history of cancer and exposure to asbestos, radon and air pollution.</p>
<p>Exposure to carcinogens in the workplace in the form of inhaled chemicals such as <a href="https://www.cancer.org/healthy/cancer-causes/chemicals/arsenic.html">arsenic</a>, beryllium, cadmium, silica and nickel is still a concern in some parts of the world. The potential lung cancer risk of <a href="https://www.cancer.org/healthy/stay-away-from-tobacco/e-cigarettes-vaping/what-do-we-know-about-e-cigarettes.html">e-cigarette</a> and marijuana smoke is still under study but of potential concern.</p>
<p>Recently, researchers have also found that <a href="https://www.cancer.org/cancer/lung-cancer/causes-risks-prevention/what-causes.html">genetics</a> <a href="https://doi.org/10.3892%2Fol.2016.5518">can play</a> <a href="https://doi.org/10.1093/oxfordjournals.aje.a008783">a role</a> in lung cancer risk in some patients with a strong history of lung cancer. Studies of these families have helped identify potential susceptibility genes for lung cancer and environmental risk factors. </p>
<p>Like <a href="https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet">BRCA1 and BRCA2</a> in breast cancer, alterations in genes that promote or protect against tumor development can contribute to lung cancer development. Researchers have yet to identify specific mutations that may predispose individuals to lung cancer. However, studying familial genetic predispositions can help elucidate how lung cancer develops and lead to <a href="https://doi.org/10.1038/s41598-020-80735-x">new biomarkers</a> for early cancer detection in high-risk groups.</p>
<h2>Lung cancer screening</h2>
<p>In 2021, the United States Preventive Services Task Force <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening">updated its lung cancer screening guidelines</a> to include younger patients with less smoking history. Now, lung cancer screening is recommended for adults ages 50 to 80 who have smoked at least one pack per day for 20 years, current smokers and former smokers who quit smoking within the last 15 years. Women at risk for lung cancer can talk to their doctors about ordering a <a href="https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/detection.html">low-dose CT scan</a> for lung cancer screening.</p>
<p>Nationwide, <a href="https://doi.org/10.1001%2Fjamanetworkopen.2022.33840">more than 70% of eligible women</a> undergo breast cancer screening but <a href="https://www.lung.org/media/press-releases/state-of-lung-cancer-2022">less than 6% of all eligible smokers</a> pursue lung cancer screening. Researchers estimate that these new screening guidelines will <a href="https://doi.org/10.1001/jamanetworkopen.2022.33840">increase the number of women</a> eligible for lung cancer screening by 40% by including those at a younger age who have less smoking exposure.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/507417/original/file-20230131-7561-l2uxyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="CT scan of lung adenocarcinoma" src="https://images.theconversation.com/files/507417/original/file-20230131-7561-l2uxyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507417/original/file-20230131-7561-l2uxyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=478&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507417/original/file-20230131-7561-l2uxyg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=478&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507417/original/file-20230131-7561-l2uxyg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=478&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507417/original/file-20230131-7561-l2uxyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=601&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507417/original/file-20230131-7561-l2uxyg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=601&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507417/original/file-20230131-7561-l2uxyg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=601&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 low-dose CT scan can help with early detection of lung cancer. In this image, the tumor is the white nodule in the upper right corner of the black space.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/9nZ2UH">Atlas of Pulmonary Pathology/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Lung cancer diagnosis</h2>
<p>In recent years, increasing understanding of the genetic changes that can lead to cancer and how to harness the immune system to treat cancer has led to new <a href="https://theconversation.com/a-new-way-to-organize-cancer-mutations-could-lead-to-better-treatment-matches-for-patients-168348">targeted therapies</a> and <a href="https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/immunotherapy.html">immunotherapies</a> that have improved the prognosis of patients with lung cancer. Women tend to have a <a href="https://doi.org/10.1053%2Fj.semtcvs.2013.05.002">better lung cancer prognosis</a> than men, especially if they never smoked and have tumors with molecular changes that can be treated with targeted therapies. </p>
<p>However, lung cancer symptoms <a href="https://www.verywellhealth.com/lung-cancer-in-women-5206947">may go unrecognized in women</a>. Symptoms of lung cancer can include coughing, shortness of breath, overwhelming fatigue and pain in the back, chest or shoulder, which could be confused for other ailments. Because women tend to be <a href="https://doi.org/10.1002/ijc.32809">slightly younger when diagnosed than men</a>, patients may be able to tolerate symptoms longer and delay seeking medical attention. Physicians also might not attribute these symptoms to lung cancer due to a patient’s younger age.</p>
<p>Recognizing the early symptoms of lung cancer, expanding lung cancer screening eligibility and testing for genetic biomarkers to select the best therapy are some of the steps that could help address the global epidemic of lung cancer in women.</p><img src="https://counter.theconversation.com/content/197581/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Estelamari Rodriguez is affiliated with University of Miami Health System. She receives funding from the American Cancer Society.</span></em></p>While lung cancer rates have decreased by 43% in men, they have risen by 79% in women. New screening guidelines and recognizing early symptoms can help address the changing face of lung cancer.Estelamari Rodriguez, Associate Director of Community Outreach in Thoracic Oncology, University of MiamiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1892882022-12-22T16:56:00Z2022-12-22T16:56:00ZChronic pain: An invisible disease whose sufferers are unfairly stigmatized<figure><img src="https://images.theconversation.com/files/481359/original/file-20220826-2852-t3iovl.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even though chronic pain is recognized by scientists as a disease in its own right, it remains largely under-recognized, under-diagnosed and, above all, subject to many prejudices. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Imagine living with pain every day for months, or even years — pain that is so intrusive, it disrupts every day of your life.</p>
<p>Unfortunately, this is the daily reality of millions of people living with chronic pain. And all too often, they find their condition being stigmatized or even denied outright.</p>
<p>As a doctoral student in the epidemiology of chronic pain, I have the opportunity to work with patient partners. Given the high prevalence and multiple impacts of this disease, it is high time we started working to change attitudes and confront the prejudices that surround it.</p>
<h2>Essential pain and acute pain</h2>
<p>Before discussing chronic pain, let’s start at the beginning. Is pain always a negative thing? Of course not. Pain is essential to our proper functioning. It acts as an <a href="https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdf">alarm system</a> to warn us of danger.</p>
<p>For example, if we were to accidentally put our hand on a hot stove top, a pain message would be sent to our brain. Before we even had time to think about it, we would remove our hand from the hot surface, avoiding an intense burn in the process. This pain provides us with the reflexes we need in order to avoid the worst situations.</p>
<p>Pain can also last a little longer. This is the case, for example, after an injury, an operation or an infection. <a href="https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdf">This pain will often resolve itself after a normal healing cycle</a> or disappear with the help of treatment. This is called acute pain. Short-term pain like this is perceived more as a symptom.</p>
<h2>Chronic pain, a disease with multiple impacts</h2>
<p>When pain persists beyond the normal healing time, it is no longer considered simply a symptom, but a <a href="https://doi.org/10.1097/j.pain.0000000000000160">disease in its own right</a>. This is called chronic pain. Chronic pain is defined as <a href="https://doi.org/10.1097/j.pain.0000000000001384">pain that persists for a minimum of three months</a>. Yet, for the vast majority of people living with this disease, the pain persists for several years.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472372/original/file-20220704-12-5r8qlt.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">‘Displacement,’ by Chloe Fleisher, 13, who lives with chronic pain. Submitted as part of the art contest titled ‘Pain and mental health,’ this artwork won an award from the Canadian Pain Society in 2022.</span>
<span class="attribution"><span class="source">(Marimée Godbout-Parent)</span></span>
</figcaption>
</figure>
<p>In these people, the pain message is somehow missing. It is no longer present to warn us of dangers, but becomes a burden on its own. Chronic pain can occur as a result of cancer, an accident, or after surgery. Unfortunately, sometimes we are unable to find the cause. This makes it difficult to treat.</p>
<p>Although this disease is not widely recognized, it is estimated to affect about <a href="https://doi.org/10.24095/hpcdp.31.4.04">20 per cent of the Canadian population</a>. Considering that our population in 2022 is estimated to be close to 39 million, this would mean that approximately 7.5 million people are living with chronic pain. For the purpose of comparison, 7.5 million Canadians is equivalent to <a href="https://worldpopulationreview.com/canadian-provinces/quebec-population">the entire population of Québec</a>. It’s an impressive and worrisome number.</p>
<p>In addition to affecting a large portion of the population, chronic pain <a href="https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdf">causes more than just physical pain</a>. The disease affects the daily functioning, psychological well-being, quality of life, social life and work of the people afflicted by it.</p>
<p>Imagine having so much pain that it reduces your ability to work, play with your children, see your friends or concentrate and even affects your ability to carry out everyday tasks. Despite the person’s desire to stay active, the body just can’t keep up. So it’s not surprising that consequences such as fatigue, frustration, sadness, anxiety and depression follow. The constant overlap between physical, psychological and social difficulties creates deep distress in this population.</p>
<h2>A stigmatized disease</h2>
<p>Despite the significant impacts associated with it, <a href="https://doi.org/10.1111/j.1526-4637.2011.01264.x">chronic pain remains largely stigmatized</a>. Indeed, negative attitudes and beliefs that people living with chronic pain <a href="https://doi.org/10.1080/24740527.2017.1369849">have become dependent on their medications, that they are exaggerating the severity of their condition, are just lazy</a> or do not want to help themselves are widespread.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/IcdsYdUls44?wmode=transparent&start=48" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Chronic pain is a very real disease.</span></figcaption>
</figure>
<p>So, knowing the multiple consequences and prevalence of chronic pain, why is there still so much prejudice and stigma towards those who suffer from it?</p>
<p>The question remains unanswered. For some, what we cannot see simply does not exist. Because pain is an experience that varies from person to person, because we don’t have a specific tool for detecting it or because we can’t necessarily see it, pain can seem invisible. We have a harder time feeling <a href="https://doi.org/10.1016/j.jpain.2013.11.002">sympathy or understanding for things that cannot be explained medically</a> with medical tests or X-rays.</p>
<h2>How to become an ally</h2>
<p>So, despite the many explanations offered by patients, they often have to deal with prejudices from health professionals, their entourage or the general population. Many people living with chronic pain feel that their pain is not understood by their friends, family, employers or even their health-care professionals, which adds to their feelings of helplessness, sadness and anger. In addition to dealing with the difficulties that chronic pain brings, these comments place an inestimable burden on sufferers. </p>
<p>Francine, who has been living with chronic pain for 15 years, regularly receives these types of comments from her family and friends:</p>
<blockquote>
<p>Well, you’ve only been walking for 10 minutes, you can do more. Just try harder.</p>
</blockquote>
<p>Sylvie, who has lived with chronic pain for 17 years, has to deal with her doctor’s comments:</p>
<blockquote>
<p>“You are the only patient I have not been able to relieve with cortisone shots in 40 years, so perhaps you should consult a psychologist instead.</p>
</blockquote>
<p>These phrases, which can sound harmless to some, are often loaded with meaning for those who hear them on a daily basis. Accepting chronic pain as a disease is an important and difficult step. It should not be coupled with such pejorative comments.</p>
<p>Without being experts in the field, we can all play a role, in one way or another, in the lives of these people. Offering an active and understanding ear, not making quick judgments and acknowledging their condition is already a huge step in the right direction.</p>
<p>Support and communication with those around you are elements that should not be neglected and can certainly make a positive difference.</p>
<p><em>This article was written in collaboration with Sylvie Beaudoin and Christian Bertrand, patient partners.</em></p><img src="https://counter.theconversation.com/content/189288/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marimée Godbout-Parent has received funding from the Canadian Institutes of Health Research (CIHR).</span></em></p>Although chronic pain is recognized by scientists as a disease in its own right, it remains largely under-recognized, under-diagnosed and, above all, associated with numerous prejudices.Marimée Godbout-Parent, Étudiante au doctorat recherche en sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1916592022-11-16T14:23:55Z2022-11-16T14:23:55ZWhy isn’t anyone talking about ‘who’ gets long COVID? — Podcast<figure><img src="https://images.theconversation.com/files/492362/original/file-20221028-68131-5gbu7p.jpg?ixlib=rb-1.1.0&rect=4%2C16%2C1364%2C874&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our guest on this episode has insights into long COVID both as a researcher and a patient.</span> <span class="attribution"><a class="source" href="https://unsplash.com/@jekafe">Jessica Felicio/Unsplash</a></span></figcaption></figure><p><em>Join us for <a href="https://dont-call-me-resilient.simplecast.com/episodes/long-covid">this episode of <em>Don’t Call Me Resilient</em></a> as we speak with Margot Gage Witvliet who has insights into long COVID both as a patient and an epidemiologist.</em></p>
<iframe height="200px" width="100%" frameborder="no" scrolling="no" seamless="" src="https://player.simplecast.com/f3b28129-0dca-4d74-9227-10bfd0cdd58e?dark=true"></iframe>
<p><iframe id="tc-infographic-572" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/572/661898416fdc21fc4fdef6a5379efd7cac19d9d5/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>If you don’t pay close attention to news about COVID, <a href="https://www.cbsnews.com/news/president-joe-biden-60-minutes-interview-transcript-2022-09-18/">you might think the pandemic is nearly over</a>. But for the millions of people worldwide suffering from long COVID, that couldn’t be further from the truth. </p>
<p>And the number of those experiencing long-term symptoms keeps growing: At least <a href="https://www.statnews.com/2022/07/06/understanding-long-covid-estimates/">one in five</a> of us infected with the virus go on to develop long COVID.</p>
<p>The effects of long COVID are staggering. <a href="https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351">Researchers</a> say it can lead to: blood clots, heart disease, damage to the blood vessels, neurological issues, cognitive impairment, nerve damage, chronic pain and extreme fatigue. </p>
<p>And there is no treatment for long COVID. </p>
<figure class="align-center ">
<img alt="Brown-skinned person with hand on head crying, sitting against a bed." src="https://images.theconversation.com/files/487873/original/file-20221003-14-pzxyeh.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C5142%2C3970&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487873/original/file-20221003-14-pzxyeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=468&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487873/original/file-20221003-14-pzxyeh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=468&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487873/original/file-20221003-14-pzxyeh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=468&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487873/original/file-20221003-14-pzxyeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=588&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487873/original/file-20221003-14-pzxyeh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=588&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487873/original/file-20221003-14-pzxyeh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=588&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Recent stats show that 80 per cent of long haulers are women.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/owBcefxgrIE">Claudia Wolff/Unsplash</a></span>
</figcaption>
</figure>
<p>So why don’t we hear more about long COVID? Why haven’t governments warned people about the risks we face with infection? </p>
<p>It might be that this debilitating disease is largely overlooked because of <em>who</em> gets it: Almost <a href="https://jamanetwork.com/journals/jama/fullarticle/2771111">80 per cent</a> of longhaulers are women. </p>
<p>And in the United States, where our guest on this episode is from, many of those suffering from the prevailing conditions of COVID are women of colour, with <a href="https://www.youtube.com/watch?v=hhrSa8c9Tj8">Black and Latinx people most likely</a> to get the illness.</p>
<p>Our insightful guest for this conversation on long COVID is Margot Gage Witvliet, assistant professor at Lamar University in Beaumont, Texas. Margot is a social epidemiologist who studies health disparities, including as they relate to long COVID and <a href="https://www.hhs.gov/about/news/2021/07/02/readout-fifth-covid-19-health-equity-task-force-meeting.html">has presented her research findings to the United States Health Equity Task Force on COVID-19</a>. </p>
<p>Margot is also a Black woman living with long COVID and has created a <a href="https://www.facebook.com/groups/bipocwomenlongcovid">support and advocacy group</a> for women of colour.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/jcs4YZ_UZeE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>Listen and Follow</h2>
<p>You can listen to or follow <em>Don’t Call Me Resilient</em> on <a href="https://podcasts.apple.com/ca/podcast/dont-call-me-resilient/id1549798876">Apple Podcasts</a>, <a href="https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9qZFg0Ql9DOA">Google Podcasts</a>, <a href="https://open.spotify.com/show/37tK4zmjWvq2Sh6jLIpzp7">Spotify</a> or <a href="https://dont-call-me-resilient.simplecast.com">wherever you listen to your favourite podcasts</a>. <a href="mailto:theculturedesk@theconversation.com">We’d love to hear from you</a>, including any ideas for future episodes. Join The Conversation on <a href="https://twitter.com/ConversationCA">Twitter</a>, <a href="https://www.facebook.com/TheConversationCanada">Facebook</a>, <a href="https://www.instagram.com/theconversationdotcom/">Instagram</a> and <a href="https://www.tiktok.com/@theconversation">TikTok</a> and use #DontCallMeResilient.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CNc2NyDrSGw/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Also in The Conversation</h2>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-a-covid-19-long-hauler-and-an-epidemiologist-heres-how-it-feels-when-symptoms-last-for-months-143676">I'm a COVID-19 long-hauler and an epidemiologist – here's how it feels when symptoms last for months</a>
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Read more:
<a href="https://theconversation.com/even-mild-covid-raises-the-chance-of-heart-attack-and-stroke-what-to-know-about-the-risks-ahead-190552">Even mild COVID raises the chance of heart attack and stroke. What to know about the risks ahead</a>
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</em>
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Read more:
<a href="https://theconversation.com/ivermectin-blood-washing-ozone-how-long-covid-survivors-are-being-sold-the-next-round-of-miracle-cures-186047">Ivermectin, blood washing, ozone: how long COVID survivors are being sold the next round of miracle cures</a>
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Read more:
<a href="https://theconversation.com/long-covid-should-make-us-rethink-disability-and-the-way-we-offer-support-to-those-with-invisible-conditions-187531">Long COVID should make us rethink disability – and the way we offer support to those with 'invisible conditions'</a>
</strong>
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Read more:
<a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">Being stressed out before you get COVID increases your chances of long COVID. Here's why</a>
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Read more:
<a href="https://theconversation.com/how-covid-19-damages-lungs-the-virus-attacks-mitochondria-continuing-an-ancient-battle-that-began-in-the-primordial-soup-192597">How COVID-19 damages lungs: The virus attacks mitochondria, continuing an ancient battle that began in the primordial soup</a>
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Read more:
<a href="https://theconversation.com/influenza-and-covid-19-whats-in-store-for-the-fall-winter-respiratory-virus-season-193076">Influenza and COVID-19: What's in store for the fall/winter respiratory virus season?</a>
</strong>
</em>
</p>
<hr>
<h2>Sources</h2>
<p><a href="https://theexperimentpublishing.com/catalogs/fall-2022/long-covid-survival-guide/"><em>The Long COVID Survival Guide: How to Take Care of Yourself and What Comes Next, Stories and Advice from Twenty Long-Haulers and Experts</em> Edited by Fiona Lowenstein</a></p>
<p><a href="https://www.simonandschuster.com/books/The-Long-Haul/Ryan-Prior/9781637581414"><em>The Long Haul: Solving the Puzzle of the Pandemic’s Long Haulers and How They Are Changing Healthcare Forever</em> By Ryan Prior</a></p>
<h2>Transcript</h2>
<p>For an unedited transcript of this episode, go <a href="https://dont-call-me-resilient.simplecast.com/episodes/long-covid/transcript">here</a>.</p>
<p><em>Don’t Call Me Resilient was produced in partnership with the Journalism Innovation Lab at UBC and with a grant from the Social Sciences and Humanities Research Council of Canada.</em></p><img src="https://counter.theconversation.com/content/191659/count.gif" alt="The Conversation" width="1" height="1" />
Long COVID impacts one in every five people who’ve had the virus. In the U.S., early research shows people of colour are most likely to develop long COVID. It has been called a mass-disabling event.Vinita Srivastava, Host + Producer, Don't Call Me ResilientLygia Navarro, Associate Producer, Don't Call Me Resilient, The ConversationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1944442022-11-15T19:08:34Z2022-11-15T19:08:34ZWhat can we expect from this latest COVID wave? And how long is it likely to last?<p>Australia is now mid-way into its fourth wave of COVID in the Omicron era, driven by a rich soup of Omicron descendants. Unlike previous waves, where a single new variant of SARS-CoV-2 variant such as BA.2 or BA.5 was responsible, we have had an explosion of <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/weekly-covid-overview-20221105.pdf">new variants</a> such as XBB.1, BQ.1.1 and BR.2.1. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1590650171280437249"}"></div></p>
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<p>
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Read more:
<a href="https://theconversation.com/from-centaurus-to-xbb-your-handy-guide-to-the-latest-covid-subvariants-and-why-some-are-more-worrying-than-others-192945">From Centaurus to XBB: your handy guide to the latest COVID subvariants (and why some are more worrying than others)</a>
</strong>
</em>
</p>
<hr>
<p>However, despite this apparent diversity, these new variants all follow a similar script, where the same set of changes have evolved independently across multiple variants. This is called convergent evolution.</p>
<p>These changes make the virus better at infecting people with immunity to existing variants. Since mid-October, the subvariants’ ability to escape immunity from vaccination and/or previous infection has been potent enough to cause a new wave in Australia. </p>
<p>The graph below shows the series of 2022 waves, with the original Omicron the first wave, followed by the double-bump BA.2 (where Western Australia had different timing), the winter BA.5 wave, and now a new upswing in November. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495218/original/file-20221114-17-44kkrd.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/495218/original/file-20221114-17-44kkrd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495218/original/file-20221114-17-44kkrd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=512&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495218/original/file-20221114-17-44kkrd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=512&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495218/original/file-20221114-17-44kkrd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=512&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495218/original/file-20221114-17-44kkrd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=643&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495218/original/file-20221114-17-44kkrd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=643&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495218/original/file-20221114-17-44kkrd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=643&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="source" href="https://ourworldindata.org/coronavirus/country/australia">Johns Hopkins University CSSE COVID-19 Data</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In some good news, this wave is likely to be a shorter and smaller version of the BA.5 wave. Here’s why.</p>
<h2>Cases are rising rapidly</h2>
<p>In Australia, the wave is already growing rapidly, with indicators such as <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics">recorded cases and hospital occupancy</a> showing significant increases in multiple states over the last two weeks. </p>
<p>New South Wales reports on the <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/weekly-covid-overview-20221105.pdf">trend in the underlying variants</a>, with a clear shift since early October. </p>
<p>Removal of mandatory reporting and isolation has led to fewer rapid antigen tests (RATs) being reported. So we may only be recording a smaller fraction of all community infections now than in previous waves. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/previous-covid-infection-may-not-protect-you-from-the-new-subvariant-wave-are-you-due-for-a-booster-193292">Previous COVID infection may not protect you from the new subvariant wave. Are you due for a booster?</a>
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</em>
</p>
<hr>
<p>In the graph below, I’ve used the <a href="https://github.com/epiforecasts/EpiNow2">EpiNow2 R package</a> (an open-source estimation and forecasting tool) to calculate the trend in the effective reproduction number (Rt) using <a href="https://data.nsw.gov.au/search/dataset/ds-nsw-ckan-aefcde60-3b0c-4bc0-9af1-6fe652944ec2/details?q=">NSW case data</a> since early September. </p>
<p>Rt represents the average number of people that a single COVID case infects at a given point in time. Epidemics decline when Rt is less than 1, while epidemic growth becomes likely once Rt is above 1 and is increasingly steep as Rt rises. This is now substantially above 1 in New South Wales:</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/495045/original/file-20221114-22-r5uyoz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495045/original/file-20221114-22-r5uyoz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=248&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495045/original/file-20221114-22-r5uyoz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=248&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495045/original/file-20221114-22-r5uyoz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=248&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495045/original/file-20221114-22-r5uyoz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=312&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495045/original/file-20221114-22-r5uyoz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=312&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495045/original/file-20221114-22-r5uyoz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=312&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Trend in the effective reproduction number (Rt) in NSW as estimated from PCR case series (produced using the EpiNow2 R package).</span>
</figcaption>
</figure>
<h2>Will the wave peak by Christmas? Lessons from Singapore</h2>
<p>I think the most likely outcome is the wave will peak by Christmas. In my own work for NSW Health, I am currently projecting a peak in NSW for the first week of December. </p>
<p>But these predictions are uncertain because it is still difficult to estimate the level of protection against infection in our population, despite impressive <a href="https://www.biorxiv.org/content/10.1101/2022.09.15.507787v4.full.pdf">near real-time laboratory science</a> that is helping to characterise this.</p>
<p>Fortunately, despite the challenges with modelling, the recent Singapore wave can guide our expectations. Caused by XBB.1, this wave was short and sharp, peaking around October 18 and then dropping back almost to <a href="https://www.moh.gov.sg/#7-day-moving-average-of-local-cases">pre-wave levels</a> by November 12. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/xbb-and-bq-1-what-we-know-about-these-two-omicron-cousins-193591">XBB and BQ.1: what we know about these two omicron 'cousins'</a>
</strong>
</em>
</p>
<hr>
<p>Singapore has also seen a <a href="https://www.moh.gov.sg/docs/librariesprovider5/local-situation-report/ceg_20221026_weekly_report_on_covid-19.pdf">significant increase in hospitalisations</a>, primarily in people aged above 70. </p>
<p>However cumulative cases, admissions and deaths are tracking to be about half those of their BA.5 wave, with no signs of increased severity. </p>
<p>Despite the ability of XBB.1 to evade vaccination and/or previous infection, in Singapore people with prior Omicron infections were about <a href="https://www.moh.gov.sg/docs/librariesprovider5/default-document-library/annexad79528af5784a1b8c95c986c82e3131.pdf">75% less likely</a> to test positive in this wave than in people without recorded prior infections. </p>
<p>Singapore has also had quite a similar COVID pandemic experience to Australia in terms of restrictions, vaccination and infection waves. One exception is that mask-wearing remains more prevalent in Singapore.</p>
<figure class="align-center ">
<img alt="People wear masks on a Singapore train" src="https://images.theconversation.com/files/495229/original/file-20221115-19-vqsivk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495229/original/file-20221115-19-vqsivk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495229/original/file-20221115-19-vqsivk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495229/original/file-20221115-19-vqsivk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495229/original/file-20221115-19-vqsivk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495229/original/file-20221115-19-vqsivk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495229/original/file-20221115-19-vqsivk.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">Singaporeans are more likely to wear masks than Australians.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/singapore-may2020-covid19-mrt-train-passengers-1749639923">Shutterstock</a></span>
</figcaption>
</figure>
<p>We should, however, expect some differences. Australia has about six times the resident population of Singapore with widely separated population centres. This might mean the wave duration across Australia is one to two weeks longer. </p>
<p>Australia also has a higher proportion of the population above 75, a large fraction of whom <a href="https://kirby.unsw.edu.au/sites/default/files/COVID19-Blood-Donor-Report-Round3-Aug-Sep-2022.pdf">haven’t had COVID</a> this year and therefore won’t have hybrid immunity (from both vaccination and prior infection). This could result in more hospital admissions and deaths per capita than in Singapore. </p>
<p>But in general, the Singapore wave supports the prediction this fourth Australian wave of 2022 will peak in early December and fall back below current levels by Christmas.</p>
<h2>Is this the new normal? What can we expect in the years to come?</h2>
<p>Beyond this year, I’m encouraged by the shift in pattern from single variants causing waves to the evolving variant soup. This evolution has been very rapid recently but there are signs this may slow considerably in 2023. </p>
<p>Firstly, the rate at which mutations occur is proportional to how much virus is circulating. The enormous number of COVID infections across this year mean that in 2022 this change has happened quickly but with each wave getting smaller, this rate of change should slow. </p>
<p>The recent variant soup evolution may also be a positive sign. The different variants in the soup have all gained a transmission advantage following the same immune-escape strategy. The set of relevant mutations were in fact predicted in advance by researchers at the University of Washington.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1551540513655754752"}"></div></p>
<p>If you are infected with one of these new variants, you should also have strong protection to the rest of the soup. The absence of big mutational jumps in dominant variants suggests SARS-CoV2, the virus that causes COVID, may now be entering a period of slower, more continuous evolution. This is <a href="https://www.cdc.gov/flu/about/viruses/change.htm">what we see for seasonal influenza</a>.</p>
<p>COVID has been full of surprises but the evidence suggests we could see SARS-CoV-2 infections fall below our recent trough levels in 2023 and the beginning of a more seasonal pattern to COVID waves.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-havent-i-had-covid-yet-193861">Why haven't I had COVID yet?</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/194444/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Wood receives funding from NSW Health and the NHMRC. He is a voting member of the Australian Technical Advisory Committee on Immunisation and is a member of the Variants of Concern subgroup of the Communicable Diseases Genomics Network of Australia. </span></em></p>The evidence so far suggests this wave could be a shorter and smaller version of the Omicron BA.5 wave.James Wood, Associate Professor, epidemiological modelling of infectious diseases, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1920282022-10-09T07:39:22Z2022-10-09T07:39:22ZNigeria’s missing virus hunters: university decline robs country of virologists<figure><img src="https://images.theconversation.com/files/488727/original/file-20221007-26-y700xw.jpg?ixlib=rb-1.1.0&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><em>Nigeria’s university system witnessed its <a href="https://www.jstor.org/stable/1166618#metadata_info_tab_contents">golden era</a> between the 1950s and 1980s. It produced globally <a href="https://theconversation.com/akin-mabogunje-nigerian-urban-geographer-who-mapped-the-origin-and-trends-of-african-cities-190378">celebrated academics </a> and <a href="https://theconversation.com/david-olufemi-olaleye-erudite-virologist-excellent-mentor-and-academic-giant-166199">virologists</a>. But the story has changed. Under funding of the university system, inadequate support for research and lack of commitment to the development of science and technology by the government are robbing the nation of quality academics. Virologists are among them. Renowned virologist, Oyewale Tomori, who graduated in the 1970s, sets out how it was then, why the country is where it is now and what it can do to restore its lost glory in science and technology education.</em></p>
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<h2>What’s the history of training virologists in Nigeria?</h2>
<p>Although modern virology began with the discovery between 1915 and 1917 of bacteriophages (that is, <a href="https://scholar.google.com/scholar?q=DOI:https://doi.org/10.1016/j.cmi.2018.12.003&hl=en&as_sdt=0&as_vis=1&oi=scholart">viruses that infect bacteria </a>, virology only became a discipline on its own in the last 50 years. </p>
<p>The discipline can be divided into the biology of viruses (molecular biology and biochemistry) and viral diseases (physiology, epidemiology, and clinical aspects of virus diseases). One branch deals with the study of the nature and properties of the virus, while the second is focused on the diseases caused by viruses and the interplay of the factors (human, animal, virus and the environment) that result in the emergence and reemergence of viral diseases. </p>
<p>Today, a thorough study of virology encompasses the <a href="https://www.cdc.gov/onehealth/index.html#:%7E:text=One%20Health%20is%20a%20collaborative,plants%2C%20and%20their%20shared%20environment">One Health concept</a>. This takes into account the interactions between humans and animals and the environment.</p>
<p>The first set of Nigerian virologists was trained outside the country. Local training of virologists started in the early 1970s, at the University of Ibadan. It was the sole training centre for virologists until the late 1990s. </p>
<p>Today, <a href="https://punchng.com/nigeria-has-only-200-virologists-expert-laments/">there are about 200 virologists in Nigeria</a>. Is this number enough?</p>
<p>Answering the question isn’t the same as measuring, for example, the ideal “doctor to patient” ratio. This is because virologists are researchers, so the headline number isn’t the main issue. Rather it’s whether those trained as virologists are functioning effectively and maximally. </p>
<p>Suffice to say that Nigeria needs more virologists given the size of the country, and the number of endemic viral infections prevalent in it. Annually, the country reports severe outbreaks of virus diseases, such as Lassa Fever, yellow fever and measles.</p>
<p>You need virolgists to be ahead of the emergence of viral disease outbreaks. </p>
<p>But the high cost of equipment and reagents, as well as other facilities for conducting virus studies have limited the output of trained virologists by the Nigerian university system. </p>
<p>Currently, the country has more virologists specialising as molecular virologists, rather than experts on the epidemiology and clinical aspects of viral diseases. And poor collaboration between laboratory scientists, epidemiologists and clinicians has robbed Nigeria of getting the needed balance between molecular virologists and those studying viral diseases. There is a disconnect between the study of viruses and the diseases they cause. We have expert virologists with little knowledge of how to control the diseases caused by viruses. </p>
<p>Virologists who will be relevant and contribute to improving the health of the society, must use their knowledge and expertise to prevent and control viral disease, otherwise they become a precious ornament of little use to someone dying of a viral disease. </p>
<p>Nigeria, a disease ridden society, has no place for virologists who discover a virus but can’t decipher what it does. Or are unable to use their knowledge to mitigate the devastation of a viral disease outbreak. </p>
<h2>What’s different now in the training of virologists?</h2>
<p>When I trained as a virologist at the University of Ibadan in South West Nigeria, the training was comprehensive. It involved both broad-based field work as well as laboratory investigation. </p>
<p>In the past, in addition to employing available techniques (antigen-antibody studies and animal experimentation) to identify and classify viruses, a detailed epidemiological study of the diseases caused by the virus was also carried out. </p>
<p>This was a One Health concept that considered the pathogen, the person, the animal, and the environment in the study of viruses and the diseases they cause. This provided information needed for the control and prevention of the disease. </p>
<p>Today, the focus is principally on studying and dissecting the virus, using more modern and highly sophisticated techniques, like <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/genome-sequencing">genomic sequencing</a>. </p>
<p>A host of hurdles stand in the way of building a bigger cohort of virologists in Nigeria.</p>
<p>Firstly, the lack of modern facilities in laboratories and the poor state of basic infrastructure and other resources (such as electricity and reagents) are working against research development. You cannot run genetic sequencing or even sterilise your equipment using a candle as your source of power.</p>
<p>Secondly, budgetary allocation to education is generally poor – at all levels, including the secondary school system. </p>
<p>Thirdly, and unfortunately, the <a href="https://guardian.ng/features/despite-tetfund-intervention-research-in-tertiary-institutions-still-poor-experts-say/">Nigerian government is not committed to funding research</a>. Financial support for science and research remains pathetic. This has led to the deterioration in the quantity and quality of trained virologists at Nigeria’s universities. The oases of excellence in the Nigerian desert of research landscape are largely funded by grants from external bodies and agencies. </p>
<p>But for how long are you going to depend on external grants to fund your research and development? It is like Africa whining and crying for equity when, for example, COVID-19 vaccines were not available for our populations. You do not beg for equity, you fight for it. You use your resources responsibly to contribute to equity, and not just be a consumer of the crumbs of equity.</p>
<p>On top of this, we have corruption and examination malpractices undermining the very foundation of integrity and probity, the pillars on which science and research stand. Consequently, our university system is neither able to retain responsible academics, nor attract the right kind of prospective students imbued with responsibility. </p>
<p>Add to these hurdles the lack of interest of many students in science and technological education. </p>
<h2>What’s missing?</h2>
<p>Sustained funding, infrastructure, facilities (regular power supply), and national government support for and sustained commitment to research. </p>
<p>There is a general national disdain for science and technology. There is also a national failure to fully recognise that science and technology are needed for the socio-economic transformation of Nigeria.</p>
<p>The government should invest in science, technology, research and development. </p>
<h2>How has this affected Nigeria’s ability to produce cutting-edge research?</h2>
<p>Adversely. </p>
<p>We are a nation consuming other countries’ returns on investment in science, research and technology. Rather than investing in research and contributing to global development through science and research, we have resorted to begging for the crumbs of equity. </p>
<p>We are only ready to consume other people’s returns on investments on science and research. </p>
<h2>What needs to be done?</h2>
<p>Go back to basics. Invest in research, science and technology. </p>
<p>Nigeria should create an enabling environment for scientists to function effectively and maximally. The nation should commit to using research outcomes in science and technology as the medium for transforming our society to a developed nation. If Nigeria refuses to fund research especially in science and technology, we will remain at the blunt-edge, rather than the cutting-edge of research, science and technology. We will not have the body of knowledge that can help us to address the nation’s health and other challenges.</p><img src="https://counter.theconversation.com/content/192028/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Oyewale Tomori 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>Financial support for science and research in Nigeria remains pathetic. This has led to the deterioration in the quantity and quality of trained virologists at universities.Oyewale Tomori, Fellow, Nigerian Academy of ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1881302022-08-08T12:21:17Z2022-08-08T12:21:17ZHow does monkeypox spread? An epidemiologist explains why it isn’t an STI and what counts as close contact<figure><img src="https://images.theconversation.com/files/477915/original/file-20220805-32086-ju4jk8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C654&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccination can help reduce the risk of monkeypox infection.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-wait-in-line-to-recieve-the-monkeypox-vaccine-before-news-photo/1241959588">Kena Betancur/AFP via Getty Images</a></span></figcaption></figure><p>Monkeypox is caused by a virus that, despite periodic outbreaks, is <a href="https://doi.org/10.1080%2F14787210.2019.1567330">not thought to spread easily from person to person</a> and historically <a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">has not spurred long chains of transmission within communities</a>. Now, many researchers are left scratching their heads as to why monkeypox seems to be propagating so readily and unconventionally in the current global outbreak.</p>
<p>The monkeypox virus typically spreads through <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381">direct contact with respiratory secretions, such as mucus or saliva</a>, or <a href="https://news.un.org/en/story/2022/07/1123212">skin lesions</a>. Skin lesions traditionally appear soon after infection as a rash – small pimples or round papules on the face, hands or genitalia. These lesions may also appear inside the mouth, eyes and other parts of the body that produce mucus. They can last for several weeks and be a source of virus before they are fully healed. <a href="https://www.who.int/news-room/questions-and-answers/item/monkeypox">Other symptoms</a> usually include fever, swollen lymph nodes, fatigue and headache.</p>
<p>I am an <a href="https://public-health.tamu.edu/directory/fischer.html">epidemiologist</a> who studies emerging infectious diseases that cause <a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">outbreaks, epidemics and pandemics</a>. Understanding what’s currently known about how monkeypox is transmitted and ways to protect yourself and others from infection can help reduce the spread of the virus.</p>
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<figcaption><span class="caption">The U.S. declared monkeypox a public health emergency on Aug. 4, 2022.</span></figcaption>
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<h2>How is this outbreak different from prior ones?</h2>
<p>The current monkeypox epidemic is a bit unusual in a few ways. </p>
<p>First, the sheer scope of the current epidemic, with <a href="https://worldhealthorg.shinyapps.io/mpx_global/">over 25,000 cases worldwide as of early August</a> and in countries where the virus has never appeared, sets it apart from previous outbreaks. Monkeypox is <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390">endemic to specific areas in central and western Africa</a>, where cases occur sporadically and outbreaks are usually contained and quickly burn out. In the current outbreak, global spread has been rapid. Young men, mostly ages 18 to 44, account for the majority of cases, and over 97% identify as men who have sex with men (MSM). <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200422">Some superspreading events</a> associated with air travel, international gatherings and multiple-partner sexual encounters contributed to early transmission of the virus.</p>
<p>Second, <a href="https://worldhealthorg.shinyapps.io/mpx_global/">the way symptoms are appearing</a> may facilitate spread among people who don’t yet know they are infected. <a href="https://doi.org/10.1111/bjd.21790">Most</a> <a href="https://doi.org/10.1136/bmj-2022-072410">patients</a> reported mild symptoms without fever or swollen lymph nodes, symptoms that typically appear before a skin rash is visible. While most people do develop skin lesions, many reported having only a single papule that was often obscured inside a mucosal area, such as inside the mouth, throat or rectum, making it easier to miss.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/Y9bjHNpqOro?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Monkeypox is not a new disease.</span></figcaption>
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<p>A number of people reported no symptoms at all. Asymptomatic infections are more likely to go undiagnosed and unreported than those with symptoms. But it is not yet known how asymptomatic individuals may be contributing to spread or how many asymptomatic cases may be undetected so far.</p>
<h2>Who is at risk of getting monkeypox?</h2>
<p>For <a href="https://www.nytimes.com/2022/08/03/well/live/monkeypox-risk.html">most people</a>, the risk of getting monkeypox is currently low. Anyone who has prolonged, close contact with an infected person is at risk, including partners, parents, children or siblings, among others. The most common settings for transmission are <a href="https://worldhealthorg.shinyapps.io/mpx_global/">within households or health care settings</a>.</p>
<p>Because of sustained transmission within the community of men who have sex with men, they are considered an <a href="https://www.washingtonpost.com/health/2022/07/27/monkeypox-gay-men-vaccine-treatment/">at-risk group</a>, and targeted recommendations can help allocate resources and limit transmission. While monkeypox is <a href="https://www.washingtonpost.com/health/2022/07/28/who-monkeypox-advice-men-sex/">spreading primarily among MSM</a>, this does not mean that the virus will remain confined to this group or that it won’t jump to other social networks. The virus itself has no regard for age, gender, ethnicity or sexual orientation. </p>
<p><a href="https://www.who.int/publications/m/item/monkeypox-public-health-advice-for-men-who-have-sex-with-men">Anyone</a> who comes into direct contact with the monkeypox virus is at risk of being infected. <a href="https://worldhealthorg.shinyapps.io/mpx_global/">New cases</a> are recorded daily, with additional countries and regions reporting their first cases and already affected countries observing a continued rise in infections. </p>
<p>As with most infections, <a href="https://www.nytimes.com/2022/08/03/well/live/monkeypox-risk.html">other factors</a>, such as the amount of viral exposure, type of contact and individual immune response, play a role in whether an infection takes hold.</p>
<h2>Is monkeypox an STI?</h2>
<p>While sexual encounters are currently the predominant mode of transmission among reported cases, monkeypox is <a href="https://www.healthline.com/health-news/monkeypox-is-not-a-sexually-transmitted-infection-what-experts-want-you-to-know">not a sexually transmitted infection</a>. STIs are spread primarily through sexual contact, while monkeypox can spread through any form of prolonged, close contact.</p>
<p>Close contact that transmits the monkeypox virus involves encounters that are typically more intimate or involved than having a casual conversation or standing next to someone in an elevator. Transmission requires exchange of mucosal fluids or direct contact with the virus in sufficient quantity to seed an infection. This could occur through physical contact during kissing or cuddling.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477920/original/file-20220805-32086-wtyh4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Electron microscope image of monkeypox particles" src="https://images.theconversation.com/files/477920/original/file-20220805-32086-wtyh4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477920/original/file-20220805-32086-wtyh4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=515&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477920/original/file-20220805-32086-wtyh4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=515&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477920/original/file-20220805-32086-wtyh4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=515&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477920/original/file-20220805-32086-wtyh4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=648&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477920/original/file-20220805-32086-wtyh4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=648&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477920/original/file-20220805-32086-wtyh4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=648&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 microscopy image shows monkeypox particles, colored red, within an infected cell, colored blue.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/2noh3om">NIAID/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
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<p>Because sexual encounters involve direct skin-to-skin physical contact where bodily fluids may be exchanged, these close encounters can transmit viruses more easily. Recently, monkeypox DNA has been detected in feces and <a href="https://doi.org/10.1016/S1473-3099(22)00513-8">various body fluids</a>, including saliva, blood, semen and urine. But the presence of viral DNA does not necessarily mean that the virus can infect someone else. Transmission from these sources is still under investigation.</p>
<p>As the virus moves through populations, <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-covid-19-media-briefing--27-july-2022">public health officials</a> focus on getting the message out to the most at-risk and hardest hit communities about how to stay safe. Currently, breaking the transmission chain among sexual contacts is a priority, including but not limited to <a href="https://www.who.int/publications/m/item/monkeypox-public-health-advice-for-men-who-have-sex-with-men">MSM communities</a>. Targeted messaging is meant to protect the health of a specific group, <a href="https://www.npr.org/2022/07/26/1113713684/monkeypox-stigma-gay-community">not to stigmatize</a> the intended audience. </p>
<p>Other modes of transmission may play a greater role outside the MSM community. <a href="https://worldhealthorg.shinyapps.io/mpx_global/">Household transmission</a>, where individuals may come into close contact with infected people or contaminated items, is one of the most common types of exposure. Research is ongoing into the potential <a href="https://doi.org/10.1101/2022.07.21.22277864">airborne and respiratory droplet</a> spread of monkeypox in the current situation. </p>
<p>Outbreaks are <a href="https://doi.org/10.1016/S2589-7500(20)30268-5">dynamic situations that evolve over time</a>, which is why public health messages may change as the epidemic progresses. Not every outbreak looks or behaves the same way – even pathogens seen in previous outbreaks can be different the next time around. As researchers learn more about how the disease is transmitted and identify changes in patterns of spread, public health officials will provide updates about specific forms of contact, behaviors or other factors that could increase infection risk. While changing guidelines can be frustrating or confusing, keeping up to date with the latest recommendations can help you protect yourself and stay safe. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477913/original/file-20220805-35557-qales6.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=1000&fit=clip"><img alt="People lining up to get monkeypox vaccine" src="https://images.theconversation.com/files/477913/original/file-20220805-35557-qales6.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477913/original/file-20220805-35557-qales6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477913/original/file-20220805-35557-qales6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477913/original/file-20220805-35557-qales6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477913/original/file-20220805-35557-qales6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477913/original/file-20220805-35557-qales6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477913/original/file-20220805-35557-qales6.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">Prioritizing at-risk groups to get vaccinated can help control the spread of the virus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/healthcare-workers-with-new-york-city-department-of-health-news-photo/1411672704">Spencer Platt/Getty Images News via Getty Images</a></span>
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<h2>What do I do if I’ve been exposed to monkeypox?</h2>
<p>Anyone who has been infected can help contain spread by isolating from others, including pets. Covering skin lesions, wearing a mask in shared spaces and decontaminating shared surfaces or items, such as bed linens, dishes, clothes or towels, can also reduce spread. </p>
<p>You can also help interrupt the transmission chain by participating in <a href="https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2022.2">contact tracing</a>, notifying public health officials of others who may have been exposed through you, which is a basic tenet and common practice of disease control.</p>
<p>The Centers for Disease Control and Prevention has further guidance on how to control monkeypox spread in both <a href="https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-home.html">household settings</a> and <a href="https://www.cdc.gov/poxvirus/monkeypox/specific-settings/congregate.html">shared living facilities</a>.</p>
<p>Lastly, <a href="https://www.cdc.gov/poxvirus/monkeypox/considerations-for-monkeypox-vaccination.html">getting vaccinated</a> as soon as possible can still protect you from severe illness even if you’ve already been infected.</p><img src="https://counter.theconversation.com/content/188130/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca S.B. Fischer receives funding from Fogarty International Center at the National Institutes of Health (K01TW010863)</span></em></p>While the majority of monkeypox cases thus far have been recorded among men who have sex with men, everyone is still at risk of contracting the disease.Rebecca S.B. Fischer, Assistant Professor of Epidemiology, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1868262022-07-27T04:13:58Z2022-07-27T04:13:58ZNew COVID variants may be more transmissible but that doesn’t mean the R0 – or basic reproduction number – has increased<p>During the pandemic we have all become familiar with a lot of epidemiological concepts. </p>
<p>One that was introduced to us early in 2020 is the “basic reproductive number”, or R0. This tells us about the intrinsic contagiousness of a virus, or its inherent capacity to be spread from one person to another in a particular population. </p>
<p>We also learned about the “effective reproductive number”, or Reff. This tells us about the rate at which a virus is actually spreading through that population.</p>
<p>With the emergence of BA.4/5, there has been some confusion around how these concepts help us to understand why one variant spreads faster than another. </p>
<p>Just because a variant spreads faster, it doesn’t necessarily mean it has a higher R0.</p>
<h2>What does the R0 actually tell us?</h2>
<p>R0 tells us about the number of secondary cases arising from a single case in a fully susceptible population. It describes the potential capacity of a pathogen (such as a virus) to spread, and is pathogen-specific. </p>
<p>Pathogens with higher R0 values have the potential to cause larger epidemics. For ancestral strains of SARS-CoV-2 (the virus that causes COVID), R0 was <a href="https://doi.org/10.1371/journal.pone.0242128">estimated to be around 3</a>. </p>
<p>R0 is also population-specific. It depends on the population’s behaviour at “baseline”, before the pandemic. For example, a densely populated city with lots of indoor venues in which people mix is likely to have a higher R0 for the same pathogen than a region with a sparse population and less mixing between groups.</p>
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Read more:
<a href="https://theconversation.com/r0-how-scientists-quantify-the-intensity-of-an-outbreak-like-coronavirus-and-predict-the-pandemics-spread-130777">R0: How scientists quantify the intensity of an outbreak like coronavirus and predict the pandemic's spread</a>
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<h2>What about the Reff?</h2>
<p>The Reff is the average number of new infections caused by an infected individual in the presence of public health measures, behavioural change, and population immunity (from previous infection and vaccination). </p>
<p>The Reff will therefore change over time.</p>
<p>It is a <a href="https://epiforecasts.io/">key indicator</a> of whether an epidemic is growing or shrinking. When the Reff is above 1, the epidemic is growing. If control measures, population immunity, or other factors can bring the Reff below 1, the epidemic is in decline.</p>
<p>Throughout the pandemic, the Reff has been routinely estimated for Australia and <a href="https://www.health.gov.au/resources/publications/australian-national-disease-surveillance-plan-for-covid-19">reported</a> to decision-makers.</p>
<h2>How do new variants out-compete existing ones?</h2>
<p>The COVID pandemic can be divided into several distinct eras, each defined by the emergence of a new variant: </p>
<ul>
<li>Alpha in late 2020</li>
<li>Delta in mid-2021</li>
<li>Omicron BA.1 in late 2021</li>
<li>Omicron BA.2 in early 2022</li>
<li>and now Omicron BA.4 and BA.5. </li>
</ul>
<p>Each of these variants was able to outcompete and replace the one before it.</p>
<p>If we observe that a hypothetical “variant A” is spreading through a population faster than “variant B”, we say that variant A has a “growth advantage” over variant B. </p>
<p>This growth advantage, if sustained, means variant A will replace variant B as the new dominant variant spreading in the population. </p>
<p>A variant can have a growth advantage and not actually be intrinsically more transmissible. In fact, the R0 of variant A may be higher, lower, or the same as variant B.</p>
<p>This is because the growth advantage of variant A, compared to variant B, may be driven by any combination of:</p>
<ol>
<li>a shorter generation time</li>
<li>increased intrinsic transmissibility (R0)</li>
<li>an increased level of “immune evasion”.</li>
</ol>
<p>Each of these drivers has a different impact on the future epidemic trajectory and implications for the effectiveness of control measures.</p>
<p><strong>Shorter generation time</strong></p>
<p>A shorter generation time means a shorter time, on average, between a person becoming infected and then infecting another person. The average number of new infections arising from each infected person is the same for both variants, but those infections happen more quickly for variant A. This will lead to a more rapid rise in cases of variant A, even when R0 is the same.</p>
<p><strong>Intrinsic transmissibility</strong></p>
<p>Increased intrinsic transmissibility refers to the situation where the R0 of variant A is higher than that of variant B. Multiple different biological changes to the virus, such as changes that increase the infectiousness of an infected person, may drive this.</p>
<p><strong>Immune evasion</strong></p>
<p>Immune evasion refers to how easily a variant infects people who have previously been infected and or vaccinated.</p>
<p>Variants with very high levels of immune evasion can spread quickly in highly immune populations because there are simply more people in the population who are able to be infected. But it doesn’t mean they are intrinsically more transmissible.</p>
<p>In fact, they may even have a reduced R0 and still have a growth advantage.</p>
<p><strong>Implications for Reff</strong></p>
<p>All three of these mechanisms can result in a growth advantage, but have different implications for the Reff of variant A compared to variant B.</p>
<p>An increase in intrinsic transmissibility or immune escape will lead to an increased Reff for variant A compared to variant B. However a shorter generation time can lead to a growth advantage without affecting the Reff. If variant A has only a shorter generation time, it will spread faster through the population than variant B.</p>
<h2>How has this played out in the COVID pandemic?</h2>
<p>Over the course of the COVID pandemic, several variants have emerged with considerable growth advantage over previous variants: Alpha, then Delta, Omicron BA.1 and BA.2, and most recently, Omicron BA.4 and BA.5. </p>
<p>The reasons for the growth advantage over previous variants have been driven by different factors.</p>
<p>Alpha’s growth advantage over ancestral strains was estimated to be due to higher intrinsic transmissibility. Scientists <a href="https://pubmed.ncbi.nlm.nih.gov/33658326/">estimated</a> the basic reproduction number (R0) of Alpha was 43–90% higher than for ancestral strains. </p>
<p>When Omicron BA.1 rapidly emerged in late 2021 in highly immune populations (including Australia, where most <a href="https://www.abc.net.au/news/2021-03-02/charting-australias-covid-vaccine-rollout/13197518">jurisdictions</a> had achieved more than 85% second-dose vaccine coverage in eligible groups), scientists immediately suspected <a href="https://twitter.com/trvrb/status/1466076797670363140">immune evasion was playing a role</a>.</p>
<p><a href="https://twitter.com/_nickgolding_/status/1468226234995773443?s=12">Analyses of emerging data</a> quantified the relative contribution of immune evasion and intrinsic transmissibility that could explain the rapid spread.</p>
<p>Most recently, we have seen the rapid rise of Omicron BA.4 and BA.5 globally. Emerging <a href="https://www.medrxiv.org/content/10.1101/2022.05.16.22275151v1">evidence</a> suggests <a href="https://www.biorxiv.org/content/10.1101/2022.05.26.493517v1">immune evasion</a> is, once again, likely a significant factor contributing to the <a href="https://www.medrxiv.org/content/10.1101/2022.04.29.22274477v1">transmission advantage</a> of BA.4 and BA.5 over previous Omicron variants.</p>
<p>This means we expect BA.4 and BA.5 to spread rapidly in Australia, despite our very high levels of vaccination coverage and lots of previous infection. </p>
<p>However, the R0 may not have <a href="https://theconversation.com/australia-is-heading-for-its-third-omicron-wave-heres-what-to-expect-from-ba-4-and-ba-5-185598">changed</a>. Even with the same intrinsic transmissibility, simply having more of the population being susceptible again, means the same R0 will end up translating to more infections. </p>
<h2>Not a simple calculation</h2>
<p>Throughout the pandemic, infectious disease epidemiologists have had to carefully evaluate the available data to estimate why a new variant has a growth advantage.</p>
<p>Others, including some scientists <a href="https://theconversation.com/australia-is-heading-for-its-third-omicron-wave-heres-what-to-expect-from-ba-4-and-ba-5-185598">on The Conversation</a>, have unfortunately simply assumed that the growth advantage is due to an increased intrinsic transmissibility.</p>
<p>They have done this by multiplying the R0 of an existing variant by how much faster a new variant is estimated to be spreading. Repeated application of this approach has resulted in an inflated R0 estimate for BA.4/5, <a href="https://theconversation.com/why-we-corrected-our-estimates-for-the-reproduction-number-of-two-covid-subvariants-187624">similar to that of measles</a>.</p>
<p>While this approach was <a href="https://pubmed.ncbi.nlm.nih.gov/33658326/">OK for Alpha</a>, because household studies showed that the variant spread more efficiently in previously unexposed populations, it was not appropriate once Omicron appeared.</p>
<p>None of these considerations are unique to COVID. For example, new influenza variants mostly arise due to <a href="https://www.antigenic-cartography.org">immune escape</a>, driving a growth advantage and replacement of the previously circulating strain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-is-heading-for-its-third-omicron-wave-heres-what-to-expect-from-ba-4-and-ba-5-185598">Australia is heading for its third Omicron wave. Here's what to expect from BA.4 and BA.5</a>
</strong>
</em>
</p>
<hr>
<h2>So what is the R0 of BA.4/5?</h2>
<p>With the emergence of each new variant, the task has become more challenging as the population’s infection history (whether you’ve been infected before, when and how many times) makes interpretation of the data more and more difficult.</p>
<p>And so it is now very difficult to estimate the R0 for BA.4/5.</p>
<p>It is certainly higher than for Alpha and Delta, with the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1005395/23_July_2021_Risk_assessment_for_SARS-CoV-2_variant_Delta.pdf">weight of evidence</a> indicating a value at least double that of the ancestral variant (3). That would make it around 6.</p>
<p>And it is likely higher still because Omicron BA.1 out-competed Delta due to both an <a href="https://twitter.com/_nickgolding_/status/1468226234995773443?s=12">increase in intrinsic transmissibility and immune escape</a>.</p>
<p>We don’t yet fully understand why BA.2 replaced BA.1, with both <a href="https://doi.org/10.1101/2022.01.28.22270044">intrinsic transmissibility and immune escape potentially contributing</a>. But we do know that immune evasion is sufficient to explain the observed growth advantage of BA.4/5 over BA.2.</p>
<p>Therefore, our current best estimate for the R0 for BA.4/5 is that it is likely similar to that for BA.2, but the actual value remains uncertain. It is likely in the range of 6-10.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-corrected-our-estimates-for-the-reproduction-number-of-two-covid-subvariants-187624">Why we corrected our estimates for the reproduction number of two COVID subvariants</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/186826/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Freya Shearer receives funding from the National Health and Medical Research Council, the Australian Government Departments of Health and Foreign Affairs and Trade, and NSW Health. </span></em></p><p class="fine-print"><em><span>Catherine Bennett receives funding from Medical Research Future Find and the National Health and Medical Research Council. Catherine is also on the scientific advisory committee for Impact Health Technology and ResApp Healthcare Pty Ltd, and was an independent expert on the AstraZeneca COVID Vaccine Advisory Committee in 2021.</span></em></p><p class="fine-print"><em><span>James McCaw receives funding from the Australian Government Departments of Health and Foreign Affairs and Trade, the Australian Research Council and the National Health and Medical Research Council. He is an invited expert member of the Communicable Disease Network of Australia and between January 2020 and May 2022 was an invited expert member of the Australian Health Protection Principal Committee.</span></em></p><p class="fine-print"><em><span>Nick Golding receives funding from Australian, NSW, and WA Government Departments of Health, the Australian Research Council and the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Hassan Vally 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>Just because a variant spreads faster, it doesn’t necessarily mean it has a higher R0.Freya Shearer, Research Fellow, Epidemic Decision Support, The University of MelbourneCatherine Bennett, Chair in Epidemiology, Deakin UniversityHassan Vally, Associate Professor, Epidemiology, Deakin UniversityJames McCaw, Professor in Mathematical Biology, The University of MelbourneNick Golding, Honorary Research Fellow, Telethon Kids Institute, and Professor, Curtin School of Population Health, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1876692022-07-26T16:05:08Z2022-07-26T16:05:08ZWhy declaring monkeypox a global health emergency is a preventative step – not a reason for panic<figure><img src="https://images.theconversation.com/files/475942/original/file-20220725-15-q3633s.jpg?ixlib=rb-1.1.0&rect=26%2C44%2C5802%2C3305&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The monkeypox virus, shown in this illustration, can be transmitted through close contact between people.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/monkeypox-virus-illustration-royalty-free-illustration/1402267440?adppopup=true">Thom Leach/Science Photos Library via Getty Images</a></span></figcaption></figure><p>Countries that are members of the United Nations are obligated to report cases of unusual diseases that have the potential to become global health threats. In May 2022, more than a dozen countries in Europe, the Americas and other regions of the world that had never before had cases of monkeypox <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385">started to report cases occurring within their borders</a>.</p>
<p>In response, the director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, convened a <a href="https://www.who.int/groups/monkeypox-ihr-emergency-committee">monkeypox emergency committee</a> to track the evolving situation. At the committee’s first meeting on June 23, 2022, the members observed that the “<a href="https://www.who.int/news/item/25-06-2022-meeting-of-the-international-health-regulations-(2005)-emergency-committee--regarding-the-multi-country-monkeypox-outbreak">multi-country outbreak</a>” might be stabilizing as case counts had plateaued in several countries. </p>
<p>However, after thousands more cases of monkeypox were diagnosed in dozens of countries in July, it became clear that the outbreak had not stagnated. On July 23, 2022, Tedros <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022">declared monkeypox a public health emergency of international concern</a>. </p>
<p>As a <a href="https://scholar.google.com/citations?user=IhG7428AAAAJ&hl=en&oi=ao">global health expert who specializes in infectious disease epidemiology</a> I do not think that most people need to be worried about monkeypox. This decision by the WHO, though it may sound ominous, is not a sign of bad things to come. Rather, it is a way to prevent monkeypox from becoming a global crisis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/475943/original/file-20220725-10610-gzehbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The logo of the World Health Organization on the groups headquarters in Geneva, Switzerland." src="https://images.theconversation.com/files/475943/original/file-20220725-10610-gzehbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475943/original/file-20220725-10610-gzehbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475943/original/file-20220725-10610-gzehbx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475943/original/file-20220725-10610-gzehbx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475943/original/file-20220725-10610-gzehbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475943/original/file-20220725-10610-gzehbx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475943/original/file-20220725-10610-gzehbx.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 director-general of the World Health Organization has the power to declare an event a public health emergency of international concern.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Logo_@_World_Health_Organization_@_Pregny-Chamb%C3%A9sy_(50637498101).jpg#/media/File:Logo_@_World_Health_Organization_@_Pregny-Chamb%C3%A9sy_(50637498101).jpg">Guilhem Vellut/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What is a public health emergency of international concern (PHEIC)?</h2>
<p>The <a href="https://www.who.int/publications/i/item/9789241580496">International Health Regulations</a> are a set of rules that guide how the WHO and United Nations member states respond to emerging health threats.</p>
<p>Under the current regulations, a “public health emergency of international concern” – often abbreviated as a PHEIC – can be declared by the WHO director-general when <a href="http://dx.doi.org/10.1136/bmjgh-2020-002502">three criteria are met</a>: the situation is an “extraordinary event,” there is a risk of spread to other countries, and the situation might “potentially require a coordinated international response.” </p>
<p>Before monkeypox, only five diseases had been designated as PHEICs since the WHO started using the term in 2005: the H1N1 influenza pandemic in 2009; polio resurgences in Afghanistan, Nigeria and Pakistan in 2014; the Ebola epidemic in Guinea, Liberia and Sierra Leone in 2014 and an Ebola outbreak in the Democratic Republic of Congo 2019; the spread of Zika virus in the Americas in 2016; and the coronavirus pandemic in 2020. While all of these events were noteworthy, only the coronavirus pandemic became a worldwide catastrophe. </p>
<p><iframe id="TUyiX" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/TUyiX/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Why is monkeypox a public health emergency of international concern?</h2>
<p>The director-general of the WHO is the only person who can declare a PHEIC, but the decision is based on advice from the designated emergency committee. After the monkeypox emergency committee met for the second time, on July 21, 2022, it released a report stating that “the multi-country outbreak of monkeypox <a href="https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox">meets all the three criteria defining a PHEIC</a>.”</p>
<p>The rapid spread of the virus to more than 70 countries was evidence of the risk of further international spread. The committee expressed concerns about whether vaccines would be priced reasonably and distributed equitably in the absence of a coordinated international response. And it agreed that there were aspects of the situation that were “extraordinary” – a vague term that is not defined in the International Health Regulations.</p>
<p>However, the committee did not express unanimous agreement that a public health emergency of international concern should be declared. Some members questioned whether a disease that has a low case fatality rate should be a PHEIC. Others worried that a PHEIC designation could further stigmatize LGBTQ communities since most cases thus far have been diagnosed among men who have sex with men. </p>
<p>The <a href="https://doi.org/10.1126/science.ade0761">vote from the emergency committee was split</a> – nine against and six for PHEIC status. But Director-General Tedros opted to go ahead and declare monkeypox a PHEIC. </p>
<h2>What happens now?</h2>
<p>The <a href="https://doi.org/10.1093/jtm/taaa227">goal of a PHEIC designation</a> is to prevent an emerging disease from becoming a global health crisis. The WHO has two initial goals for monkeypox. First, to try to stop the virus from beginning to circulate in susceptible populations where it is not currently present. And second, to distribute vaccines and antiviral medications to the countries and communities that need them most. </p>
<p>After the PHEIC declaration, the WHO released a <a href="https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox">set of temporary recommendations</a> that asks countries to work harder on preventing cases in affected and at-risk communities, to improve clinical care for people with monkeypox and to contribute to research on vaccines and treatments for monkeypox. The recommendations also ask countries to advise infected individuals and their direct contacts not to travel except in urgent situations, but they do not impose any restrictions on international travel or trade. </p>
<p>Finally, the WHO has advised that individuals who are members of at-risk communities take steps to protect themselves from the virus, but has not called for changed behavior in the general public.</p>
<p>A public health emergency of international concern is the highest level of alert in the International Health Regulations, but it is not a synonym for a pandemic. The status is a tool for protecting global population health and not a declaration that a global crisis is already happening.</p><img src="https://counter.theconversation.com/content/187669/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn H. Jacobsen 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>By late July 2022, monkeypox was present in more than 70 countries with significant spread in certain communities. As a result, the World Health Organization began taking steps to fight the virus.Kathryn H. Jacobsen, William E. Cooper Distinguished University Chair, Professor of Health Studies, University of RichmondLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1868722022-07-15T12:19:03Z2022-07-15T12:19:03ZIs monkeypox a pandemic? An epidemiologist explains why it isn’t likely to become as widespread as COVID-19, but is worth watching<figure><img src="https://images.theconversation.com/files/474184/original/file-20220714-32258-jxqdeg.jpg?ixlib=rb-1.1.0&rect=30%2C69%2C2871%2C1705&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Monkeypox is caused by the monkeypox virus, which are the ovals and circles seen in this electron microscope image of the skin of a person infected with monkeypox.</span> <span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=22664">Cynthia S. Goldsmith, Russell Regnery/CDC</a></span></figcaption></figure><p>Monkeypox is the latest global public health threat to make headlines. Most people who contract the monkeypox virus experience flu-like symptoms and a <a href="https://www.cdc.gov/poxvirus/monkeypox/symptoms.html">blistery rash</a> that lasts two to four weeks, but a small percentage of infected people develop sepsis or other severe and <a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">potentially fatal complications</a>.</p>
<p>It is not uncommon for there to be <a href="https://doi.org/10.1371/journal.pntd.0007791">small outbreaks of monkeypox</a> in Central and West Africa, but in the last few weeks, dozens of countries from other world regions have reported <a href="https://ourworldindata.org/monkeypox">thousands of cases of monkeypox</a>. </p>
<p>As an infectious disease epidemiologist, I’ve received many inquiries from colleagues and friends about whether a monkeypox pandemic will be the next big disruption to our lives. A disease is considered to be <a href="https://doi.org/10.1093/oso/9780192897855.003.0002">pandemic</a> when two separate conditions are met: cases are occurring globally and the number of cases being diagnosed is large enough to qualify as <a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">epidemic</a>. An epidemic is characterized by new cases of a disease occurring at a <a href="https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html">higher than typical rate in at least several communities</a>.</p>
<p>While the monkeypox situation is certainly newsworthy, as of mid-July 2022, it did not clearly meet both of the requirements for pandemic status. More importantly, the current evidence suggests that <a href="https://theconversation.com/what-is-monkeypox-a-microbiologist-explains-whats-known-about-this-smallpox-cousin-183499">monkeypox</a> is very unlikely to become a global health catastrophe even if the virus spreads and becomes pandemic.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A map showing much of the world in red." src="https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=305&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=305&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=305&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=383&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=383&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474185/original/file-20220714-32290-5vz2ce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=383&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As of mid-July 2022, monkeypox cases associated with the current outbreak (shown in red on the map, with previous outbreaks in other colors) were occurring mostly in Europe and the Americas, and few cases were being reported from Africa and Asia.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Monkeypox_By_Country.svg#/media/File:Monkeypox_By_Country.svg">ArcMachaon/Wikimedia Commons</a></span>
</figcaption>
</figure>
<h2>Is monkeypox global?</h2>
<p>Both the 2009 <a href="https://www.who.int/emergencies/situations/influenza-a-(h1n1)-outbreak">H1N1 influenza</a> virus and the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019">SARS-CoV-2 coronavirus</a> that emerged in 2019 quickly spread to every region of the world. Global health experts were in full agreement that those were pandemic events. By contrast, the <a href="https://www.who.int/groups/ebola-virus-disease-in-west-africa-(2014-2015)-ihr-emergency-committee">Ebola virus</a> epidemic in West Africa from 2014 to 2016 was mostly contained to just that one region of the world and never spread globally. </p>
<p>The <a href="https://www.who.int/emergencies/situations/monkeypox-oubreak-2022">current distribution</a> of monkeypox cases is somewhere between those two scenarios. As of mid-July 2022, about <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-covid-19-media-briefing--12-july-2022">9,200 total cases</a> of monkeypox had been reported by 63 countries. For reasons that are not yet fully understood, almost all of those cases happened in <a href="https://cdn.who.int/media/docs/default-source/2021-dha-docs/20220706_monkeypox_external_sitrep_final.pdf">Europe and the Americas</a>, and only a few cases were reported by <a href="https://ourworldindata.org/monkeypox">African, Asian and Middle Eastern</a> countries.</p>
<p>Is that distribution sufficiently global to meet the definition of a pandemic? Maybe. </p>
<h2>Is monkeypox an epidemic?</h2>
<p>The next condition to meet the pandemic threshold is whether places where monkeypox is present are experiencing epidemics.</p>
<p>Europe and the Americas typically have <a href="https://doi.org/10.1371/journal.pntd.0010141">zero cases</a> of monkeypox per year, so the current case counts in these regions are much higher than normal. </p>
<p>But it is also important to look at how much community transmission is happening. If hundreds of people get sick after attending a single event – like a concert or festival – that would typically be classified as an outbreak. The situation would only become an epidemic if infections started occurring among many people who were not close contacts of event attendees. Once widespread and sustained community transmission begins occurring, it is much harder to control a virus. </p>
<p>Most of the people diagnosed with monkeypox in May and June 2022 were 20- to 50-year-old men who identify as members of the <a href="https://doi.org/10.1126/science.add5497">LGBT+ community</a>. In July 2022, cases were not yet occurring at significant levels in multiple age and sociodemographic groups. </p>
<p>Is the current pattern of spread sufficient to classify monkeypox as an epidemic rather than an outbreak? Maybe, but only in some of the countries that have reported monkeypox cases this year.</p>
<p>Since the answers to whether monkeypox is global and an epidemic are both “maybe” rather than “yes,” this suggests that monkeypox is not a pandemic – at least not yet. But it could become one soon.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A photo of a man's torso with many small lesions" src="https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474186/original/file-20220714-9428-a0lb0l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Monkeypox produces blistery skin lesions, as shown in this photo from the Centers for Disease Control and Prevention taken in the Democratic Republic of Congo in 1997.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Monkeypox/3a2240b22aff43aab5eb20d5f5793149/photo?Query=monkeypox&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=33&currentItemNo=1">Associated Press/CDC</a></span>
</figcaption>
</figure>
<h2>How worried should you be about monkeypox?</h2>
<p>Pathogens like <a href="https://doi.org/10.3389/fpubh.2018.00241">monkeypox</a> are usually spread through touch and other types of <a href="https://www.cdc.gov/poxvirus/monkeypox/transmission.html">close contact</a> with an infected person. Epidemiologists worry much less about pathogens with “person-to-person” transmission than they do about respiratory viruses like influenza and the coronavirus that can spread easily through the air.</p>
<p>Over the course of just a few months, COVID-19 transitioned from a local concern in Wuhan, China, into the worst pandemic in a century. That is <a href="https://doi.org/10.1093/cid/cit703">not going to happen with monkeypox</a>.</p>
<p>Why? First, the monkeypox virus is <a href="https://doi.org/10.2471%2FBLT.19.242347">much less contagious</a> than the circulating strains of coronavirus. Second, monkeypox is less deadly than COVID-19. The <a href="https://cdn.who.int/media/docs/default-source/2021-dha-docs/20220706_monkeypox_external_sitrep_final.pdf">case fatality rate</a> during the current international outbreak is less than one death for every 1,000 adult cases, which is lower than the percentage of unvaccinated people who die after getting <a href="https://doi.org/10.1016/S1473-3099(20)30244-9">COVID-19</a>. And, third, <a href="https://apps.who.int/iris/rest/bitstreams/1433527/retrieve">existing vaccines</a> will be able to help slow the spread of monkeypox in high-risk populations if <a href="https://www.msn.com/en-us/news/us/public-health-clinics-running-out-of-monkeypox-vaccine-as-lines-form-and-systems-crash/ar-AAZxMuv">problems with limited supplies</a> can be resolved.</p>
<p>The World Health Organization follows a set of rules called the <a href="https://www.who.int/publications/i/item/9789241580496">International Health Regulations</a> that guide global public health responses to emerging threats. Under these regulations, the WHO has the authority to declare a “public health emergency of international concern” – commonly shortened to the acronym <a href="https://doi.org/10.1093%2Fjtm%2Ftaaa227">PHEIC</a> – when an infectious disease is spreading internationally and might “potentially require a coordinated international response.” The goal is to detect and respond to potential global health crises and prevent them from becoming pandemics.</p>
<p>An <a href="https://www.who.int/emergencies/situations/monkeypox-oubreak-2022">expert panel convened by the World Health Organization on June 23</a> determined that monkeypox was a “multi-country outbreak” but did not meet the criteria to be a public health emergency of international concern. The panel will meet again on July 21 to examine the distribution and frequency of new case reports. If the rate of new cases continues to increase and there is evidence of transmission within more diverse populations, monkeypox may be declared a public health emergency. </p>
<p>But even if monkeypox is declared to be a public health emergency of international concern, it is not going to become a devastating pandemic like COVID-19.</p><img src="https://counter.theconversation.com/content/186872/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn H. Jacobsen 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 monkeypox virus, which is commonly found in West and Central Africa, is now causing many infections in the U.S., Europe and Latin America.Kathryn H. Jacobsen, William E. Cooper Distinguished University Chair, Professor of Health Studies, University of RichmondLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1862092022-07-10T20:27:15Z2022-07-10T20:27:15ZThe next breakthrough tool in biology? It’s maths. Here are some ways mathematical biology is helping change the world<figure><img src="https://images.theconversation.com/files/473158/original/file-20220708-21-mwxmyr.jpeg?ixlib=rb-1.1.0&rect=132%2C109%2C3702%2C2046&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>Biology is rich in patterns. You’ll find them everywhere – from the number of petals on a flower (which generally correspond to a number in the Fibonacci sequence), to the number of vertebrae in mammals (giraffes, humans and quokkas all have seven neck vertebrae). Even many viruses follow patterns and have symmetry in their shells.</p>
<p>Mathematics is, at its core, the science of patterns. Patterns can be subtle. So without using maths to formally describe and understand them, we could miss them completely. </p>
<p>For a long time, biological research had largely progressed without the advanced mathematical modelling that has now become core to physics, engineering and climate science. But this is changing.</p>
<p>Mathematical biology is a growing field which promises to revolutionise microbiology, biotechnology, evolutionary biology and health care. With maths, scientific breakthroughs that previously required years of trial-and-error experimentation (and tonnes of waste) can be achieved in a fraction of the time. </p>
<p>Here are some of the latest advances being made in mathematical biology. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weve-discovered-a-new-rule-of-nature-it-explains-why-animals-pointy-parts-grow-the-way-they-do-157229">We've discovered a new rule of nature. It explains why animals' pointy parts grow the way they do</a>
</strong>
</em>
</p>
<hr>
<h2>Viruses and the natural world</h2>
<p>As children, most of us would have played rock, paper, scissors, that game where rock crushes scissors, scissors cut paper and paper covers rock.</p>
<p>Well, the same maths we use to describe rock, paper, scissors can also be used to predict the cycle of dominance between animal species in a region that allows their coexistence. For example, there are three varieties of side-blotched lizards in south-western United States. Each variety has an advantage over one of the others, and a disadvantage to the third. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473160/original/file-20220708-23-bog7bk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A male side-blotched lizard sits diagonally on a rock" src="https://images.theconversation.com/files/473160/original/file-20220708-23-bog7bk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473160/original/file-20220708-23-bog7bk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473160/original/file-20220708-23-bog7bk.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473160/original/file-20220708-23-bog7bk.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473160/original/file-20220708-23-bog7bk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473160/original/file-20220708-23-bog7bk.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473160/original/file-20220708-23-bog7bk.jpeg?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">Each variety of the side-blotched lizard has distinct advantages and disadvantages compared to the others.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Maths has also been at the forefront of our fight against COVID-19. If you watch the news you’ve probably heard of R0, a mathematical concept that indicates if an epidemic will occur. When R0 is greater than 1 the number of infections rises. With R0 less than 1 the epidemic will eventually die out.</p>
<p>This crucial concept in infectious disease epidemiology is a result of the power of maths and statistics to detect patterns in data that are too subtle to notice otherwise. It has been the key to predicting and managing the spread of the COVID-19 virus. What’s perhaps less well known is maths is also being used to:</p>
<ul>
<li>design <a href="https://www.sciencedirect.com/science/article/pii/S2667119022000039">viruses</a> to kill cancer cells, such as by making combination therapies to treat <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cso2.1035">ovarian cancer</a> </li>
<li>design interventions to help <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002453#">eliminate malaria</a> </li>
<li><a href="https://aricjournal.biomedcentral.com/articles/10.1186/s13756-018-0406-1">identify</a> the cause of antimicrobial resistance</li>
<li>create clean drinking water for developing nations and arid regions</li>
<li>unlock the inner workings of living cells.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-flatten-the-curve-of-coronavirus-a-mathematician-explains-133514">How to flatten the curve of coronavirus, a mathematician explains</a>
</strong>
</em>
</p>
<hr>
<h2>Whole cell models</h2>
<p>We’re now at the onset of a new era in biology – one in which we can build mathematical models to comprehensively describe an individual biological cell in order to predict its fate. This is called the “whole cell model”. It allows us to compute the life of a cell and is helping us understand how the human body works.</p>
<p>One writer for The New Yorker magazine <a href="https://www.newyorker.com/magazine/2022/03/07/a-journey-to-the-center-of-our-cells">called</a> the quest to understand the intracellular world the “final frontier”. And despite the field still being in its infancy, potential applications are everywhere.</p>
<p>Imagine for a moment if we could build a mathematical replica model of the inner cellular workings of the Methicillin-resistant <em>Staphylococcus aureus</em> (MRSA), a bacterial superbug that doesn’t respond to standard antibiotics. </p>
<p>With a whole cell model of MSRA, we could use computer simulations informed by biological experiments to engineer new ways of both preventing and treating MRSA bacterial infections. This would add another layer of defence in our fight against resistant superbugs.</p>
<p>The benefit of whole cell modelling extends to cancer treatment too. For example, cancer immunotherapy relies on using a patient’s own immune system to fight the cancer. If we had a complete cell model of immune cells, we could fine-tune specific anti-tumour responses to improve therapies against cancer – and do so without any invasive exploration of the patient. </p>
<h2>Clean water</h2>
<p>Beyond health care, whole cell models are giving us methods to provide clean water for agriculture and food production. Effective water treatment produces high-quality water by removing microorganisms, organic matter and micropollutants. </p>
<p>However, buildup of the removed biological matter will cause the filters to become blocked by a layer of biological material, or “biofilm”. The biofilm must be removed for the filtration process to work again. In water desalination plants, around one-quarter of the running costs are <a href="https://www.researchgate.net/publication/347520309_Cost_of_fouling_in_full-scale_reverse_osmosis_and_nanofiltration_installations_in_the_Netherlands">attributed</a> to the removal of biofilms — it’s a big problem. </p>
<p>Whole cell models will allow us to dissect the mechanisms underpinning how biofilms form. We’ll then be able to identify suitable targets to inhibit biofilm formation in the first place, or destroy biofilms once they’re created, to restore the integrity of the water supply.</p>
<p>This is just one of many examples. Being able to understand, predict and control the behaviour of cells will fast-track discoveries in biotechnology and health care, ensuring a healthier, more secure and prosperous future for everyone. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-heightens-water-problems-around-the-world-140167">COVID-19 heightens water problems around the world</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/186209/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Flegg receives funding from the Australian Research Council (ARC). </span></em></p><p class="fine-print"><em><span>Michael P.H. Stumpf has received funding from the Biotechnology and Biological Sciences Research Council.</span></em></p>Our ability to use mathematical modelling is accelerating breakthrough discoveries in health care and biotechnology.Jennifer Flegg, Associate Professor in Applied Mathematics, The University of MelbourneMichael P.H. Stumpf, Professor for Theoretical Systems Biology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1736132022-06-12T12:11:32Z2022-06-12T12:11:32ZCats that are allowed to roam can spread diseases to humans and wildlife<figure><img src="https://images.theconversation.com/files/467255/original/file-20220606-13103-fk8xfg.jpg?ixlib=rb-1.1.0&rect=7%2C15%2C5077%2C3369&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Domestic cats are allowed to roam can transmit parasites and diseases to humans and wildlife.</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/cats-that-are-allowed-to-roam-can-spread-diseases-to-humans-and-wildlife" width="100%" height="400"></iframe>
<p>For decades, scientists have warned that ecologically destructive activities increase the risk of <a href="https://doi.org/10.1126/science.287.5452.443">diseases spilling over between wildlife and human populations</a>. Examples of these drivers include climate change, <a href="https://doi.org/10.1038/nature09575">habitat loss, wildlife trafficking</a>, environmental contamination, expansion of anthropocentric activities and invasive species introduction. </p>
<p>Domestic animals also contribute to the movement of diseases between species. Free-roaming domestic animals, like cats, can facilitate the spread and transfer of diseases, impacting both humans and wildlife.</p>
<h2>Infectious parasites</h2>
<p>Free-roaming cats — which include feral, stray and house cats — present a particularly compelling case because of their large population sizes and their central role in the life cycle of a parasite called <em>Toxoplasma gondii</em> (<em>T. gondii</em>) that infects both wildlife and humans. Most people may have only heard of toxoplasmosis from their doctors during a pregnancy or <a href="https://www.science.org/content/article/reality-check-can-cat-poop-cause-mental-illness">in articles on “brain-altering” parasites</a>. </p>
<p>However, <em>T. gondii</em> is one of the most common zoonotic parasites globally and is estimated to affect <a href="https://doi.org/10.1371/journal.pone.0090203">about 30 to 50 per cent of the global human population</a>. <em>T. gondii</em> infections can have <a href="https://doi.org/10.1016/J.PT.2017.04.001">severe and life-threatening consequences</a>; especially for immunocompromised people and infants infected during pregnancy.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/467258/original/file-20220606-18-9z8rjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a woman in a pink shirt holds a black cat" src="https://images.theconversation.com/files/467258/original/file-20220606-18-9z8rjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467258/original/file-20220606-18-9z8rjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467258/original/file-20220606-18-9z8rjl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467258/original/file-20220606-18-9z8rjl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467258/original/file-20220606-18-9z8rjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467258/original/file-20220606-18-9z8rjl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467258/original/file-20220606-18-9z8rjl.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">Pregnant women are often advised to avoid interacting with cat feces because of the risk posed to their unborn children.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><em>Toxoplasma gondii</em> forms a permanent resting tissue cyst in the muscle or nervous tissue of a host, so even healthy infected people are impacted. Chronic toxoplasma infections have been linked with illnesses including degenerative neurological diseases, schizophrenia and <a href="https://doi.org/10.1016/j.canep.2022.102119">brain cancer</a>. </p>
<p>Domestic cats or wild felids — like lions, jaguars or cougars — <a href="https://www.routledge.com/Toxoplasmosis-of-Animals-and-Humans/Dubey/p/book/9780367543129">intermittently excrete millions of <em>T. gondii</em> eggs (called oocysts)</a> into the environment <a href="https://doi.org/10.1016/j.vetpar.2017.10.021">through their feces</a>. These oocysts persist under favourable conditions for years in water and soil, <a href="https://doi.org/10.1371/journal.pone.0255664">with the capacity for long-distance dispersal</a>.</p>
<p>If any warm-blooded animal ingests an oocyst, it can become infected with <em>T. gondii</em>. This can happen if a person or animal ingests oocysts in contaminated water or food, or through eating another animal that has already become infected.</p>
<h2>Spreading diseases</h2>
<p>Although both wild felids and domestic cats are sources of toxoplasma, domestic cats outnumber wild felids by several orders of magnitude. We recently tested whether mammals living in environments with greater densities of domestic cats would show higher infection rates of <em>T. gondii</em>. </p>
<p>While there are no global data sets showing domestic cat densities, domestic cats are closely associated with humans, and therefore, measures of human population density can act as a surrogate for the density of free-roaming cats. Using data from over 200 studies, we demonstrated that indeed, <a href="https://doi.org/10.1098/rspb.2021.1724">wildlife living in areas of higher human density</a> had higher infection rates of <em>T. gondii</em>. </p>
<p>We concluded that this higher infection rate occurred due to a combination of two phenomenon: high densities of free-roaming domestic cats producing infected feces, and the loss of natural habitats. Natural ecosystems have important roles in filtering, sequestering and <a href="https://doi.org/10.1128/AEM.01435-10">removing <em>T. gondii</em></a> and <a href="https://doi.org/10.1023/A:1013169401211">other pathogens</a> from human, livestock and wildlife exposure pathways. Breaking the lifecycle by preventing cats from hunting and landscape restoration are key preventative measures.</p>
<p>If wildlife have an increased risk of exposure to <em>T. gondii</em> in certain areas, then humans and livestock can also be unintended targets. Public health researchers have shown this repeatedly by <a href="https://doi.org/10.1016/j.vetpar.2014.08.003">sampling soil</a>, <a href="https://doi.org/10.1007/s10096-011-1414-8">vegetable gardens</a> and <a href="https://doi.org/10.1016/j.vetpar.2010.02.045">playgrounds</a>.</p>
<h2>Rabies risk</h2>
<p>Rabies is another disease whose risk is increased by free-roaming cats. In the United States, cats are <a href="https://doi.org/10.2460/JAVMA.258.11.1205">the most common rabies positive domestic species</a>, with cats posing <a href="https://doi.org/10.1111/zph.12077">two-and-a-half times the rabies exposure risk compared to bats in Pennsylvania</a>. In Canada, we recently found similar public health concerns of free-roaming cats when we <a href="https://doi.org/10.1371/JOURNAL.PGPH.0000357">examined patterns of rabies submissions of bats in Canada</a>. </p>
<p>In Canada, free-roaming cats were associated with 10 times more bats being submitted for rabies testing compared to indoor cats. In fact, in our dataset, there were five records of free-roaming cats bringing bats into the house that subsequently were found to be rabies positive. This hunting activity by cats is obviously dangerous for people in the household, and is a very simple explanation for cases of cryptic rabies infections (rabies cases without an identifiable source).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/467910/original/file-20220609-12-wecu74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a silver-haired bat" src="https://images.theconversation.com/files/467910/original/file-20220609-12-wecu74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467910/original/file-20220609-12-wecu74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467910/original/file-20220609-12-wecu74.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467910/original/file-20220609-12-wecu74.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467910/original/file-20220609-12-wecu74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467910/original/file-20220609-12-wecu74.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467910/original/file-20220609-12-wecu74.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"></a>
<figcaption>
<span class="caption">In areas with large numbers of free-roaming cats predating bats, the risk that a human will be exposed to rabies is expected to increase.</span>
<span class="attribution"><span class="source">(Jared Hobbs)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>This risk is directly proportionate to the frequency of free-roaming cats killing bats, which is unfortunately common. Single cats have been known to <a href="https://doi.org/10.1080/03014223.2011.649770">kill a hundred bats in a week</a>. </p>
<p>In our dataset, one free-roaming cat killed nine endangered little brown bats in one month, with another record of a cat killing 14 bats in a single evening. Many bat populations have undergone severe declines, especially due to <a href="https://doi.org/10.1111/nyas.14045">an introduced fungal disease</a>. Bats are <a href="https://doi.org/10.1007/s11284-012-1010-0">long-lived with low reproduction</a>, so this additional source of mortality can severely impact bat populations.</p>
<p>Since cats only bring home <a href="https://doi.org/10.1016/j.biocon.2013.01.008">20 per cent of what they kill</a>, prey returns and rabies submissions only provide a tiny glimpse of the true cat predation rates. It is therefore apparent that although natural rabies prevalence in bats is low — <a href="https://doi.org/10.7589/0090-3558-47.1.64">less than one per cent</a> — in areas with cats killing large numbers of bats, rabies exposure risks will increase.</p>
<h2>Protecting health and wildlife</h2>
<p>There is broad consensus among <a href="https://www.canadianveterinarians.net/policy-and-outreach/position-statements/statements/free-roaming-owned-abandoned-and-feral-cats/">veterinarians</a>, <a href="https://doi.org/10.1016/j.biocon.2019.04.002">ecologists</a>, <a href="https://doi.org/10.1111/j.1863-2378.2012.01522.x">public health experts</a> and <a href="https://www.peta.org/about-peta/why-peta/feral-cats/">animal rights activists</a> that free roaming by domestic cats is detrimental for feline welfare, wildlife welfare, conservation and human health. Wildlife have the same capacity for distress and pain as domestic animals, and perform irreplaceable ecosystem services with <a href="https://doi.org/10.1007/s11284-012-1010-0">tangible economic benefits</a>, making their predation unjustifiable from an ethical or economic perspective. </p>
<p>Free-roaming cats suffer from increased mortality through <a href="https://doi.org/10.2460/javma.2004.225.1377">traumatic injury, disease, neglect and abandonment</a>. This marginalization of cats needs to be replaced with <a href="https://www.adventurecats.org/about/">progressive enrichment resources</a> and <a href="https://doi.org/10.1111/CSP2.12706">responsible management that does not foster an inhumane and biased disregard</a> for feline welfare standards, wildlife welfare, conservation and human health. </p>
<p><em>David Lapen, research scientist with Agriculture and Agri-Food Canada, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/173613/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Wilson has done research contract work for Environment and Climate Change Canada. </span></em></p><p class="fine-print"><em><span>Scott Wilson works for and receives research funding from Environment and Climate Change Canada </span></em></p>Allowing cats to roam unsupervised is detrimental to humans, wildlife and the cats themselves. Managing free-roaming cats should consider the risks they pose to other species.Amy Wilson, Adjunct Professor, Forest and Conservation Sciences, University of British ColumbiaScott Wilson, Adjunct Professor, Forest and Conservation Sciences, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.