The Covid-19 Pandemic

With the acute phase of the Covid-19 pandemic fading even as the coronavirus persists and evolves, a new normal is taking shape around the world.

A long Covid patient received a checkup last year. A study of more than 154,000 Covid patients found that they were 36 percent more likely to have gastrointestinal problems a year later than people who didn’t get Covid.

Long Covid Patients More Likely to Have Gastrointestinal Problems, Study Finds

The study, which examined patients infected early in the pandemic, found they were significantly more likely than people who didn’t get Covid to experience lingering reflux, constipation and other issues.

  By Pam Belluck

The Wuhan Institute of Virology in 2021. The U.S. Energy Department has concluded with “low confidence” that an accidental laboratory leak in China most likely caused the coronavirus pandemic.

What We Know and Don’t Know About the Origins of Covid

Scientists and spy agencies have tried to determine where the coronavirus originated, but conclusive evidence is hard to come by and the nation’s intelligence agencies are split.

  By Sheryl Gay Stolberg and Benjamin Mueller

The Wuhan Institute of Virology in Wuhan, China.

China Dismisses Latest Claim That Lab Leak Likely Caused Covid

The response came after the Energy Department concluded with “low confidence” that the coronavirus emerged from a lab in Wuhan, China.

  By David Pierson

The Wuhan Institute of Virology in 2021. The U.S. Energy Department has concluded with “low confidence” that an accidental laboratory leak in China most likely caused the coronavirus pandemic.

Lab Leak Most Likely Caused Pandemic, Energy Dept. Says

The conclusion, which was made with “low confidence,” came as America’s intelligence agencies remained divided over the origins of the coronavirus.

  By Julian E. Barnes

The F.D.A.’s desire to streamline vaccine recommendations is a reflection of just how complicated and confusing they have become.

Who Should Get a Covid Booster Now? New Data Offers Some Clarity.

If you are high-risk, the answer is straightforward. If you are low-risk, there is less consensus.

  By Dana G. Smith

feature article about covid 19 pandemic

What the End of the Covid Public Health Emergency Could Mean for You

The emergency expires in May, complicating access to tests and treatment in the U.S.

  By Dani Blum

The White House said that the nation needed an orderly transition out of the public health emergency, which has been in effect for all of President Biden’s time in office.

U.S. Plans to End Public Health Emergency for Covid in May

The end of the emergency, planned for May 11, will bring about a complex set of policy changes and signals a new chapter in the government’s pandemic response.

  By Sharon LaFraniere and Noah Weiland

the new old age

Eleanor Bravo of Corrales, N.M., lost her sister to Covid early in the pandemic, and two years passed before the family could gather for a memorial. “I had this inordinate fear that if I got Covid, I would die too,” she said.

For Older Americans, the Pandemic Is Not Over

Seniors are increasingly left to protect themselves as the rest of the country abandons precautions: “Americans do not agree about the duty to protect others.”

  By Paula Span

Nepalese health workers prepared Covid vaccines, obtained through the Covax program, for storage in Kathmandu, Nepal, in 2021.

Vaccine Makers Kept $1.4 Billion in Prepayments for Canceled Covid Shots for the World’s Poor

Separately, Johnson & Johnson is demanding additional payment for unwanted shots, confidential documents show.

  By Stephanie Nolen and Rebecca Robbins

Receiving Covid vaccines and boosters at a mobile distribution site in Salt Lake City in September.

Republicans Assail Vaccine and Mandates With Misleading Claims

The house debated for hours on tuesday before voting for measures that would end a public health emergency and a vaccine mandate for some health care workers..

Republicans are hoping to capitalize on discontent over the pandemic response and tap into the grievances of parents over school closures.

House Votes to End Covid Precautions as G.O.P. Uses Pandemic in Political Attacks

Republicans in congress are seeking to capitalize on discontent about the federal coronavirus response while the party’s presidential contenders are vying to be the biggest foe of restrictions..

A booster vaccination clinic in Salt Lake City last year.

No Increased Stroke Risk Linked to Pfizer’s Covid Boosters, Federal Officials Say

An uptick hinted at in surveillance data was a mirage, the officials said..

Administering a bivalent booster shot at the Hebrew Home in the Bronx in September.

New Covid Booster Shots Cut Risk of Hospitalization by Half, C.D.C. Reports

The research was conducted in part when older variants of the coronavirus were spreading. other factors may have influenced the conclusions..

A survey found that 28 percent of U.S. adults now say that parents should have the authority to make school vaccine decisions for their children. In a 2019 poll, that view was held by 16 percent of adults.

Opposition to School Vaccine Mandates Has Grown Significantly, Study Finds

A third of parents now feel they should be the ones to decide whether to get their children immunized against measles, mumps and other childhood diseases., maps and trackers.

feature article about covid 19 pandemic

Coronavirus in the U.S.: Latest Map and Case Count

Track covid-19 in your area, and get the latest state and county data on cases, deaths, hospitalizations, tests and vaccinations..

feature article about covid 19 pandemic

See How Vaccinations Are Going in Your County and State

See where doses have gone, and who is eligible for a shot in each state..

feature article about covid 19 pandemic

Coronavirus World Map: Tracking the Global Outbreak

The virus has infected and killed millions of people around the world. see detailed maps and charts for each country..

feature article about covid 19 pandemic

Coronavirus Vaccine Tracker

A look at all the vaccines that have reached trials in humans..

feature article about covid 19 pandemic

Coronavirus Drug and Treatment Tracker

An updated list of potential treatments for covid-19..

Experts and activists said that Moderna had for years resisted acknowledging its true debt to the government and to academic researchers.

After Long Delay, Moderna Pays N.I.H. for Covid Vaccine Technique

Moderna has paid $400 million to the government for a chemical technique key to its vaccine. but the parties are still locked in a high-stakes dispute over a different patent..

Jahmir Harris, 18, center, sat on the bench as he watched his former basketball team play against Monsignor Farrell High School in January.

How Covid and the Rule Book Kept a Promising Athlete on the Bench

Jahmir harris, a top basketball player at fordham prep in the bronx, was starting to get interest from college programs, but a last-minute decision by league officials cost him his senior season..

feature article about covid 19 pandemic

America Should Be in the Middle of a Schools Revolution

Covid disrupted education, and now the task is to build something new..

feature article about covid 19 pandemic

Opening Up Jobs for Those Without a College Degree

Readers react to an editorial urging employers to consider skills and experience, not just degrees. also: long covid; trump, rino; online romance scams..

Elementary school students returning to in-person learning in a school in California in 2021. Education deficits were equivalent to about 35 percent of a school year and remained steady, according to a new study.

Students Lost One-Third of a School Year to Pandemic, Study Finds

Learning delays and regressions were most severe in developing countries and among children from low-income backgrounds. and students still haven’t caught up..

For the past two months, travelers coming from China have been required to present a negative Covid test before entering the United States.

U.S. Will Lift Covid Testing Requirement for Travelers From China

The restriction was put into place as the end of china’s “zero covid” policy prompted a surge of cases in the country..

John Lee, the chief executive of Hong Kong, discussing a campaign to promote tourism in the city.

Hong Kong Tries to Repair Its Battered Image With Plane Ticket Giveaway

The city’s reputation has been hammered by protests, a harsh security law and strict covid measures. it hopes a giveaway of 500,000 plane tickets woos back tourists..

Chinese tourists, dressed in Thai traditional costumes rented from a clothing rental shop, during a visit to Bangkok in late January.

Chinese Travel Is Set to Return. The Question Is, When?

The country has dropped restrictions on overseas journeys for its citizens, but once-popular destinations are still waiting for the flood of vacationers to arrive..

Marlborough is New Zealand’s most important wine region and a good start for a road trip through the country’s South Island.

In New Zealand, Sauvignon Wishes and Sashimi Dreams

A road trip in the country’s south island offered perfect wines, stunning views, intimate restaurants and the chance to make a pilgrimage to a salmon shangri-la..

People embracing at the international arrivals gate at Beijing International Airport on Sunday, after China opened its borders.

As China Lifts Pandemic Border Controls, Mixed Feelings at Home and Abroad

Friends and families are planning reunions; tourists are booking flights. but amid the anticipation, there’s a whiff of anxiety..

The cuts are coming as inflation remains persistently high and many other coronavirus-era programs end.

Low-Income Families Brace for End of Extra Food Stamp Benefits

When a pandemic-era boost ends on wednesday, more than 30 million people will lose a significant amount of assistance..

The Covid lab-leak theory is back.

How the Lab Leak Theory Could Strain U.S.-China Relations

The u.s. energy department’s report identifying the wuhan institute of virology as the likely source of the coronavirus has already generated pushback in beijing..

President Biden’s State of the Union address touched on the economy, the war in Ukraine, and the power of democracy.

Fact-Checking Biden’s State of the Union Address

The president’s speech contained no outright falsehoods, but at times omitted crucial context or exaggerated the facts..

President Biden wants to use Tuesday’s speech to make the case that government works, pointing to legislation that passed on bipartisan votes.

For Biden, a Chance for a Fresh Start in a New Era of Divided Government

The president plans to use his first state of the union address since republicans took control of the house to call for bipartisan cooperation. neither he nor many others expect that to happen..

A chicken breeding farm in Missouri.

Forget Pandemic Puppies. Meet the Inflation Chicken.

People are snapping up chickens that are “heavy layers” in response to egg inflation. the chick situation holds lessons about the broader economy., lives we've lost.

Stephen Wilhite, the creator of the animation format known as GIF, received a lifetime achievement honor at the Webby Awards in 2013.

Stephen Wilhite, Creator of the GIF, Is Dead at 74

The looping animations known as graphics interchange format quickly became a staple of the internet, although the pronunciation of ‘gif’ was a frequent subject of debate..

Sidney Miller II in an undated photo. His magazine, Black Radio Exclusive, examined the world of Black music and hosted an annual conference.

Sidney Miller, Who Championed Black Music, Dies at 89

He founded the influential trade magazine black radio exclusive and presented a popular annual conference that featured unknowns and superstars..

Hans Neuenfels in 2014. He was renowned for provocative interpretations of classic works.

Hans Neuenfels, Opera Director With a Pointed View, Dies at 80

A leading proponent of “director’s theater,” he was known for productions with a provocative stamp that often provoked outrage..

The photographer and filmmaker James Bidgood in 2019. The pictures he took for men’s physique magazines were lavish fantasies full of references to mythology, adventurous lighting and props, and attractive men — sometimes in costume, sometimes in nothing.

James Bidgood, a Master of Gay Photography, Dies at 88

In addition to his elaborately staged images of gay fantasies, he made the film “pink narcissus,” a cult classic released anonymously in 1971..

Arnie Kantrowitz last year. He was an early advocate for gay rights and fairer depiction of gay people in the media.

Arnie Kantrowitz, Pioneer of Gay Liberation, Dies at 81

A professor, author and activist, he fought against discrimination because of sexual orientation and for fairness from the media..

feature article about covid 19 pandemic

The Debate Over Covid’s Origin

Both U.S. political parties are now open to the idea that Covid may have come from a lab in China.

By German Lopez

feature article about covid 19 pandemic

Pacientes con covid prolongada tienen más probabilidades de sufrir problemas gastrointestinales, según nuevo estudio

Una nueva investigación reveló que los pacientes con ese tipo de secuela de la covid son más propensos a experimentar molestias como reflujo persistente, estreñimiento y otros problemas.

By Pam Belluck

feature article about covid 19 pandemic

Your Thursday Briefing: Covid Origins Hearing Opens in the U.S.

Also, protests in Georgia and armed villagers in Kashmir.

By Amelia Nierenberg

feature article about covid 19 pandemic

Times Video

House panel holds hearing on covid origins.

A House subcommittee held its first hearing examining what may have caused the coronavirus pandemic, a question that continues to be the subject of intense political and scientific debate.

By The Associated Press

Republicans Push Lab Leak Theory on Covid’s Origins, but Lack ‘Smoking Gun’

The first hearing of a House panel charged with investigating the origins of the pandemic underscored just how difficult it might be to turn up conclusive evidence.

By Sheryl Gay Stolberg and Benjamin Mueller

feature article about covid 19 pandemic

New York Today

Some new yorkers are not ready to pull down their masks.

Mayor Eric Adams has told shops to bar customers who are masked when they enter, but not everyone’s on board.

By James Barron

feature article about covid 19 pandemic

Hearing on Covid’s Origins Promises Politics Mixed With Substance

In advance of a hearing on Wednesday expected to focus on the lab leak theory, House Republicans took aim at Dr. Anthony S. Fauci, whom they have long vowed to investigate.

feature article about covid 19 pandemic

Supreme Court Hints That It May Duck Two Big Cases

Recent orders suggest that the justices are thinking of dismissing cases involving the “independent state legislature” theory and Title 42, an immigration measure imposed during the pandemic.

By Adam Liptak

feature article about covid 19 pandemic

political memo

Ex-minister’s texts lift the veil on u.k. covid policy. it isn’t pretty..

A trove of more than 100,000 WhatsApp messages exchanged between Matt Hancock, then the British health secretary, and other government figures revealed the scramble to coordinate the virus response.

By Mark Landler

feature article about covid 19 pandemic

Mayor Adams to New York City Shoppers: Drop That Mask

To prevent robberies, Mayor Eric Adams is telling shopkeepers to bar customers who refuse to lower their masks when they first enter stores.

By Liam Stack


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Feature Article: Here’s What We’ve Learned About COVID-19—An Update

Much has been said about the pandemic. Scientists all around the world have been laser-focused on studying SARS-CoV-2, the virus that causes COVID-19, for nearly two years and the flood of information can be overwhelming. That’s why a trusted, unified resource that organizes our collective knowledge is so valuable.

The Science and Technology Directorate (S&T)’s Master Question List (MQL) is just that. This consolidation of recent, accurate COVID-19 information is regularly updated with the latest results and data relevant to weathering the pandemic. S&T started publishing the MQL in early 2020 as part of its COVID-19 response .

“The MQL is important for us because it identifies what we don’t know. And with finite lab resources, it ensures we don’t duplicate something that is already being studied elsewhere,” said Dr. Lloyd Hough, director of S&T’s Hazard Awareness and Characterization Technology Center , in S&T’s previous ‘ Here's What We’ve Learned About COVID-19 ’ article. “It’s really a matter of identifying the highest priority gaps—the things that are most impactful for better understanding the disease and helping us to respond to it.”

One current high-priority item is the highly infectious Delta variant, which is now responsible for most new COVID-19 cases in the United States. S&T published the first Delta Variant Supplemental Reference (SR) late last month to quickly summarize key information about it for government decision-makers and the public. The SR is one example of how our nation’s response has had to adapt as the COVID-19 pandemic evolves—which in the case of the Delta variant, is meant quite literally.

We’ve learned quite a bit since last year, but there are still many unknowns as we continue to navigate the national pandemic response. That’s why the MQL is so critical; S&T continues to support the nation’s scientific, medical, and academic communities with a central resource for tracking the most need-to-know information. In the last article , S&T provided asked-and-answered MQL questions that were not only critical for public awareness about COVID-19 but were a testament to the tireless work of our researchers.

The following is a new batch of answers to questions in S&T’s current MQL .

Are there effective vaccines?

According to the U.S. Centers for Disease Control and Prevention (CDC), the vast majority of U.S. COVID-19 hospitalizations (95-99.9%) and deaths (94-99.8%) are occurring in unvaccinated individuals. In the U.S., both Pfizer/BioNTech and Moderna vaccine efficacy has been estimated at 88% overall in a study published by the U.S. National Library of Medicine. Research shows that six months after the first dose of the Pfizer/BioNTech vaccine (in a fully vaccinated person), efficacy is greater than 95% in terms of preventing hospitalization and around 91% in terms of preventing symptomatic infection. Against the Delta variant, the Pfizer/BioNTech vaccine provides 93-96% efficacy against hospitalization and 64-88% efficacy against symptomatic infection , as reported by the New England Journal of Medicine.

The Pfizer/BioNTech, Moderna, and Johnson & Johnson/Janssen vaccines are safe according to extensive data from the CDC and other trustworthy sources . All three vaccines were granted Emergency Use Authorization by the U.S. Food and Drug Administration (FDA) to strengthen our nation’s public health protections during the pandemic crisis. The Pfizer/BioNTech vaccine received full FDA approval in late August. Moderna has completed its submission for full FDA approval and Johnson & Johnson is not far behind.

The FDA has rigorous scientific standards. Thorough evidence of safety and effectiveness from clinical trials with thousands of participants is required for any authorization and continuous monitoring is in place to rapidly detect any issues. The CDC’s tally shows that more than 180 million people in the United States are fully vaccinated.

How does the disease agent compare to previous strains?

The Delta variant of the SARS-CoV-2 virus emerged in India in September 2020, quickly spread to over 100 countries, and now accounts for more than 90% of new COVID-19 cases in the U.S., according to the CDC. The Delta variant is highly transmissible . A study published in the Journal of the Royal Society of London showed an estimated reproduction number (R0) of 5-9, which is far higher than the 2.2-3.1 R0 of the original, wild-type SARS-CoV-2. Another study showed that the Delta variant may lead to higher viral load in infected individuals compared to those with wild-type SARS-CoV-2 or other variants. The viral load of vaccinated individuals with breakthrough Delta variant infection was found by the CDC to be similar to infected, unvaccinated individuals , suggesting that breakthrough cases may be equally capable of transmitting to others.

The CDC has also found that the Delta variant may produce more severe illness and be more likely to cause reinfection—particularly for the unvaccinated. Household secondary attack rates of the Delta variant can be as high as 53% and may be higher in individuals younger than 10 years old. Early evidence published by the British Medical Journal suggests that the Delta variant spreads rapidly in schools .

Are there tools to diagnose infected individuals?

Diagnosis of COVID-19 is based on symptoms consistent with COVID-19, polymerase chain reaction (PCR)-based testing of active cases, and/or the presence of SARS-CoV-2 antibodies in individuals. Screening solely by temperature or other symptoms is unreliable. Nasopharyngeal swabs are the gold standard for COVID-19 diagnosis.

PCR is a method widely used to rapidly make millions of copies of a specific DNA sample. The timing of diagnostic PCR tests impacts results . As reported in the American College of Physicians (ACP) Journal, Annals of Internal Medicine , the false-negative rate is lowest between 7 and 9 days after exposure. PCR tests are more likely to give false-negative results before symptoms begin (within 4 days of exposure) and more than 14 days after exposure.

What are the long-term symptoms of COVID-19 infection?

Post-Acute Sequelae of SARS-CoV-2 (PASC) infection, also known as “long-haul COVID” or simply “long COVID”, affects 5-10% of patients and is a persistent infection lasting longer than four weeks. Another ACP study showed fatigue, loss of taste or smell, shortness of breath, and headache are the most common chronic symptoms and they can persist for months. Neurological impairment has also been reported and may affect the patient’s ability to return to work.

How easily is it spread?

Worldwide, COVID-19 has caused at least 225 million infections and claimed over 4.6 million lives . The U.S. alone has seen over 42 million cases and more than 670,000 deaths. These and other statistics are available via the Johns Hopkins University COVID-19 Dashboard .

COVID-19 has reportedly spread to numerous animals both in the wild and in captivity, including otters, deer, mink, ferrets, gorillas, tigers, and lions—though there doesn’t seem to be evidence of transmission to humans in these cases.

What personal protective equipment is effective, and who should be using it?

The CDC asserts that face masks are effective at reducing transmission of COVID-19. Numerous studies have supported this finding, including research published by the American Society for Microbiology   (PDF, 5 pgs., 1.62MB) , the Journal of the American Medical Association , and Nature Research . Wearing a mask protects others as well as yourself. Updated CDC guidance states that in general, mask-wearing is not necessary in outdoor settings. For the unvaccinated, or if COVID-19 cases are high in the area, mask-wearing in crowded outdoor settings should be considered. Wearing a mask in indoor public places maximizes protection. To be effective, a face mask must fully cover the nose and mouth; masks should fit snugly against the sides of the face and not have gaps.

There is a path forward.

Not a question, but a final note of hope and encouragement: we have made great strides in conquering this crisis, though plenty remains to be done. There are a number of recommended treatments depending on disease severity, but none of them are a guarantee of recovery. The best thing we can all do is follow the recommendations of the CDC and our local public health authorities.

“I urge anyone who is concerned about their health and the health of their loved ones from COVID-19 to refer to CDC’s guidance, to talk to their doctor, and to educate themselves using official, trustworthy scientific sources,” added Dr. Hough. “We’re doing the science to help keep people safe, and it is incumbent upon all of us to do our part and stay informed.”

If you’d like to learn more about any of the science presented here, check out the MQL or the new Delta Variant SR . You can find comprehensive public health guidance on the CDC website . For related media requests, contact [email protected]

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COVID-19 Archive

Does COVID-19 damage the brain?

Does COVID-19 damage the brain?

COVID-19 can damage the brain in many ways. Initially, it can cause brain inflammation that causes confusion, difficulty concentrating, and memory problems. COVID also can cause new psychological disorders such as depression or anxiety. It can even cause people to see and hear things that aren’t there and to believe things that aren’t true. COVID often damages the brain’s autonomic nervous system, leading to abnormalities in heart rate and blood pressure. Additionally, the virus that causes COVID can infect and injure the lining of blood vessels and make blood clot more easily, which can lead to strokes and heart attacks.

Vaccination may protect against long COVID

Vaccination may protect against long COVID

Getting at least one dose of a COVID vaccine lowers the risk of developing long COVID even among people who were previously unvaccinated and recovered from COVID.

Genes protective during the Black Death may now be increasing autoimmune disorders

Genes protective during the Black Death may now be increasing autoimmune disorders

Genes that helped people survive during the time of the Black Death are more likely to be found in people with autoimmune diseases alive today. Does this tell scientists anything about what surviving the COVID-19 pandemic might mean for the world’s population?

Want to stay healthy over the holidays?

Want to stay healthy over the holidays?

Another holiday season is here, and this year we need to contend with other viruses besides COVID-19. Three Harvard experts share their thoughts on the best ways to keep ourselves and our family members healthy as we celebrate holidays together.

High blood pressure linked to severe COVID despite vaccination

High blood pressure linked to severe COVID despite vaccination

A 2022 study found that high blood pressure more than doubled the risk of being hospitalized from an Omicron-variant COVID-19 infection regardless of full vaccination, including a booster dose of an mRNA vaccine.

Is the COVID-19 pandemic over, or not?

Is the COVID-19 pandemic over, or not?

Infections and deaths from COVID-19 are still occurring every day in the US, although many people are acting like the pandemic is over. So is it over, or not?

Why life expectancy in the US is falling

Why life expectancy in the US is falling

Life expectancy is one measure of the general health of a population. In the US, life expectancy had been climbing for more than a century — until the pandemic. After dropping in 2020, it dropped again in 2021, and some population groups fared worse than others.

Vaccines against the flu and COVID-19: What you need to know

Vaccines against the flu and COVID-19: What you need to know

Autumn is when infectious respiratory diseases start to spread more readily. That’s why October is the ideal time to boost your immunity against the viruses that cause flu and COVID-19.

More fallout from COVID-19

More fallout from COVID-19

Hair loss is common in the months after recovering from COVID-19 infection. It can also happen in people with long COVID or because of mental stress from the pandemic. COVID-related hair loss is a form of telogen effluvium, a condition in which normal hair shedding ramps up after intense physical or mental trauma. Hair regrowth usually takes six to 12 months. People can speed and support hair regrowth by avoiding harsh hair habits, checking nutrient levels, and applying minoxidil (Rogaine) to the scalp.

Severe COVID infection may lead to noticeable cognitive loss

Severe COVID infection may lead to noticeable cognitive loss

A 2022 study found that survivors of severe COVID-19 infections can develop cognitive problems, such as brain fog or trouble finding words, equivalent to the loss of 10 IQ points or 20 years of aging.

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Feature Article: Wondering about Coronavirus?

Published on Mar 05, 2020 in Parents PACK

Parents PACK

Editor’s Note: This article, and the associated PDF, is being updated as more information becomes available. The date at the bottom of this webpage, and on the PDF, will indicate the most recent edits.

In recent weeks, the news has been dominated with stories about coronavirus. The virus, now called COVID-19, first sickened people in Wuhan, China, in late 2019. Since then, many thousands of people around the globe have fallen ill, and some have died.

What is coronavirus?

Coronaviruses are a family of viruses that contain RNA (instead of DNA, like people have). The viruses are circular in shape with spikes on the surface, which appear like a halo when the virus is viewed with a microscope. This halo of spikes is what led scientists to name these “coronaviruses.”

Coronaviruses were first discovered in the 1930s, and as with other families of viruses, some coronaviruses are more worrisome than others. The earliest discovered coronaviruses infected farm animals, causing lung infections in chickens and digestive illness in pigs. Later, scientists found a couple of types that infected people, causing symptoms of the common cold. 

This family of viruses garnered more attention in the early 2000s with the epidemic known as severe acute respiratory syndrome, or SARS. The SARS virus infected civet cats and then gained the ability to infect people, leading to the epidemic. In 2012, a similar occurrence led to the Middle East respiratory syndrome, or MERS, epidemic. In this situation a coronavirus that infected camels gained the ability to infect people. Currently, scientists think that COVID-19 also originated in an animal and then infected people, but, right now, it remains uncertain as to which animal.

Why is COVID-19 such a big deal?

When a virus that normally infects animals gains the ability to infect people, two things can happen:

The second of these scenarios is what is currently occurring with COVID-19.

What are scientists and public health officials doing about it?

When a new virus emerges, scientists and public health officials have a long “to do” list that includes:

We have watched this scenario of “people versus novel virus” play out many times in history, such as during the 1918 influenza pandemic, during the 1980s with the AIDS epidemic, and more recently, related to SARS (2003), H1N1 influenza (2009) and MERS (2012). The good news is that public health officials and scientists who work with infectious diseases have learned from each of these events. The bad news is that new viruses are unknown and, therefore, less predictable.

What should I worry about?

In situations such as the current COVID-19 pandemic, it is important not to “FORGET” these points:

F – Follow advice of officials — Officials are continuing to monitor the spread of COVID-19, and as necessary, they are adjusting recommendations and protective health practices. The best approach is to listen to this advice since they have the latest information available. Check the latest CDC guidance.

O – Observe the big picture — While tens or hundreds of thousands of cases of COVID-19 have occurred, only a few thousand people have died. While this sounds scary, let’s consider the big picture. Public health officials have estimated that about 1% of those infected have died.

To put this in context in the U.S., between the beginning of December 2019 and the end of January 2020, more than 28,000 people have died from influenza and pneumonia. This represents almost 7% of the total deaths that occurred in the U.S. during this two-month period. So, the big picture in the current situation is that you, or a family member, is significantly more likely to be exposed to, get sick with, and, possibly, die from influenza than from coronavirus.

R – Remain calm — It is completely understandable for people to be upset and worry about coronavirus, especially when hearing about it regularly, but it is important to manage emotions. This is especially true for parents of children old enough to understand the news. If you are upset, your children are likely to sense that and be upset too. Situations like this offer “teachable moments” in which we can discuss the situation with our children in an age-appropriate way, reassure them that adults are monitoring the situation to keep them safe, and remind them about the importance of good preventive measures, such as handwashing, covering coughs, and getting vaccinated when vaccines are available.

G – Get reliable information — Misinformation, and even scams, are rampant. So much so, in fact, that the World Health Organization (WHO) had to post a scam alert on their website . Don’t just retweet or repost if you are not sure of the source. Don’t rely solely on social media or online news feeds to get information. Go to reliable sources, like the WHO or the Centers for Disease Control and Prevention (CDC) to get answers to your questions. Both have special website sections they are keeping updated with information.

E – Expect information to change — Public health officials, scientists and healthcare providers are learning as they go, so new information should be expected, not viewed as poor communication. Certainly, there may be specific situations or reports that, in retrospect, people will feel could have been handled better, but understand that these experts are all doing the best they can under the circumstances.

T – Take preventive health measures — Even though COVID-19 has not become widespread in the U.S. at this point, it could. And we are in the midst of cold and flu season, so preventive health measures, like handwashing, covering coughs, and staying home when ill are all good practices to follow, and to reinforce with children.

Download a printable version of this article in PDF format.

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Last updated: March 12, 2020

Categories: Parents PACK March 2020 , Feature Article

Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.

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The 1918 Flu (H1N1 virus) Pandemic got its name as the “Spanish” Flu because it was journalists and Spanish newspapers that accurately reported that a mysterious and virulent flu was spreading widely among Allied soldiers during the first world war. British, French, and US newspapers had censored any mention of the H1N1 flu virus. The earliest reported case of the H1N1 virus, also known as the “bird flu”, was in 1918, where US soldiers training at Camp Funston in Kansas had been stricken with ‘grippe’. It would be US soldiers that helped to contribute to the spread of the virus that would claim an estimate of 50 to 100 million people globally.

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Covid backlash hobbles public health and future pandemic response

Lawsuits and legislation have stripped public health officials of their powers in three years.

When the next pandemic sweeps the United States, health officials in Ohio won’t be able to shutter businesses or schools, even if they become epicenters of outbreaks. Nor will they be empowered to force Ohioans who have been exposed to go into quarantine. State officials in North Dakota are barred from directing people to wear masks to slow the spread. Not even the president can force federal agencies to issue vaccination or testing mandates to thwart its march.

Conservative and libertarian forces have defanged much of the nation’s public health system through legislation and litigation as the world staggers into the fourth year of covid.

At least 30 states, nearly all led by Republican legislatures, have passed laws since 2020 that limit public health authority, according to a Washington Post analysis of laws collected by Kaiser Health News and the Associated Press as well as the Association of State and Territorial Health Officials and the Center for Public Health Law Research at Temple University.

Health officials and governors in more than half the country are now restricted from issuing mask mandates , ordering school closures and imposing other protective measures or must seek permission from their state legislatures before renewing emergency orders, the analysis showed.

The movement to curtail public health powers successfully tapped into a populist rejection of pandemic measures following widespread anger and confusion over the government response to covid. Grass-roots-backed candidates ran for county commissions and local health boards on the platform of dismantling health departments’ authority. Republican legislators and attorneys general, religious liberty groups and the legal arms of libertarian think tanks filed lawsuits and wrote new laws modeled after legislation promoted by groups such as the American Legislative Exchange Council, a conservative, corporate-backed influence in statehouses across the country.

The Alabama legislature barred businesses from requiring proof of coronavirus vaccination. In Tennessee, officials cannot close churches during a state of emergency. Florida made it illegal for schools to require coronavirus vaccinations.

Cut short: One million covid deaths

The result, public health experts warn, is a battered patchwork system that makes it harder for leaders to protect the country from infectious diseases that cross red and blue state borders.

“One day we’re going to have a really bad global crisis and a pandemic far worse than covid, and we’ll look to the government to protect us, but it’ll have its hands behind its back and a blindfold on,” said Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law. “We’ll die with our rights on — we want liberty but we don’t want protection.”

Those seeking to dismantle public health powers say they’re fighting back against an intrusion on their rights by unelected bureaucrats who overstepped amid a national crisis.

“We don’t want to concentrate power in a single set of hands,” said Rick Esenberg, head of the Wisconsin Institute for Law & Liberty, a libertarian law firm that won a state Supreme Court case barring health officials from closing schools . “It’s a usurpation of the legislative role.”

Many conservatives said they did not believe the public health orders were effective in saving lives, despite evidence to the contrary . One study, for example, found that coronavirus vaccines prevented 3.2 million additional deaths in the United States.

Leaders in the public health establishment readily admit that many of their problems have been self-inflicted. Among the mistakes: an early failure by the Centers for Disease Control and Prevention to roll out a diagnostic test for covid; an about-face on whether people should wear masks to limit the spread of the virus; and confusing messages on when to exit isolation after an infection. The duration of school closures remains a source of recriminations .

“We deserve to have that backlash to some extent,” said Deborah Birx, the coordinator of the White House coronavirus task force under President Donald Trump, citing early CDC stumbles.

More than 1,000 legal decisions have been made at the local, state and federal level regarding public health protections since March 2020, according to research published in January in the American Journal of Public Health . While only a quarter succeeded in weakening public health powers, the rulings have substantially chipped away at the legal standing of health agencies and officials to protect the public, said Wendy Parmet, director of Northeastern University’s Center for Health Policy and Law, who co-wrote the paper. “The courts are leaving us vulnerable,” Parmet said.

The lawsuits found a conservative Supreme Court and federal judiciary transformed by Trump and ready to strip the federal government’s public health powers to issue mandates or other disease-control measures, said Jennifer Piatt, a deputy director with the Network for Public Health Law.

A single federal judge in Florida was able to defeat the CDC’s travel mask mandate. Republican attorneys general knocked out a federal vaccinate-or-test mandate issued by the Occupational Safety and Health Administration .

Three days in the deadliest month of the covid pandemic

These “big court wins” ensure that the next time there is a pandemic, the country will not be able to respond as it had in 2020 with government overreach, said Peter Bisbee, executive director of the Republican Attorneys General Association.

“People are going to push for more freedom in every aspect of their lives, but specifically when it comes to the ability to make decisions regarding health and medicine,” Bisbee said. “So many people lost faith with the government messaging on public health crises.”

The consequences are already playing out in Columbus, Ohio, where a child with measles was able to wander around a mall before showing symptoms in November, potentially spreading the highly contagious disease. The state legislature in 2021 had stripped the city health commissioner’s ability to order someone suspected of having an infectious disease to quarantine.

Columbus Health Commissioner Mysheika Roberts bemoans the basic public health functions she has lost control of — such as the ability to shut down a restaurant with a hepatitis A outbreak as she had done before covid. “ All the other workers exposed preparing food for others to eat — they could continue to go to work and shed hepatitis A” under the new legislation, she said.

In Wisconsin, the constant threat of lawsuits by the Wisconsin Institute for Law & Liberty has made officials wary of acting quickly to address any public health threat, said Kirsten Johnson, the former health commissioner of Milwaukee who is now the state’s health secretary.

Before the pandemic, Johnson said, she had threatened to shut down a prominent local golf tournament after E. coli was found in the well water, which forced the organizers to bring in bottled water. Now, she said, she’s afraid to issue such a threat, for fear of legal retribution.

“At the beginning of the pandemic, it didn’t even occur to me that public health authority was an issue,” Johnson said. “Fast forward a year later, I had great hesitation of what was appropriate.”

The next time a pandemic hits, many public health officials will be forced to go to state legislatures and to Congress to ask for explicit authorization to act — a delay that could cost lives, said Edward Fallone, a constitutional law expert at Marquette University Law School.

“Masking requirements, vaccine requirements, school closures are completely off the table without new legislation,” Fallone said.

The push to dismantle the nation’s public health system was ramping up in the summer of 2020 — months into a widespread shutdown of restaurants, workplaces and schools — when the Heritage Foundation , a conservative think tank, hosted a virtual forum on how state legislatures could curtail governors’ shutdown powers.

On tap were representatives from the American Legislative Exchange Council (ALEC) as well as a think tank and legal support group.

The message was clear: The government reaction to covid is a threat to individual liberties that must be stopped.

“You have to narrowly define the authorities of the governor and make it very clear to society and to the courts that certain things are to be protected, such as individual and constitutional liberties,” said Jonathon Hauenschild, who had worked on model legislation for ALEC, according to a video recording of the July 2020 forum.

The delta variant is ravaging this Missouri city. Many residents are still wary of vaccines.

Many states drew inspiration from the council’s model legislation.

In Missouri, John Wiemann, a former speaker pro tempore in the state House of Representatives, said he used the council’s model legislation when he co-sponsored a 2021 law that curtailed local public health leaders’ ability to extend emergency orders without approval from elected officials.

“It provided protections for the consumers and businesses with regards to public health agencies out of control, unchecked with any kind of supervision from elected officials,” he said.

Kelley Vollmar, health department director in Jefferson County, Mo., said the new law whittled her ability to fight covid and future infectious diseases. In addition, a circuit court ruling stripped health departments of their power to issue orders such as mandating masks and closing schools without the support of an elected health board or county commission. The state’s Republican attorney general refused to appeal the ruling on behalf of the Missouri health department.

Backlash against her attempts to issue a mask mandate was so severe that the mandate lasted just four months . The attorney who was supposed to defend her department quit. Community members chattered online about finding Vollmar’s address and chasing her out of the county.

Now, a gun store owner who gained local infamy for banning anyone from wearing masks in his store says he is campaigning for an elected spot on the health board so he can fire Vollmar and gut the department.

Ian McFarland vowed on Facebook to give the health department “hell” and used profane language to threaten workers with sexual assault in December 2021, according to a screenshot Vollmar shared with The Post. McFarland, in an October 2020 post she also shared, had suggested holding a Second Amendment rally at a coronavirus testing site where Vollmar’s staff would be working.

McFarland told The Post he was just joking around and was angry because he believes the health department acted beyond its authority and destroyed people’s lives and livelihoods.

“You can’t deny what they did was inappropriate and wrong if you are a normal person who looked at life and liberty in America,” said McFarland, a self-described constitutionalist who has vowed to turn away government money if he wins.

He cited the $2 million in additional revenue he said his gun store recorded as evidence his views are widely shared by the community, which he said came to support him after his mask ban.

Amid the county’s contentious race for health board, Vollmar said a quarter of her 81-person staff is on the verge of quitting. They change out of their uniform polos before leaving work because of the continued barrage of harassment and threats.

Vollmar said she is dismayed by the way the narrative of the pandemic has become distorted. The basic facts have been lost, she said; these public health measures were stopgaps to protect people’s lives before vaccines and treatment were available. A majority of Americans in 2021 said they supported mask mandates and social distancing in both red and blue states, according to a Monmouth University poll .

What haunts her most, Vollmar said, is the more than 600 lives that have been lost to covid in Jefferson County. That despite her best efforts, even she could not protect her own mother from contracting the disease that killed her in December 2020. That even if she keeps her job after the April health board election, Americans are now at greater risk — not only for covid, but for whatever comes next.

“The reality is public health has been silenced,” Vollmar said.

Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot . New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

New covid variant: The XBB.1.5 variant is a highly transmissible descendant of omicron that is now estimated to cause about half of new infections in the country. We answered some f requently asked questions about the bivalent booster shots .

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious . We’ve also created a guide to help you decide when to keep wearing face coverings .

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world . In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people . Nearly nine out of 10 covid deaths are people over the age 65 .

For the latest news, sign up for our free newsletter .

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Science takes back seat to politics in first House hearing on origin of COVID-19 pandemic

Familiar arguments aired in yet another republican and democratic sparring match.

Nicholas Wade, Jamie Metzl, Paul Auwaerter, and Robert Redfield testify before the House Select Subcommittee on the Coronavirus Pandemic

Some scientists and legislators might have hoped this morning’s U.S. congressional hearing on the origin of the COVID-19 pandemic would move beyond partisan politics and seriously investigate what has become a deeply divisive debate . But members of the House of Representatives’s Select Subcommittee on the Coronavirus Pandemic mostly hammered home long-standing Republican or Democratic talking points, shedding no new light on the central question: Did SARS-CoV-2 naturally jump from animals to humans or did the virus somehow leak from a laboratory in Wuhan, China?

“It was very disappointing, and almost unbelievably divorced from the science,” says University of Arizona evolutionary biologist Michael Worobey, whose published research in Science supporting a natural “zoonotic” origin of the virus has been attacked by proponents of the lab-leak scenario.

In his opening remarks of the first House hearing on the pandemic’s origin, subcommittee chair Brad Wenstrup (R–OH) charged that his Democratic colleagues had “failed to ask” where the virus came from in the 3 years of the pandemic when they were in the majority. Wenstrup and his Republican colleagues spent much of the next 2.5 hours questioning four witnesses about the likelihood that the virus came from the Wuhan Institute of Virology (WIV), which received some funding from the U.S. National Institute of Allergy and Infectious Diseases (NIAID) to study bat coronaviruses. They repeatedly suggested the possibility of a lab leak had been suppressed by high level U.S. government officials, including former NIAID head Anthony Fauci.

The ranking member, Raul Ruiz (D–CA), countered with criticism of the Republicans’ “slate of handpicked witnesses”—the three selected by the majority all favored the lab-leak scenario and neither Fauci nor Worobey were invited to the hearing. Ruiz complained that the “hearing marks a concerning step down the path of letting extremism get in the way of an inquiry that should be led by science and facts.”

Ruiz said he was particularly “alarmed” about one of the three witnesses selected by the Republicans, journalist Nicholas Wade, who previously covered science for The New York Times , Nature , and Science . Ruiz said Wade’s 2014 book, A Troublesome Inheritance: Genes, Race and Human History , had been “applauded by white supremacists,” and the congressman charged that his “participation hurts the credibility of this hearing.” Another Democrat on the hearing panel, Kweisi Mfume (D–MD), who is Black, said it “burns me” that the forum included “somebody with these sorts of beliefs.”

Wade, who has written extensively about what he sees as mainstream media’s failure to investigate COVID-19’s origin and has argued that scientists at WIV likely created SARS-CoV-2 by engineering a coronavirus in their collection, strongly objected to the bashing of his character and the book. “I am not a racist,” Wade said. “I don’t have anything in common with the views of white supremacists.”

When the hearing returned to COVID-19’s origin, it took a deep dive into some key scientific issues—all of which have received abundant attention in the past. One is the undisputed fact that SARS-CoV-2 includes what’s known as a furin cleavage site (FCS) in its surface protein, a feature that makes it easier for the virus to infect human cells. No severe acute respiratory syndrome (SARS)-related bat coronaviruses yet found has an FCS, and some scientists early in the pandemic raised the idea that the virus had been lab created.

Wade focused on a now-infamous 1 February 2020 teleconference in which Fauci listened to several of these concerned scientists discuss this possibility with coronavirus experts. Four of these scientists later published a paper in Nature Medicine that concluded “we do not believe that any type of laboratory-based scenario is plausible.”

Wade described their change of thinking, which released emails suggest happened by 4 February, as a “strange thing.” And without providing any evidence, he linked the shift to a $9 million grant that two of the co-authors of the Nature Medicine commentary soon received from NIAID. On 5 March, the subcommittee’s Republican majority released a memorandum that, based on newly disclosed emails, also alleged Fauci “prompted” the drafting of the Nature Medicine paper.

But many scientists have said SARS-CoV-2’s FCS could have evolved naturally. Researchers have found SARS-related coronaviruses that have mutations moving their surface proteins in this direction. They also note that members of the larger beta coronavirus genus, to which SARS-CoV-2 belongs, have these cleavage sites and have been found in bats.

Fauci also issued a statement on 6 March that said the Republican memorandum “contains false and misleading assertions” about his role in the contested commentary. “I did not ‘prompt’ the drafting of any publication that would ‘disprove’ the lab leak theory nor was I involved in drafting or editing any portion of the Nature Medicine paper,” he said.

Kristian Andersen, who co-authored the paper and was one of the recipients of the $9 million grant , notes that an independent peer-review panel scored the proposal in November 2019 and the NIAID council approved it in January 2020, which was before the teleconference took place.

Representative Debbie Dingell (D–MI) urged that her Republican colleagues not “smear” public health officials, “rehashing unfounded theories” that “Dr. Fauci and other health experts have blocked investigations into the pandemic’s origins.”

Hearing witness Robert Redfield, a virologist who directed the U.S. Centers for Disease Control and Prevention during former President Donald Trump’s administration, said he was chagrined that he had not been invited to that 1 February phone call. He claimed it was because of his position that the virus could have come from a Wuhan lab—although several members on that call expressed similar views at that time. “It was told to me that they wanted a single narrative,” said Redfield, who contended, “They squashed debate.”

Wade also said the Wuhan lab had in 2018 written in a grant proposal to a branch of the U.S. Department of Defense that it wanted to insert an FCS into bat coronaviruses, a charge repeated by members of the subcommittee. He said rather than a SARS-CoV-2 progenitor evolving this cleavage site, it was “easier to believe that the Wuhan researchers did exactly what they proposed and generated the SARS-2 virus in their lab.”

But the proposal he refers to, which was submitted by the nonprofit EcoHealth Alliance and included many collaborators, explicitly says those proposed experiments were meant to take place at the University of North Carolina (UNC), not WIV. “This section of the proposal was written by collaborators at UNC in the U.S., where the work would have been carried out,” says Peter Daszak, head of EcoHealth, which posted a lengthy critique of other claims made at the hearing. “Importantly the grant was not funded and the work not done.”

Wade did not reply to a request from Science asking whether he had evidence to support his claim that WIV, not a U.S. university, had proposed to do the insertion of the cleavage site.

Jamie Metzl, a lawyer and historian at the Atlantic Council think tank, was the third Republican witness favoring the lab-leak hypothesis. Metzl, who says he is a lifelong Democrat, stressed that “the Chinese government has done everything in its power to prevent the type of investigation into the origins of the COVID-19 pandemic that is 3 years overdue and urgently required.” Metzl, who has a large following on social media, urged the subcommittee not to make this “primarily about Dr. Fauci,” which he said would be “inappropriately serving the Chinese government a propaganda coup on a silver platter.”

The one witness invited by the panel’s Democrats, Paul Auwaerter, said he was speaking on behalf of the Infectious Diseases Society of America—he’s a past president—not his employer, the Johns Hopkins University School of Medicine. Auwaerter, who has not previously spoken publicly about the debate, said at the moment he thought the evidence pointed more strongly toward the zoonotic hypothesis “but that we need to attend to both.”

At the hearing’s end, Metzl wrote Science that “there was a lot of political grandstanding,” but said “it was positive to hear both parties agree a lab origin is a distinct possibility and that we need a comprehensive investigation into all relevant origin hypotheses.”

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Jon Cohen

Jon Cohen is a staff writer for Science .

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Nicholas Wade, Jamie Metzl, Paul Auwaerter, and Robert Redfield testify before the House Select Subcommittee on the Coronavirus Pandemic


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How the pandemic might play out in 2021 and beyond

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June 2021. The world has been in pandemic mode for a year and a half. The virus continues to spread at a slow burn; intermittent lockdowns are the new normal. An approved vaccine offers six months of protection, but international deal-making has slowed its distribution. An estimated 250 million people have been infected worldwide, and 1.75 million are dead.

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To end this pandemic, we must trust science

Researchers are struggling in fits and starts to understand the coronavirus, but that's how science works.

If a theme runs through the books and articles I’ve written over the past 40 years, it’s a fascination with what scientists have learned about the human body. A long career spent explaining biomedical research has led me to a deep respect for the scientific process. Despite its occasional missteps and self-corrections, I believe it ultimately moves us toward a clearer understanding of the world and how to thrive in it.

So as scientists first scrambled to figure out the never-before-seen coronavirus, I was primed to follow their advice about how to keep safe, based on the hypothesis that the virus was transmitted mostly by droplets from coughs and sneezes lingering on surfaces. I dutifully wiped down countertops, refrained from touching my face, and washed my hands so emphatically that the little diamond in my wedding ring shone like never before.

And then, about two and a half weeks after my city, New York, shut down restaurants, Broadway plays, and the largest public school system in the country, scientists switched to a different message—that everyone should wear a mask. This was a startling about-face. The initial advice, confidently delivered, had been not to wear a mask, unless you were a frontline health-care worker. The revision was largely based on a new hypothesis, that the coronavirus spread mostly through the air. ( See where coronavirus casese are growing and declining in the U.S. )

Which was it, then? Surface transmission or aerosols? Should we be more afraid of contaminated elevator buttons or people breathing near us? Did scientists even know?

The shift in advice about masks spooked me, I must admit. Not because of the new advice itself—I was more than happy to wear a mask if the experts said I should—but because of the ominous meta message I sensed beneath it: Scientists were figuring this thing out on the fly. The most earnest pronouncements from the world’s smartest experts suddenly sounded like little more than well-meant educated guesses.

As this devastating year draws to its raggedy close, it’s worth taking a moment to wonder what the long-term effect will be of watching scientists bob and weave on their way to a better understanding of the coronavirus and how to thwart the disease it causes, COVID-19—all out in public and all at breakneck speed. Even for a science geek like me, it has been unsettling to watch them debate, disagree, pivot, and reassess. I’ve been wishing instead that some lab-coated hero would just swoop in and make it go away. I was a baby in 1955 when Jonas Salk introduced his polio vaccine and vanquished a dread disease; ever after, my mother spoke his name with reverence. (1)

As scientists hustle to deliver us from a terrifying, seemingly intractable plague, there could be another happy ending—one that involves not just survival but also wisdom. If we learn any big takeaway from this doleful experience, I hope it’s not that our fellow human beings are myopic fools but that the scientific process can be trusted to get us through an existential crisis. ( Follow National Geographic's comprehensive coronavirus coverage. )

Make no mistake: The challenge is huge and unprecedented. If a typical virus is a riddle wrapped in a mystery inside an enigma, the coronavirus known as SARS-CoV-2 is all that and more. It combines contagiousness and lethality in a ferocious mixture that Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, has called his “worst nightmare.” For one thing, when it appeared, no one on Earth had immunity. Second, it’s airborne and infects the upper respiratory tract, which means it’s readily spewed back into the air where it can drift from person to person. Third, and arguably worst, the virus is most contagious before it causes symptoms, meaning that carriers feel well enough to be up and about precisely when they’re most likely to infect us. ( See what the coronavirus does to the body. )

The tricks this virus uses to foil the body’s counterattack are diabolically effective. Once it gets inside via the nose or mouth, the coronavirus eludes the first line of immune defense, slides easily into cells, churns out copies of itself by hijacking the cell’s machinery, and makes sure those copies work by using a proofreading mechanism that many other viruses don’t even have. Its effect is relentless: It can turn a person’s lung cells into useless material that looks like ground glass; blow open blood vessels or destroy them with microscopic clots; and gunk up the workings of a kidney, heart, or liver, rendering them too stiff to repair. It can defang the cells that attack invading viruses and then provoke a secondary immune reaction that goes badly haywire, paradoxically causing its own catastrophe. (2) And anyone who comes in close contact with a person already infected is likely—though no one is sure how likely—to get infected too.

Fauci’s worst nightmare? I could barely get to sleep.

As this pandemic threatens the entire world, the fight against it has been a very public one. The average citizen is getting insight into scientific theorizing that is normally confined to academic conferences and slow-moving journals. Much of the debate over these ideas is taking place on television, as well as on Twitter, on Facebook, and in the backyard gatherings of lawn chair epidemiologists. I find myself wondering if anyone engaged in this chatter understands how science actually works.

One way it doesn’t work is through the lone Jonas Salk–like hero that captivated me as a child. Science is a collaboration, with many heroes. We’re seeing that now, as thousands of researchers have reoriented their labs, no matter how far afield from virology or infectious disease, to attack this hydra-headed problem collectively. There has never been anything like it, with scientists collaborating across borders at full throttle—even as some of their political leaders snipe at one another.

Watching this ramped-up scientific effort has felt double-edged: encouraging to see but so hard to follow that it also added to my free-floating anxiety. So I did what I’ve done my whole adult life—called up some scientists to see what they think. This is a wonderful benefit to being a journalist, being allowed to ask dumb questions of smart people. Usually it helps me clarify my own thinking. This time … not so much.

Science on the frontier always exposes how little is known, even by the putative experts, so these phone calls made it clear to me how far we have to go. Still, it was nice to hear that a lot of scientists were looking for answers.

“It’s been amazing to see how people are using their talents and gifts to address this,” Gregg Gonsalves, co-director of the Global Health Justice Partnership at Yale University, told me. “People all want to do something,” even if their training is in law, geography, anthropology, fine arts, or similarly far-flung fields.

All that research focus has led to a remarkable amount of information in a remarkably short time. Within weeks of the first known animal-to-human transmission, scientists had sequenced the virus’s full genome. By summertime, more than 270 potential COVID-19 drugs were in active clinical trials in the United States. As for the quest for the holy grail, a vaccine, an international phalanx of researchers from the U.S., China, Great Britain, India, Germany, Spain, Canada, Thailand, and elsewhere had identified more than 165 candidates by early August. Progress was so rapid that even a hyper-realist like Fauci—who tends to emphasize how important it is to conduct large-scale clinical trials before introducing new drugs—has said he is “cautiously optimistic” that a vaccine could be available early next year. If he’s right—oh please, oh please, let him be right—that would be three years faster than the fastest vaccine development in history. (3)

Sometimes science simply cannot be rushed, though. “There is some sort of serendipity to the scientific enterprise,” Gonsalves told me. “The speed and scale of what is happening now could be just a prelude to the chance discoveries we’re going to have to make over a longer period.” Bottom line: “You can’t scream a cure out of a test tube.”

Next I called Howard Markel, director of the Center for the History of Medicine at the University of Michigan, to talk about another source of my anxiety: that the coronavirus seemed to shape-shift in a uniquely terrifying way. It felt like every day I opened the newspaper to read that a new organ system was subject to its ravages or a new age group was vulnerable. But Markel, who has made a career studying the history of epidemics, told me that was to be expected: The apparent explosion of new and varied symptoms happens with any highly contagious virus when it bursts on the scene.

“The more clinical material you have, the more patients, the more chances you have to see this protean nature,” he said. It’s what happened in the early days of the AIDS pandemic in the 1980s, when Markel was just starting his career. At the dawn of any new disease, strange manifestations keep showing up and surprising doctors. Even if the odds of a rare symptom are, say, just one in a thousand, doctors are going to see a lot of it, Markel said, because a thousand patients can accumulate practically overnight with a crazily contagious new illness like this one.

So the U-turns and revised pronouncements about COVID-19 aren’t signs that scientists are flummoxed; they’re signs that scientists are generating a torrent of new information and are trying to make sense of it as they go.

Last I called an old friend, Stephen Morse, a professor of epidemiology at the Columbia University Mailman School of Public Health. Morse was the subject of a book I wrote nearly 30 years ago about emerging viruses, in which he basically predicted our current catastrophe. (4) Today he feels a bit put off by the frenzy.

“This is not the way I would like to see science being done—it’s happening so quickly,” Morse told me. He strained to look for a bright side. “A lot of knowledge is becoming available,” he ventured. And if some of that supposed knowledge ends up being wrong, he said, seeming to strain even harder, couldn’t that be construed as a good thing? “Science is a self-corrective process. Maybe even the effort to correct the errors will lead to improved knowledge.” Maybe. But I didn’t feel better when we hung up.

Still troubling me were a couple of things. First, the politicization of the process could upend everything. Even if science closes in on a more accurate view of COVID-19 and how to treat and eventually prevent it, that might not be how the story is spun. Enough conflicting interests and alliances exist for the truth to be turned on its head without too much effort, making it seem as if scientists who amended their views based on new evidence were pretty much wrong from the start. (5)

Second, the science itself might suffer. If researchers take shortcuts for the sake of expediency or jump too far ahead of their data to offer advice, they might unwittingly tarnish the very process they depend on. Indeed, not long after I spoke to Morse, I read a report from a team of epidemiologists and biostatisticians from the Johns Hopkins Bloomberg School of Public Health that suggested a lot of the early research was too perfunctory to be of much use.

The scholars analyzed the first 201 COVID-19 clinical trials, which had been conducted in China, the U.S., and other countries. It seemed there had been a lot of corner cutting. One-third of the trials had no clear definition of treatment success; nearly one-half were so small (100 or fewer patients) they weren’t really informative; and two-thirds lacked the gold standard safeguard known as “blinding,” which keeps investigators from knowing which subjects are getting the treatment under study.

These less-than-ideal clinical trials were reported anyway, partly because leading scientific journals, such as the New England Journal of Medicine and those published by PLOS, had pledged to accelerate the peer review process, rushing coronavirus articles into print in half the usual time. Another avenue of publication involves preprint servers, which post articles online before they’re peer-reviewed. These servers, created to promote transparency in scientific research, predate the pandemic, but they exploded in popularity as coronavirus studies were churned out. Journalists, their readers ravenous for any updates, wrote articles about studies on these preprint servers no matter how small, no matter how tentative. (6)

As new findings, even weak or conditional ones, are publicized that contradict earlier findings, those of us trying to follow along can end up frustrated and confused. But while frustration and confusion among the science-minded might be unfortunate, it’s not deadly. What really worries me is that those skeptical of science might see the apparent flip-flops as reason to turn against evidence-based advice altogether.

The anti-science sentiment is out there, in the U.S. and elsewhere, and it’s pernicious, having led to doubt about expert consensus on climate change, gun control, vaccine safety, and other hot-button issues. We’re also seeing the emergence of COVID truthers, who insist the pandemic is either a conspiracy or a hoax. (Or maybe both? It’s hard to keep track.) They venomously slam public health officials, some of whom have quit after one too many death threats. It has been astonishing to watch videos of people screaming at store owners or city council members for requiring them to wear masks. ( New algorithms can detect whether people are complying with public health guidance. )

This is not just an American phenomenon. With coronavirus misinformation, disinformation, and conspiracy theories circulating around the globe, the World Health Organization has declared that we are facing two public health outbreaks at once: the pandemic itself and an “infodemic” of dangerously misguided ideas about it.

But you don’t need to be an unhinged COVID truther to be resistant to learning whatever lessons this pandemic can teach us; you just need to be an ordinary, shortsighted, fallible human.

“Every epidemic I’ve ever studied always ends with global amnesia,” Markel said. “We go back to our merry lives.” The “glaring problems” that contributed to the outbreak—urbanization, habitat destruction, international travel, climate change, war refugees—simply persist, he said, as people lose interest in demanding that more time, money, and brainpower be devoted to science. “Politicians move on to the next show, while policymakers cry out in the wilderness, ‘We still need this!’ ”

Already the 21st century has been what Markel calls the century of epidemics: SARS in 2003, H1N1 influenza (swine flu) in 2009, MERS in 2012, Ebola in 2014 to 2016, and now COVID-19 in 2019, 2020, and who knows how many years beyond. Five epidemics in 20 years, each one a little worse than the one before—and this one many times worse than the other four put together.

Maybe, in a weird way, watching scientists try to build a plane while they’re flying it—as some have described coronavirus research—will be good for our overall understanding of the scientific process. Maybe the pandemic will persuade even the skeptics how crucial scientific discovery is to human flourishing.

That’s the hope of Lin Andrews, director of teacher support at the National Center for Science Education. “People innately trust scientists overall, but when it’s a polarized topic, things can go wonky,” said Andrews, a former high school biology teacher. She and 10 colleagues, seeing the pandemic as a teachable moment, have devised a five-part lesson plan, good for classroom or home use depending on whether particular school districts are open. It focuses on epidemiology as a way to educate high school students—and, by extension, their parents—about what the scientific process entails.

The course shows how scientists construct their theories, Andrews said, by emphasizing “all these stumbles that were made along the way.” It includes milestones in epidemiology, such as when British scientist John Snow traced the London cholera outbreak of 1854 to contaminated drinking water. No one believed Snow—the prevailing theory was that cholera was spread through the air in a contagious “miasma”—until he had the handle removed from the water pump on Broad Street, shutting off the contaminated water supply and stopping the outbreak. (7)

Snow’s realization came years before the confirmation of germ theory, which explains the existence of pathogens. He didn’t understand how cholera was transmitted in the water, simply that patterns of disease indicated it was. Learning about the step-by-step progression of historical discoveries will, Andrews hopes, put in context the fits and starts of contemporary scientists’ attempts to understand COVID-19.

Maybe our unfiltered view will turn out to be a good thing. After all, the best way to build trust in science is by showing all of its hypothesis testing and hypothesis tweaking—maddening to watch while we’re anxiously awaiting answers to a global plague, but in the end the only way toward results that will allow us to move on with our lives.

Surveys show the general public is less dismayed by watching scientists in action than I had feared. Since 2015, the Pew Research Center has tracked what Americans think about science, and it has steadily become more positive, including in a poll conducted in April and May 2020 as the coronavirus was cresting and many of those surveyed were under lockdown.

In January 2019, the last survey before the pandemic, respondents were already inclined to trust scientists, with 86 percent saying they had a “great deal” or a “fair amount” of confidence that scientists had the public interest at heart. That level of trust inched up to 87 percent amid the pandemic.

But when I called Cary Funk, the director of science and society research at Pew, to talk about these encouraging results, she told me not to get ahead of myself, that the story is a bit more complicated. According to Funk, the surveys show a deep partisan divide in how much scientists are trusted. Republicans and Republican-leaning independents still seem reluctant to embrace science wholeheartedly. They are about half as likely as Democrats to express a “great deal” of trust in scientists—a proportion that has stayed stubbornly low at 27 percent. (8)

Pew’s surveys also reflect a deep racial divide in attitudes toward science. Black adults, according to the poll conducted earlier this year, are less likely than the general population to trust medical scientists. They are also less likely to have confidence in new COVID-19 treatments or vaccines; just 54 percent of Black respondents would “definitely” or “probably” get a COVID-19 vaccine, compared with 74 percent of whites and Hispanics. This distrust, exacerbated by the substandard care many Black patients get in doctor’s offices and emergency rooms, is especially troubling in the context of COVID-19, which kills Blacks at more than twice the rate at which it kills whites.

The racial and political divides in how science is viewed are especially insidious now, when skeptics could undermine whatever progress scientists make in the coronavirus fight. In the worst-case scenario, if enough doubters ignore control measures and vaccines, that could strip science of its ability to protect us altogether.

I'd like to believe Andrews is right about this being a teachable moment—maybe not so much for those of us already fixed in our views, but for those whose childhood is being shaped by the coronavirus. These children—whom some are calling Generation C—might grow up with less patience for the polarization fogging our responses today. Let’s say they spend their formative years watching the scientific process up close. And let’s say that in the end, scientists actually do save the day.

Now it’s the year 2040, and Gen C is all grown up. Suddenly a new pandemic emerges. Based on what they learned by living through COVID-19 at an impressionable age, these young adults recognize the urgency of the new outbreak, quickly dismissing any claims that it’s a hoax. They put on masks, maintain social distance, get vaccinated as soon as a vaccine is developed (and it’s developed quickly, because scientists have also learned a thing or two in the interim, as have politicians). They follow experts’ recommendations because they know it’s the best way to protect not only themselves but also their neighbors from a plague similar to the one they grew up with that killed hundreds of thousands of people around the world.

Gen C gets through the new pandemic with relatively few deaths or economic disruptions because they learned some crucial lessons when they were children: that public health advice is based on the best available data, that such advice can change as new evidence accumulates, that science is an iterative process that cannot be fast-tracked.

Maybe by then there also will be more workers in the professions that got us through the coronavirus catastrophe: more doctors, nurses, paramedics; more specialists in infectious disease, epidemiology, virology, and microbiology, each of them having chosen a career that as kids they had watched in its finest hour. It has happened before. Some of the scientists now engaged in the struggle against the coronavirus, such as Gonsalves and Markel, ended up where they did after working to help untangle AIDS, an earlier viral mystery that killed us in ways never seen before.

So the question is whether Gen C will respond with something other than “global amnesia” when the next plague arrives, as it almost surely will. This is what I yearn for, not just for the sake of my own bruised confidence but also for the sake of my two beloved granddaughters, who would have to live the reality I’m most fretting about.

Much depends on what happens in the coming months.

Imagine, for the sake of argument, that the epidemiological curves I’ve obsessed over all year ultimately play out in our favor, and we can return to some semblance of normal. Imagine that effective treatments are found that make COVID-19 short-term and curable for just about anyone. Imagine that a vaccine is developed soon and that a significant portion of the world population gets it. If all that happens, why wouldn’t we emerge from this with a greater appreciation of the scientific enterprise in all its messy brilliance?

I try to hold on to that hope, despite the catcalls of politicians and “personal choice” zealots who second-guess everything the scientists do. I try to tell myself that sometimes our better angels prevail. And that there’s an army’s worth of better angels—scientists, educators, doctors, nurses, public health advocates—who, since that eerie image of the spiky coronavirus started haunting our collective dreams, have been working tirelessly toward a happy ending.

That’s the ending I’m trying to believe in, where we emerge from this with a renewed appreciation of science as humanity’s best chance of salvation from suffering and untimely death.

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Chinese lab leak theory for coronavirus pandemic deserves further investigation, Congress hears

feature article about covid 19 pandemic

Though there's no "smoking gun," experts called by congressional Republicans  at the first national-level hearing into the origins of the coronavirus pandemic say the United States should continue investigating whether a Chinese lab accidentally released the virus that causes COVID-19.

Most international health experts have downplayed that possibility, instead preferring to focus on learning from the global response itself to the pandemic that has killed an estimated 7 million people worldwide. But a subcommittee formed after Republicans took control of the House of Representatives in January is examining theories that have been widely dismissed by the scientific community as racist conspiracies.

Where did COVID come from?

Determining the origins is politically sensitive because the investigations could further heighten U.S.-China tensions. Public health experts say international cooperation is key in fighting pandemics, and assigning blame could reduce future cooperation.

None of the witnesses called by the Republican-controlled House Select Subcommittee on the Coronavirus Pandemic provided new evidence proving their contention that the virus came from a lab but instead cited events, grant proposals and other incidents as too coincidental to ignore.

Last month, The Wall Street Journal reported that the U.S. Department of Energy, which oversees some high-security labs of its own, concluded with low confidence the virus came from a lab leak in Wuhan, China. FBI Director Christopher Wray echoed that, saying a lab leak was "most likely" the source. 

"This is not necessarily a smoking gun, but the growing body of circumstantial evidence suggests a gun that is, at very least, warm to the touch," testified Jamie F. Metzl, an international relations expert, commentator and senior fellow at the Atlantic Council.

House Republicans investigate COVID origins

Metzl joined virologist Dr. Robert Redfield, former director of the Centers for Disease Control and Prevention, and former New York Times science journalist Nicholas Wade, in pushing for further investigations into the possibility of a lab leak.

Redfield was an early proponent of the lab leak theory. He and others have called for a global moratorium on gain-of-function research, arguing it's too dangerous under current structures.

In gain-of-function research, scientists deliberately alter a virus to test the effectiveness of vaccines or other treatments. Redfield argued oversight of such research should not be limited to scientists, and the broader community should decide whether it's worth the risks.

The CDC and the labs it oversees have themselves violated containment procedures hundreds of times, as USA TODAY reporting has shown , including a 2014 incident in which smallpox vials were moved between labs in a cardboard box.

Redfield ran the CDC under President Donald Trump, who praised the Chinese government's pandemic response but also called the virus the "Kung flu," a label that many Asian American leaders accused of helping drive anti-Asian attacks nationally since the pandemic began.

Most experts say the pandemic probably started when an existing coronavirus naturally mutated and jumped from an animal to a human, possibly at a wildlife market in Wuhan. That's how other viruses, including MERS, SARS and Ebola, are believed to have started, in a process called zoonosis. But citing reports of respiratory illness among Wuhan researchers in fall 2019, the lab leak theory argues that scientists researching gain-of-function made the coronavirus more virulent and then accidentally released it.

Subcommittee chairman Rep. Brad Wenstrup, an Ohio Republican, noted that the two origin theories have sharply divided Americans and said he is committed to following the science. He also criticized Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, for pushing the health community to downplay the possibility of a lab leak.

Stopping the next global pandemic

Speaking at the request of the subcommittee's Democrats, Dr. Paul Auwaerter, of the  Infectious Diseases Society of America, echoed many of Fauci's previous statements during the hearing and stressed the importance of global cooperation. 

"We may never know conclusively where the COVID-19 pandemic originated. Making claims that cannot be supported sufficiently by available data fuels confusion and mistrust," he said. "But we can still learn valuable information from these investigations. And ultimately, we should use that information to prevent outbreaks and pandemics with environmental or human-based origins to avoid loss of life and severe societal disruption."

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Seven Charts That Explain the COVID-19 Pandemic in 2021

COVID-19 continued its worldwide spread in 2021, spurred by more contagious variants. Vaccines are highly effective, though have been unevenly distributed. Follow the pandemic’s story over the last year through graphics.

Article by Claire Klobucista and Will Merrow

December 9, 2021 1:10 pm (EST)

The rollout of safe and effective vaccines at the start of this year marked a turning point in a pandemic that wrought devastation for much of 2020. But 2021 still brought daunting challenges, including fears about omicron and other new variants, mounting death tolls and continued strain on health-care systems, and stark inequity in vaccine access across countries. Here are seven graphics that show what course the COVID-19 pandemic took over the past year and how the world responded.

Delta Brings Devastation

By midyear, one variant—given the name delta—had quickly become the dominant strain worldwide. The variant was first identified in India, where it sent the country spiraling into one of the world’s worst outbreaks of the pandemic. Evidence has shown delta to be more than two times as contagious as the original strain first discovered in Wuhan, China. Some data suggests that delta also causes more severe illness in unvaccinated individuals, though scientists are continuing to study how the strain behaves.

COVID-19 Becomes Leading Killer

People around the world grieved loved ones lost to COVID-19 as the disease became the fourth leading cause of death globally , writes Think Global Health, an initiative of CFR and the University of Washington. In the fall, the death toll surpassed five million people, including roughly 750,000 in the United States, the highest fatality figures in the world. Experts believe these numbers to be significant undercounts, and some estimate the global death toll to be twice as large. COVID-19 was the leading killer in most of Western Europe and Latin America, including in Brazil and Mexico, which rank in the top five for cumulative deaths from the disease. At the top of that list is the United States, where COVID-19 accounted for more than 11 percent of all deaths since the start of the pandemic.

Vaccines Put to the Test

More than half a dozen vaccines, mostly from China and the West, have been approved for broad use in different parts of the world. They’ve proven highly effective at protecting immunized individuals from hospitalization and death due to COVID-19, even with the spread of delta and other variants. So even amid new waves of infections, countries with relatively high proportions of vaccinated people—such as the Netherlands and the United Kingdom—have not experienced the spikes in COVID-19 deaths seen in those with low vaccination levels. Evidence also shows that these widely used vaccines can reduce the risk of infection, though scientists are still working to determine how long that protection lasts.

Rich Nations Slow to Follow Through on Donations

2021 in Review

Public Health Threats and Pandemics

Pharmaceuticals and Vaccines

Only after wealthy nations made considerable progress immunizing their populations in the first half of the year did promises of donations to poorer countries start to ramp up. As of November 2021, countries had committed to donating a combined 2.74 billion doses , around 70 percent of which was promised by the United States and China. (Some countries, particularly in Europe, have opted to donate funding to the global COVAX initiative rather than doses.) But countries have been sluggish to follow through on their promises, Think Global Health finds: less than half of pledged doses had been delivered by the end of November. The United States has focused its efforts on parts of Asia and Latin America, while China has donated primarily to countries participating in its Belt and Road Initiative .

Global Vaccination Divide Grows

A graphic showing the vaccinated and unvaccinated populations of countries by income group.

By November, half of the world had received at least one vaccine dose. Yet, a wide gap emerged between the vaccination rates of higher-income countries and lower-income ones, exacerbated by the slow pace of donations. Across all low-income nations at that time, just 4 percent of people were at least partially vaccinated. However, some have bucked the trend, such as Cambodia, where more than three-quarters of residents have been immunized.

The Debate Over Boosters

The world this week, a weekly digest of the latest from cfr on the biggest foreign policy stories of the week, featuring briefs, opinions, and explainers. every friday., daily news brief, a summary of global news developments with cfr analysis delivered to your inbox each morning.  most weekdays., think global health.

A curation of original analyses, data visualizations, and commentaries, examining the debates and efforts to improve health worldwide.  Weekly.

The global vaccination divide has driven intense debate about when and how to administer booster shots for COVID-19. As scientists continue to study how long different vaccines provide protection, some health officials and leaders around the globe have argued that the large number of unvaccinated individuals should be prioritized for doses before vaccinated people get boosters. By year’s end, some countries, including the United States, China, and members of the European Union, were already administering boosters despite the calls to prioritize the unvaccinated. A global rollout of boosters could mean another monumental supply challenge , Think Global Health shows: boosters just for immunocompromised people will require an additional 150 million doses; widening the criteria to anyone over the age of sixty increases that number to over one billion.

Fears About New Variants Persist

As the year neared to a close, fresh fears arose about the potential for new strains to take hold, including the omicron variant, which was first reported by South Africa in November. Scientists flagged omicron due to its high number of mutations, which could affect factors such as how easily it spreads and the severity of illness it causes, though researchers are in the early stages of studying its behavior. Its emergence led dozens of countries to reinstate restrictions on foreign travel, largely from southern Africa, and prompted calls to ramp up global vaccinations. A highly infectious variant carries significant risk for unvaccinated or partially vaccinated communities, as it can increase hospitalizations and overall strain on health-care facilities. In this way, a more infectious strain could lead to a higher death toll than a more lethal one would.

Melissa Manno contributed to this article.

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Covid-19: The history of pandemics

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The novel coronavirus pandemic, known as Covid-19, could not have been more predictable. From my own reporting, I knew this first-hand. In October 2019, I attended a simulation involving a fictional pandemic , caused by a novel coronavirus, that killed 65 million people, and in the spring of 2017 I wrote a feature story for TIME magazine on the subject. The magazine cover read: “Warning: the world is not ready for another pandemic”.

There was little special about my insight. Over the past 15 years, there has been no shortage of articles and white papers issuing dire warnings that a global pandemic involving a new respiratory disease was only a matter of time. On BBC Future in 2018, we reported that experts believed a flu pandemic was only a matter of time and that there could be millions of undiscovered viruses in the world , with one expert telling us, “I think the chances that the next pandemic will be caused by a novel virus are quite good.” In 2019, US President Donald Trump’s Department of Health and Human Services carried out a pandemic exercise named “Crimson Contagion”, which imagined a flu pandemic starting in China and spreading around the world . The simulation predicted that 586,000 people would die in the US alone. If the most pessimistic estimates about Covid-19 come true, the far better named “Crimson Contagion” will seem like a day in the park.

As of 26 March, there were more than 470,000 confirmed cases of Covid-19 around the world and more than 20,000 deaths, touching every continent save Antarctica. This was a pandemic, in reality, well before the World Health Organization finally declared it one on 11 March. And we should have seen it coming.

Covid-19 has touched every continent but Antarctica – and we should have seen it coming (Credit: Getty Images)

Covid-19 has touched every continent but Antarctica – and we should have seen it coming (Credit: Getty Images)

Covid-19 marks the return of a very old – and familiar – enemy. Throughout history, nothing has killed more human beings than the viruses, bacteria and parasites that cause disease. Not natural disasters like earthquakes or volcanoes. Not war – not even close.

Mass killers

Take the mosquito-borne disease malaria. It has stalked humanity for thousands of years, and while death tolls have dropped significantly over the past 20 years, it still snuffs out nearly half a million people every year.

Over the millennia, epidemics, in particular, have been mass killers on a scale we can’t begin to imagine today – even in the time of the coronavirus.

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The plague of Justinian struck in the 6th Century and killed as many as 50 million people, perhaps half the global population at the time. The Black Death of the 14th Century – likely caused by the same pathogen – may have killed up to 200 million people. Smallpox may have killed as many as 300 million people in the 20th Century alone, even though an effective vaccine – the world’s first – had been available since 1796.

Some 50 to 100 million people died in the 1918 influenza pandemic – numbers that surpass the death toll of World War One, which was being fought at the same time. The 1918 flu virus infected one in every three people on the planet. (Read more about how the 1918 flu changed the world ). HIV, a pandemic that is still with us and still lacks a vaccine, has killed an estimated 32 million people and infected 75 million, with more added every day.

The 1918 influenza epidemic killed some 50 to 100 million people around the world, including here in St Louis, Missouri (Credit: Getty Images)

The 1918 influenza epidemic killed some 50 to 100 million people around the world, including here in St Louis, Missouri (Credit: Getty Images)

If these numbers shock, it’s because today epidemics are rarely discussed in history classes, while in the not so distant past, they were simply a terrible fact of life. There are few memorials to the victims of disease. The historian Alfred Crosby was the author of America’s Forgotten Pandemic, one of the great books on the 1918 flu. But Crosby was only prompted to begin researching the pandemic when he stumbled on the forgotten fact that American life expectancy had suddenly dropped from 51 years in 1917 to 39 years in 1918, before rebounding the following year. That plummet in 1918 was because of a virus just 120 nanometers wide. 

Viral advantage

Pathogens make such effective mass killers because they are self-replicating. This sets them apart from other major threats to humanity. Each bullet that kills in a war must be fired and must find its target. Most natural disasters are constrained by area: an earthquake that strikes in China can’t directly hurt you in the UK.

But when a virus – like the novel coronavirus – infects a host, that host becomes a cellular factory to manufacture more viruses. Bacteria, meanwhile, are capable of replicating on their own in the right environment.

The symptoms created by an infectious pathogen – such as sneezing, coughing or bleeding – put it in a position to spread to the next host, and the next, a contagiousness captured in the replication number, or “R0” of a pathogen, or how many susceptible people one sick person can infect. (Imperial College London has estimated the novel coronavirus’s R0 at 1.5 to 3.5 .) And because human beings move around – interacting with other human beings as they do so in every manner from a handshake to sexual intercourse – they move the microbes with them. (Read more about what makes viruses so difficult to outsmart ).

No wonder militaries have long tried to harness disease as a tool of war. No wonder that, until recently, far more soldiers died of disease than died in combat . A pathogen is a perfectly economical weapon, turning its victims into its delivery system.

Madrid is installing a hospital for Covid-19 with 5,500 beds and an intensive care unit (Credit: Getty Images)

Madrid is installing a hospital for Covid-19 with 5,500 beds and an intensive care unit (Credit: Getty Images)

The constant threat of disease, as much as any other factor, kept the reins on human development and expansion. At the dawn of the 19th Century, global life expectancy was just 29 years – not because human beings couldn’t live to much older ages even then, but because so many of us died in infancy from disease, or from infection during childbirth or after a wound. (Read more about whether our life spans are really longer than that of our ancestors ).

The cities of the pre-modern era were only able to keep up their populations through a continual infusion of migrants to make up for citizens who died off from disease. The development first of sanitation, and then of countermeasures like vaccines and antibiotics, changed all that.

“The defeat of infection overcame these barriers and allowed us to have these great global cities,” says Charles Kenny, a senior fellow at the Center for Global Development, a think tank in Washington DC, and the author of the forthcoming book Winning the War on Death: Humanity, Infection and the Fight for the Modern World.

It was a victory that won us the modern world as we know it.

A better era

It can be difficult to comprehend how quickly that war was seemingly won. My great-grandparents could have fallen victim to the 1918 flu. My grandparents lived their infancy and youth before penicillin was developed. My parents were born before the polio vaccine was invented in 1954. Yet by 1962, the Nobel Prize-winning virologist Sir Frank Macfarlane Burnet could note that “to write about infectious disease is almost to write of something that has passed into history”.

In the developed world, we are now far more likely to die from non-communicable diseases like cancer, heart disease or Alzheimer’s than from a contagion

In the developed world, and increasingly in the developing world, we are now far more likely to die from non-communicable diseases like cancer, heart disease or Alzheimer’s than from a contagion. The decline of infectious disease is the best evidence that life on this planet truly is getting better.

The polio vaccine, shown here studied by scientists in the 1950s, eliminated, in most of the world, a disease in that used to kill or disable millions (Credit: Getty Images)

The polio vaccine, shown here studied by scientists in the 1950s, eliminated, in most of the world, a disease in that used to kill or disable millions (Credit: Getty Images)

While reporting my book End Times, I visited the epidemiologist Marc Lipsitch at his office at the Harvard T.H. Chan School of Public Health in Boston one rainy morning in the spring of 2018. Lipsitch is one of the most influential epidemiologists in the United States, and one who takes seriously the possibility that disease pandemics might constitute a true global catastrophic risk – which is why I was there to see him.

But that morning Lipsitch showed me something I wasn’t expecting: a chart that graphed infectious disease mortality in the United States over the course of the 20th Century.

What it shows is a drastic decline, from around 800 deaths from infectious disease per 100,000 people in 1900 to about 60 deaths per 100,000 by the last years of the century. There was a brief spike in 1918 – that would be the flu – and a slight and temporary upturn during the worst of the AIDS epidemic in the 1980s. But, Lipsitch told me, “death rates from infectious disease dropped by nearly 1% a year, about 0.8 % per year, all the way through the century.”

Not over yet

That’s the good news. The bad news, as Covid-19 reminds us, is that infectious diseases haven’t vanished. In fact, there are more new ones now than ever: the number of new infectious diseases like Sars, HIV and Covid-19 has increased by nearly fourfold over the past century. Since 1980 alone, the number of outbreaks per year has more than tripled.

The number of new infectious diseases like Sars, HIV and Covid-19 has increased by nearly fourfold over the past century

There are several reasons for this uptick. For one, over the past 50 years, we’ve more than doubled the number of people on the planet. This means more human beings to get infected and in turn to infect others, especially in densely populated cities. We also have more livestock now than we did over the last 10,000 years of domestication up to 1960 combined, and viruses can leap from those animals to us.

We’ve more than doubled our population in the last 50 years, meaning more human beings with the potential to get infected and to infect others (Credit: Getty Images)

We’ve more than doubled our population in the last 50 years, meaning more human beings with the potential to get infected and to infect others (Credit: Getty Images)

As Covid-19 is painfully demonstrating, our interconnected global economy both helps spread new infectious diseases – and, with its long supply chains, is uniquely vulnerable to the disruption that they can cause. The ability to get to nearly any spot in the world in 20 hours or fewer, and pack a virus along with our carry-on luggage, allows new diseases to emerge and to grow when they might have died out in the past.

For all the advances we’ve made against infectious disease, our very growth has made us more vulnerable, not less, to microbes that evolve 40 million times faster than humans do.

Antibiotics have saved hundreds of millions of lives since the serendipitous discovery of penicillin in 1928, but bacterial resistance to these drugs is growing by the year, a development doctors believe is one of the greatest threats to global public health . In fact, 33,000 people die each year from antibiotic resistant infections in Europe alone, according to a 2018 study . The “antibiotic apocalypse”, as England’s former chief medical officer, Sally Davies, called it , puts us in danger of returning to a time when even run-of-the-mill infections could kill.

Back in 2013, a World Bank estimate of how much the 1918 flu could cost our now much richer and more connected global economy put the figure at more than $4 trillion, nearly the entire GDP of Japan. Early estimates of the economic damage from Covid-19 have already crossed the trillion-dollar mark .

Economic damage from Covid-19 may already have crossed the trillion-dollar mark (Credit: Getty Images)

Economic damage from Covid-19 may already have crossed the trillion-dollar mark (Credit: Getty Images)

The World Health Organization, which performed so well under the stress of Sars, has botched more recent outbreaks so badly that experts have called for the entire organisation to be overhauled. Climate change is expanding the range of disease-carrying animals and insects like the Aedes aegyptimosquitoes that transmit the Zika virus.

Even human psychology is at fault. The spread of vaccine scepticism has been accompanied by the resurrection of long-conquered diseases like measles , leading the WHO in 2019 to name the antivaccination movement one of the world’s top 10 public-health threats.

The spread of vaccine scepticism means the world is taking a step backwards in the fight against preventable infectious diseases (Credit: Getty Images)

The spread of vaccine scepticism means the world is taking a step backwards in the fight against preventable infectious diseases (Credit: Getty Images)

Covid-19 is very much a disease of the moment, emerging in a crowded city in a newly prosperous and connected China before spreading to the rest of the world in a matter of months. But our response to it has been both hyper-modern – and practically medieval. Scientists around the world are using cutting-edge tools to rapidly sequence the genome of the coronavirus, pass along information about its virulence, and collaborate on possible countermeasures and vaccines, all far quicker than could have been done before.

But when the virus arrived among us, our only effective response was to shut down society and turn off the assembly line of global capitalism. Minus the text alerts, the videoconferencing and the Netflix, what we were doing wasn’t that different from what our ancestors might have tried to halt an outbreak of the plague. The result has been chemotherapy for the global economy.

Just as the eventual emergence of something like Covid-19 was easily predictable, so too are the actions we should have taken to shore ourselves against its coming.

We need to strengthen the antennae of global health, to ensure that when the next virus emerges — which it will — we’ll catch it faster, perhaps even snuff it out. The budget of the WHO, the agency ostensibly charged with safeguarding the health of the world’s 7.8 billion citizens, is somehow no more than that of a large urban hospital in the U.S.

We need to double down on the development of vaccines, which will include assuring large pharma companies that their investments won’t be wasted should an outbreak end before one is ready.

Medical staff cheer themselves up before going into an ICU ward for Covid-19 patients in Wuhan, China (Credit: Getty Images)

Medical staff cheer themselves up before going into an ICU ward for Covid-19 patients in Wuhan, China (Credit: Getty Images)

We need to build more slack into our public health systems. Just as the US military is designed — and funded — to fight a war on two fronts, so our health care systems should have the surge capacity to meet the next pandemic.

One ongoing challenge in pandemic preparation is what experts call shock and forgetting. Too often politicians make funding promises in the immediate aftermath of a crisis like Sars or Ebola, only to let those pledges lapse as the memory of the outbreak fades.

Somehow, I expect that won’t be the case with Covid-19. We need to do all we can to not just survive this pandemic, but to ensure it remains a throwback from the past, not a sign of things to come.

* Bryan Walsh is the Future Correspondent for Axios and the author of End Times: A Brief Guide to the End of the World , from which this story was adapted and updated. End Times is published by Hachette Books.

As an award-winning science site, BBC Future is committed to bringing you evidence-based analysis and myth-busting stories around the new coronavirus. You can read more of our Covid-19 coverage here .

Join one million Future fans by liking us on Facebook , or follow us on Twitter or Instagram .

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What has the pandemic revealed about the US health care system — and what needs to change?

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With vaccinations for Covid-19 now underway across the nation, MIT SHASS Communications asked seven MIT scholars engaged in health and health care research to share their views on what the pandemic has revealed about the U.S. health care system — and what needs to change. Representing the fields of medicine, anthropology, political science, health economics, science writing, and medical humanities, these researchers articulate a range of opportunities for U.S. health care to become more equitable, more effective and coherent, and more prepared for the next pandemic.

Dwaipayan Banerjee , associate professor of science, technology, and society

On the heels of Ebola, Covid-19 put to rest a persistent, false binary between diseases of the rich and diseases of the poor. For several decades, health care policymakers have labored under the impression of a great epidemiological transition. This theory holds that the developed world has reached a stage in its history that it no longer needs to worry about communicable diseases. These "diseases of the poor" are only supposed to exist in distant places with weak governments and struggling economies. Not here in the United States.

On the surface, Covid-19 made clear that diseases do not respect national boundaries. More subtly, it tested the hypothesis that the global north no longer need concern itself with communicable disease. And in so doing, it undermined our assumptions about global north health-care infrastructures as paradigmatically more evolved. Over the last decades, the United States has been focused on developing increasingly sophisticated drugs. While this effort has ushered in several technological breakthroughs, a preoccupation with magic-bullet cures has distracted from public health fundamentals. The spread of the virus revealed shortages in basic equipment and hospitals beds, the disproportionate effects of disease on the marginalized, the challenge of prevention rather than cure, the limits of insurance-based models to provide equitable care, and our unacknowledged dependence on the labor of underpaid health care workers.

To put it plainly, the pandemic did not create a crisis in U.S. health care. For many in the United States, crisis was already a precondition of care, delivered in emergency rooms and negotiated through denied insurance claims. As we begin to imagine a "new normal," we must ask questions about the old. The pandemic made clear that the "normal" had been a privilege only for a few well-insured citizens. In its wake, can we imagine a health-care system that properly compensates labor and recognizes health care as a right, rather than a privilege only available to the marginalized when an endemic crisis is magnified by a pandemic emergency? 

Andrea Campbell , professor of political science

No doubt, the pandemic reveals the dire need to invest in public-health infrastructure to better monitor and address public-health threats in the future, and to expand insurance coverage and health care access. To my mind, however, the pandemic’s greatest significance is in revealing the racism woven into American social and economic policy.

Public policies helped create geographic and occupational segregation to begin with; inadequate racist and classist public policies do a poor job of mitigating their effects. Structural racism manifests at the individual level, with people of color suffering worse housing and exposure to toxins, less access to education and jobs, greater financial instability, poorer physical and mental health, and higher infant mortality and shorter lifespans than their white counterparts. Residential segregation means many white Americans do not see these harms.

Structural racism also materializes at the societal level, a colossal waste of human capital that undercuts the nation’s economic growth, as social and economic policy expert Heather McGhee shows in her illuminating book, "The Sum of Us." These society-wide costs are hidden as well; it is difficult to comprehend the counterfactual of what growth would look like if all Americans could prosper. My hope is that the pandemic renders this structural inequality visible. There is little point in improving medical or public-health systems if we fail to address the structural drivers of poor health. We must seize the opportunity to improve housing, nutrition, and schools; to enforce regulations on workplace safety, redlining, and environmental hazards; and to implement paid sick leave and paid family leave, among other changes. It has been too easy for healthy, financially stable, often white Americans to think the vulnerable are residual. The pandemic has revealed that they are in fact central. It’s time to invest for a more equitable future.

Jonathan Gruber , Ford Professor of Economics

The Covid-19 pandemic is the single most important health event of the past 100 years, and as such has enormous implications for our health care system. Most significantly, it highlights the importance of universal, non-discriminatory health insurance coverage in the United States. The primary source of health insurance for Americans is their job, and with unemployment reaching its highest level since the Great Depression, tens of millions of workers lost, at least temporarily, their insurance coverage.

Moreover, even once the economy recovers, millions of Americans will have a new preexisting condition, Covid-19. That’s why it is critical to build on the initial successes of the Affordable Care Act to continue to move toward a safety net that provides insurance options for all without discrimination.

The pandemic has also illustrated the power of remote health care. The vast majority of patients in the United States have had their first experience with telehealth during the pandemic and found it surprisingly satisfactory. More use of telehealth can lead to increased efficiency of health care delivery as well as allowing our system to reach underserved areas more effectively.

The pandemic also showed us the value of government sponsorship of innovation in the health sciences. The speed with which the vaccines were developed is breathtaking. But it would not have been possible without decades of National Institute of Health investments such as the Human Genome Project, nor without the large incentives put in place by Operation Warp Speed. Even in peacetime, the government has a critical role to play in promoting health care innovation

The single most important change that we need to make to be prepared for the next pandemic is to recognize that proper preparation is, by definition, overpreparation. Unless we are prepared for the next pandemic that doesn’t happen, we won’t possibly be ready for the next pandemic that does.

This means working now, while the memory is fresh, to set up permanent, mandatorily funded institutions to do global disease surveillance, extensive testing of any at-risk populations when new diseases are detected, and a permanent government effort to finance underdeveloped vaccines and therapeutics.

Jeffrey Harris , professor emeritus of economics and a practicing physician The pandemic has revealed the American health care system to be a non-system. In a genuine system, health care providers would coordinate their services. Yet when Elmhurst Hospital in Queens was overrun with patients, some 3,500 beds remained available in other New York hospitals. In a genuine system, everyone would have a stable source of care at a health maintenance organization (HMO). While our country has struggled to distribute the Covid-19 vaccine efficiently and equitably, Israel, which has just such an HMO-based system, has broken world records for vaccination.

Germany, which has all along had a robust public health care system, was accepting sick patients from Italy, Spain, and France. Meanwhile, U.S. hospitals were in financial shock and fee-for-service-based physician practices were devastated. We need to move toward a genuine health care system that can withstand shocks like the Covid-19 pandemic. There are already models out there to imitate. We need to strengthen our worldwide pandemic and global health crisis alert systems. Despite concerns about China’s early attempts to suppress the bad news about Covid-19, the world was lucky that Chinese investigators posted the full genome of SARS-CoV-2 in January 2020 — the singular event that triggered the search for a vaccine. With the recurrent threat of yet another pandemic — after H1N1, SARS, MERS, Ebola, and now SARS-Cov-2 — along with the anticipated health consequences of global climate change, we can’t simply cross our fingers and hope to get lucky again.

Erica Caple James , associate professor of medical anthropology and urban studies The coronavirus pandemic has revealed some of the limits of the American medical and health care system and demonstrated many of the social determinants of health. Neither the risks of infection nor the probability of suffering severe illness are equal across populations. Each depends on socioeconomic factors such as type of employment, mode of transportation, housing status, environmental vulnerability, and capacity to prevent spatial exposure, as well as “preexisting” health conditions like diabetes, obesity, and chronic respiratory illness.

Such conditions are often determined by race, ethnicity, gender, and “biology,” but also poverty, cultural and linguistic facility, health literacy, and legal status. In terms of mapping the prevalence of infection, it can be difficult to trace contacts among persons who are regular users of medical infrastructure. However, it can be extraordinarily difficult to do so among persons who lack or fear such visibility, especially when a lack of trust can color patient-clinician relationships.

One’s treatment within medical and health care systems may also reflect other health disparities — such as when clinicians discount patient symptom reports because of sociocultural, racial, or gender stereotypes, or when technologies are calibrated to the norm of one segment of the population and fail to account for the severity of disease in others.

The pandemic has also revealed the biopolitics and even the “necropolitics” of care — when policymakers who are aware that disease and death fall disproportionately in marginal populations make public-health decisions that deepen the risks of exposure of these more vulnerable groups. The question becomes, “Whose lives are deemed disposable?” Similarly, which populations — and which regions of the world — are prioritized for treatment and protective technologies like vaccines and to what degree are such decisions politicized or even racialized?

Although no single change will address all of these disparities in health status and access to treatment, municipal, state, and federal policies aimed at improving the American health infrastructure — and especially those that expand the availability and distribution of medical resources to underserved populations — could greatly improve health for all.

Seth Mnookin , professor of science writing

The Covid-19 pandemic adds yet another depressing data point to how the legacy and reality of racism and white supremacy in America is lethal to historically marginalized groups. A number of recent studies have shown that Black, Hispanic, Asian, and Native Americans have a significantly higher risk of infection, hospitalization, and death compared to white Americans.

The reasons are not hard to identify: Minority populations are less likely to have access to healthy food options, clean air and water, high-quality housing, and consistent health care. As a result, they’re more likely to have conditions that have been linked to worse outcomes in Covid patients, including diabetes, hypertension, and obesity.

Marginalized groups are also more likely to be socioeconomically disadvantaged — which means they’re more likely to work in service and manufacturing industries that put them in close contact with others, use public transportation, rely on overcrowded schools and day cares, and live in closer proximity to other households. Even now, more vaccines are going to wealthier people who have the time and technology required to navigate the time-consuming vaccine signup process and fewer to communities with the highest infection rates.

This illustrates why addressing inequalities in Americans’ health requires addressing inequalities that infect every part of society. Moving forward, our health care systems should take a much more active role in advocating for racial and socioeconomic justice — not only because it is the right thing to do, but because it is one of the most effective ways to improve health outcomes for the country as a whole.

On a global level, the pandemic has illustrated that preparedness and economic resources are no match for lies and misinformation. The United States, Brazil, and Mexico have, by almost any metric, handled the pandemic worse than virtually every other country in the world. The main commonality is that all three were led by presidents who actively downplayed the virus and fought against lifesaving public health measures. Without a global commitment to supporting accurate, scientifically based information, there is no amount of planning and preparation that can outflank the spread of lies.

Parag Pathak , Class of 1922 Professor of Economics   The pandemic has revealed the strengths and weaknesses of America’s health care systems in an extreme way. The development and approval of three vaccines in roughly one year after the start of the pandemic is a phenomenal achievement. At the same time, there are many innovations for which there have been clear fumbles, including the deployment of rapid tests and contact tracing.   The other aspect the pandemic has made apparent is the extreme inequality in America’s health systems. Disadvantaged communities have borne the brunt of Covid-19 both in terms of health outcomes and also economically. I’m hopeful that the pandemic will spur renewed focus on protecting the most vulnerable members of society. A pandemic is a textbook situation in economics of externalities, where an individual’s decision has external effects on others. In such situations, there can be major gains to coordination. In the United States, the initial response was poorly coordinated across states. I think the same criticism applies globally. We have not paid enough attention to population health on a global scale. One lesson I take from the relative success of the response of East Asian countries is that centralized and coordinated health systems are more equipped to manage population health, especially during a pandemic. We’re already seeing the need for international cooperation with vaccine supply and monitoring of new variants. It will be imperative that we continue to invest in developing the global infrastructure to facilitate greater cooperation for the next pandemic.

Prepared by MIT SHASS Communications Editor and designer: Emily Hiestand Consulting editor: Kathryn O'Neill

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Workers at the Inhauma cemetery in Rio de Janeiro, Brazil, carry the coffin containing the remains of 89-year-old Irodina Pinto Ribeiro on Friday, June 18, 2021. Brazil has now marked 500,000 deaths from Covid-19 -- the second-highest death toll in the world.

In pictures: The coronavirus pandemic

Here’s a look at the coronavirus outbreak, declared a pandemic by the World Health Organization. The coronavirus, called Covid-19 by WHO, originated in China and is the cousin of the SARS virus.

Coronaviruses are a large group of viruses that are common among animals. The viruses can make people sick, usually with a mild to moderate upper respiratory tract illness, similar to a common cold. Coronavirus symptoms include a runny nose, cough, sore throat, possibly a headache and maybe a fever, which can last for a couple of days.

Case Tracking

WHO Situation Reports

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CNN’s early reporting on the coronavirus

December 31, 2019 - Cases of pneumonia detected in Wuhan , China, are first reported to WHO. During this reported period, the virus is unknown. The cases occur between December 12 and December 29, according to Wuhan Municipal Health.

January 1, 2020 - Chinese health authorities close the Huanan Seafood Wholesale Market after it is discovered that wild animals sold there may be the source of the virus.

January 5, 2020 - China announces that the unknown pneumonia cases in Wuhan are not SARS or MERS . In a statement , the Wuhan Municipal Health Commission says a retrospective probe into the outbreak has been initiated.

January 7, 2020 - Chinese authorities confirm that they have identified the virus as a novel coronavirus, initially named 2019-nCoV by WHO.

January 11, 2020 - The Wuhan Municipal Health Commission announces the first death caused by the coronavirus. A 61-year-old man, exposed to the virus at the seafood market, died on January 9 after respiratory failure caused by severe pneumonia.

January 17, 2020 - Chinese health officials confirm that a second person has died in China. The United States responds to the outbreak by implementing screenings for symptoms at airports in San Francisco, New York and Los Angeles.

January 20, 2020 - China reports 139 new cases of the sickness, including a third death. On the same day, WHO’s first situation report confirms cases in Japan, South Korea and Thailand.

January 20, 2020 - The National Institutes of Health announces that it is working on a vaccine against the coronavirus. “The NIH is in the process of taking the first steps towards the development of a vaccine,” says Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases.

January 21, 2020 - Officials in Washington state confirm the first case on US soil.

January 23, 2020 - At an emergency committee, WHO says that the coronavirus does not yet constitute a public health emergency of international concern.

January 23, 2020 - The Beijing Culture and Tourism Bureau cancels all large-scale Lunar New Year celebrations in an effort to contain the growing spread of coronavirus. On the same day, Chinese authorities enforce a partial lockdown of transport in and out of Wuhan. Authorities in the nearby cities of Huanggang and Ezhou Huanggang announce a series of similar measures.

January 28, 2020 - Chinese President Xi Jinping meets with WHO Director General Tedros Adhanom in Beijing. At the meeting, Xi and WHO agree to send a team of international experts, including US Centers for Disease Control and Prevention staff, to China to investigate the coronavirus outbreak.

January 29, 2020 - The White House announces the formation of a new task force that will help monitor and contain the spread of the virus, and ensure Americans have accurate and up-to-date health and travel information, it says.

January 30, 2020 - The United States reports its first confirmed case of person-to-person transmission of the coronavirus. On the same day, WHO determines that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC).

January 31, 2020 - The Donald Trump administration announces it will deny entry to foreign nationals who have traveled in China in the last 14 days.

February 2, 2020 - A man in the Philippines dies from the coronavirus – the first time a death has been reported outside mainland China since the outbreak began.

February 3, 2020 - China’s Foreign Ministry accuses the US government of inappropriately reacting to the outbreak and spreading fear by enforcing travel restrictions.

February 4, 2020 - The Japanese Health Ministry announces that ten people aboard the Diamond Princess cruise ship moored in Yokohama Bay are confirmed to have the coronavirus. The ship, which is carrying more than 3,700 people, is placed under quarantine scheduled to end on February 19.

February 6, 2020 - First Covid-19 death in the United States: A person in California’s Santa Clara County dies of coronavirus, but the link is not confirmed until April 21 .

February 7, 2020 - Li Wenliang, a Wuhan doctor who was targeted by police for trying to sound the alarm on a “SARS-like” virus in December, dies of the coronavirus. Following news of Li’s death, the topics “Wuhan government owes Dr. Li Wenliang an apology,” and “We want freedom of speech,” trend on China’s Twitter-like platform, Weibo, before disappearing from the heavily censored platform.

February 8, 2020 - The US Embassy in Beijing confirms that a 60-year-old US national died in Wuhan on February 6, marking the first confirmed death of a foreigner.

February 10, 2020 - Xi inspects efforts to contain the coronavirus in Beijing, the first time he has appeared on the front lines of the fight against the outbreak. On the same day, a team of international experts from WHO arrive in China to assist with containing the coronavirus outbreak.

February 10, 2020 - The Anthem of the Seas, a Royal Caribbean cruise ship, sets sail from Bayonne, New Jersey, after a coronavirus scare had kept it docked and its passengers waiting for days.

February 11, 2020 - WHO names the coronavirus Covid-19.

February 13, 2020 - China’s state-run Xinhua News Agency announces that Shanghai mayor Ying Yong will be replacing Jiang Chaoliang amid the outbreak. Wuhan Communist Party chief Ma Guoqiang has also been replaced by Wang Zhonglin, party chief of Jinan city in Shandong province, according to Xinhua.

February 14, 2020 - A Chinese tourist who tested positive for the virus dies in France, becoming the first person to die in the outbreak in Europe. On the same day, Egypt announces its first case of coronavirus, marking the first case in Africa.

February 15, 2020 - The official Communist Party journal Qiushi publishes the transcript of a speech made on February 3 by Xi in which he “issued requirements for the prevention and control of the new coronavirus” on January 7, revealing Xi knew about and was directing the response to the virus on almost two weeks before he commented on it publicly.

February 17, 2020 - A second person in California’s Santa Clara County dies of coronavirus, but the link is not confirmed until April 21.

February 18, 2020 - Xi says in a phone call with British Prime Minister Boris Johnson that China’s measures to prevent and control the epidemic “are achieving visible progress,” according to state news Xinhua.

February 21, 2020 - The CDC changes criteria for counting confirmed cases of novel coronavirus in the United States and begins tracking two separate and distinct groups: those repatriated by the US Department of State and those identified by the US public health network.

February 25, 2020 - The NIH announces that a clinical trial to evaluate the safety and effectiveness of the antiviral drug remdesivir in adults diagnosed with coronavirus has started at the University of Nebraska Medical Center in Omaha. The first participant is an American who was evacuated from the Diamond Princess cruise ship docked in Japan.

February 25, 2020 - In an effort to contain the largest outbreak in Europe, Italy’s Lombardy region press office issues a list of towns and villages that are in complete lockdown. Around 100,000 people are affected by the travel restrictions.

February 26, 2020 - CDC officials say that a California patient being treated for novel coronavirus is the first US case of unknown origin. The patient, who didn’t have any relevant travel history nor exposure to another known patient, is the first possible US case of “community spread.”

February 26, 2020 - Trump places Vice President Mike Pence in charge of the US government response to the novel coronavirus, amid growing criticism of the White House’s handling of the outbreak.

February 29, 2020 - A patient dies of coronavirus in Washington state. For almost two months, this is considered the first death due to the virus in the United States, until autopsy results announced April 21 reveal two earlier deaths in California.

March 3, 2020 - The Federal Reserve slashes interest rates by half a percentage point in an attempt to give the US economy a jolt in the face of concerns about the coronavirus outbreak. It is the first unscheduled, emergency rate cut since 2008, and it also marks the biggest one-time cut since then.

March 3, 2020 - Officials announce that Iran will temporarily release 54,000 people from prisons and deploy hundreds of thousands of health workers as officials announced a slew of measures to contain the world’s deadliest coronavirus outbreak outside China. It is also announced that 23 members of Iran’s parliament tested positive for the virus.

March 4, 2020 - The CDC formally removes earlier restrictions that limited coronavirus testing of the general public to people in the hospital, unless they had close contact with confirmed coronavirus cases. According to the CDC, clinicians should now “use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.”

March 8, 2020 - Italian Prime Minister Giuseppe Conte signs a decree placing travel restrictions on the entire Lombardy region and 14 other provinces, restricting the movements of more than 10 million people in the northern part of the country.

March 9, 2020 - Conte announces that the whole country of Italy is on lockdown.

March 11, 2020 - WHO declares the novel coronavirus outbreak to be a pandemic. WHO says the outbreak is the first pandemic caused by a coronavirus. In an Oval Office address, Trump announces that he is restricting travel from Europe to the United States for 30 days in an attempt to slow the spread of coronavirus. The ban, which applies to the 26 countries in the Schengen Area, applies only to foreign nationals and not American citizens and permanent residents who’d be screened before entering the country.

March 13, 2020 - Trump declares a national emergency to free up $50 billion in federal resources to combat coronavirus.

March 18, 2020 - Trump signs into law a coronavirus relief package that includes provisions for free testing for Covid-19 and paid emergency leave.

March 19, 2020 - At a news conference, officials from China’s National Health Commission report no new locally transmitted coronavirus cases for the first time since the pandemic began.

March 23, 2020 - United Nations Secretary-General António Guterres calls for an immediate global ceasefire amid the pandemic to fight “the common enemy.”

March 24, 2020 - Japan’s Prime Minister Shinzo Abe and International Olympic Committee (IOC) president Thomas Bach agree to postpone the Olympics until 2021 amid the outbreak.

March 25, 2020 - The White House and Senate leaders reach an agreement on a $2 trillion stimulus deal to offset the economic damage of coronavirus, producing one of the most expensive and far-reaching measures in the history of Congress.

March 27, 2020 - Trump signs the stimulus package into law.

April 2, 2020 - According to the Department of Labor , 6.6 million US workers file for their first week of unemployment benefits in the week ending March 28, the highest number of initial claims in history. Globally, the total number of coronavirus cases surpasses 1 million , according to Johns Hopkins University’s tally .

April 3, 2020 - Trump says his administration is now recommending Americans wear “non-medical cloth” face coverings , a reversal of previous guidance that suggested masks were unnecessary for people who weren’t sick.

April 8, 2020 - China reopens Wuhan after a 76-day lockdown.

April 14, 2020 - Trump announces he is halting funding to WHO while a review is conducted , saying the review will cover WHO’s “role in severely mismanaging and covering up the spread of coronavirus.”

April 20, 2020 - Chilean health officials announce that Chile will begin issuing the world’s first digital immunity cards to people who have recovered from coronavirus, saying the cards will help identify individuals who no longer pose a health risk to others.

April 21, 2020 - California’s Santa Clara County announces autopsy results that show two Californians died of novel coronavirus in early and mid-February – up to three weeks before the previously known first US death from the virus .

April 28, 2020 - The United States passes one million confirmed cases of the virus, according to Johns Hopkins.

May 1, 2020 - The US Food and Drug Administration issues an emergency-use authorization for remdesivir in hospitalized patients with severe Covid-19 . FDA Commissioner Stephen Hahn says remdesivir is the first authorized therapy drug for Covid-19.

May 4, 2020 - During a virtual pledging conference co-hosted by the European Union , world leaders pledge a total of $8 billion for the development and deployment of diagnostics, treatments and vaccines against the novel coronavirus.

May 11, 2020 - Trump and his administration announce that the federal government is sending $11 billion to states to expand coronavirus testing capabilities . The relief package signed on April 24 includes $25 billion for testing, with $11 billion for states, localities, territories and tribes.

May 13, 2020 - Dr. Mike Ryan, executive director of WHO’s health emergencies program, warns that the coronavirus may never go away and may just join the mix of viruses that kill people around the world every year .

May 19, 2020 - WHO agrees to hold an inquiry into the global response to the coronavirus pandemic. WHO member states adopt the proposal with no objections during the World Health Assembly meeting , after the European Union and Australia led calls for an investigation.

May 23, 2020 - China reports no new symptomatic coronavirus cases , the first time since the beginning of the outbreak in December.

May 27, 2020 - Data collected by Johns Hopkins University reports that the coronavirus has killed more than 100,000 people across the US , meaning that an average of almost 900 Americans died each day since the first known coronavirus-related death was reported nearly four months earlier.

June 2, 2020 - Wuhan’s Health Commission announces that it has completed coronavirus tests on 9.9 million of its residents with no new confirmed cases found .

June 8, 2020 - New Zealand Prime Minister Jacinda Ardern announces that almost all coronavirus restrictions in New Zealand will be lifted after the country reported no active cases .

June 11, 2020 - The United States passes 2 million confirmed cases of the virus , according to Johns Hopkins.

June 16, 2020 - University of Oxford scientists leading the Recovery Trial, a large UK-based trial investigating potential Covid-19 treatments, announce that a low-dose regimen of dexamethasone for 10 days was found to reduce the risk of death by a third among hospitalized patients requiring ventilation in the trial .

June 20, 2020 - The NIH announces that it has halted a clinical trial evaluating the safety and effectiveness of drug hydroxychloroquine as a treatment for the coronavirus . “A data and safety monitoring board met late Friday and determined that while there was no harm, the study drug was very unlikely to be beneficial to hospitalized patients with Covid-19,” the NIH says in a statement.

June 26, 2020 - During a virtual media briefing, WHO announces that it plans to deliver about 2 billion doses of a coronavirus vaccine to people across the globe . One billion of those doses will be purchased for low- and middle-income countries, according to WHO.

July 1, 2020 - The European Union announces it will allow travelers from 14 countries outside the bloc to visit EU countries , months after it shut its external borders in response to the pandemic. The list does not include the US, which doesn’t meet the criteria set by the EU for it to be considered a “safe country.”

July 6, 2020 - In an open letter published in the journal Clinical Infectious Diseases, 239 scientists from around the world urge WHO and other health agencies to be more forthright in explaining the potential airborne transmission of coronavirus . In the letter, scientists write that studies “have demonstrated beyond any reasonable doubt that viruses are released during exhalation, talking, and coughing in microdroplets small enough to remain aloft in air and pose a risk of exposure at distances beyond 1 to 2 meters (yards) from an infected individual.”

July 7, 2020 - The Trump administration notifies Congress and the United Nations that the United States is formally withdrawing from WHO . The withdrawal goes into effect on July 6, 2021.

July 7, 2020 - Brazil’s president Jair Bolsonaro announces he has tested positive for Covid-19 , following months of downplaying the virus.

July 21, 2020 - European leaders agree to create a €750 billion ($858 billion) recovery fund to rebuild EU economies ravaged by the coronavirus .

July 27, 2020 - A vaccine being developed by the Vaccine Research Center at the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, in partnership with the biotechnology company Moderna, enters Phase 3 testing. The trial is expected to enroll about 30,000 adult volunteers and evaluates the safety of the vaccine and whether it can prevent symptomatic Covid-19 after two doses , among other outcomes.

August 11, 2020 - In a live teleconference, Russian President Vladimir Putin announces that Russia has approved a coronavirus vaccine for public use before completion of Phase 3 trials , which usually precedes approval. The vaccine, which is named Sputnik-V, is developed by the Moscow-based Gamaleya Institute with funding from the Russian Direct Investment Fund (RDIF).

August 15, 2020 - Russia begins production on Sputnik-V , according to Russian state news agency TASS.

August 23, 2020 - The FDA issues an emergency use authorization for the use of convalescent plasma to treat Covid-19 . It is made using the blood of people who have recovered from coronavirus infections.

August 27, 2020 - The CDC notifies public health officials around the United States to prepare to distribute a potential coronavirus vaccine as soon as late October . In the documents, posted by The New York Times, the CDC provides planning scenarios to help states prepare and advises on who should get vaccinated first – healthcare professionals, essential workers, national security “populations” and long-term care facility residents and staff.

September 4, 2020 - The first peer-reviewed results of Phase 1 and Phase 2 clinical trials of Russia’s Covid-19 vaccine are published in the medical journal The Lancet . The results “have a good safety profile” and the vaccine induced antibody responses in all participants, The Lancet says.

October 2, 2020 - Trump announces that he and first lady Melania Trump have tested positive for Covid-19 . He spends three nights at Walter Reed National Military Medical Center receiving treatment before returning to the White House.

October 12, 2020 - Drugmaker Johnson & Johnson announces it has paused the advanced clinical trial of its experimental coronavirus vaccine because of an unexplained illness in one of the volunteers.”Following our guidelines, the participant’s illness is being reviewed and evaluated by the ENSEMBLE independent Data Safety Monitoring Board (DSMB) as well as our internal clinical and safety physicians,” the company said in a statement . ENSEMBLE is the name of the study. The trial resumes later in the month.

December 10, 2020 - Vaccine advisers to the FDA vote to recommend the agency grant emergency use authorization to Pfizer and BioNTech’s coronavirus vaccine.

December 14, 2020 - US officials announce the first doses of the FDA authorized Pfizer vaccine have been delivered to all 50 states, the District of Columbia and Puerto Rico.

December 18, 2020 - The FDA authorizes a second coronavirus vaccine made by Moderna for emergency use. “The emergency use authorization allows the vaccine to be distributed in the U.S. for use in individuals 18 years and older,” the FDA said in a tweet .

January 14, 2021 - The WHO team tasked with investigating the origins of the outbreak in Wuhan arrive in China.

January 20, 2021 - Newly elected US President Joe Biden halts the United States’ withdrawal from WHO .

February 22, 2021 - The death toll from Covid-19 exceeds 500,000 in the United States.

February 27, 2021 - The FDA grants emergency use authorization to Johnson & Johnson’s Covid-19 vaccine , the first single dose Covid-19 vaccine available in the US.

March 30, 2021 - According to a 120-page report from WHO, the novel coronavirus that causes Covid-19 probably spread to people through an animal , and probably started spreading among humans no more than a month or two before it was noticed in December of 2019. The report says a scenario where it spread via an intermediate animal host, possibly a wild animal captured and then raised on a farm, is “very likely.”

April 17, 2021 - The global tally of deaths from Covid-19 surpasses 3 million , according to data compiled by Johns Hopkins.

August 3, 2021 - According to figures published by the CDC, the more contagious Delta variant accounts for an estimated 93.4% of coronavirus circulating in the United States during the last two weeks of July . The figures show a rapid increase over the past two months, up from around 3% in the two weeks ending May 22.

August 12, 2021 - The FDA authorizes an additional Covid-19 vaccine dose for certain immunocompromised people.

August 23, 2021 - The FDA grants full approval to the Pfizer/BioNTech Covid-19 vaccine for people age 16 and older , making it the first coronavirus vaccine approved by the FDA.

September 24, 2021 - CDC Director Dr. Rochelle Walensky diverges from the agency’s independent vaccine advisers to recommend boosters for a broader group of people – those ages 18 to 64 who are at increased risk of Covid-19 because of their workplaces or institutional settings – in addition to older adults, long-term care facility residents and some people with underlying health conditions.

November 2, 2021 - Walensky says she is endorsing a recommendation to vaccinate children ages 5-11 against Covid-19, clearing the way for immediate vaccination of the youngest age group yet in the US .

November 19, 2021 - The FDA authorizes boosters of the Pfizer/BioNTech and Moderna Covid-19 vaccines for all adults. The same day, the CDC also endorses boosters for all adults .

December 16, 2021 - The CDC changes its recommendations for Covid-19 vaccines to make clear that shots made by Moderna and Pfizer/BioNTech are preferred over Johnson & Johnson’s vaccine .

December 22, 2021 - The FDA authorizes Pfizer’s antiviral pill, Paxlovid, to treat Covid-19, the first antiviral Covid-19 pill authorized in the United States for ill people to take at home, before they get sick enough to be hospitalized. The following day, the FDA authorizes Merck’s antiviral pill, molnupiravir.

December 27, 2021 - The CDC shortens the recommended times that people should isolate when they’ve tested positive for Covid-19 from 10 days to five days if they don’t have symptoms – and if they wear a mask around others for at least five more days. The CDC also shortens the recommended time for people to quarantine if they are exposed to the virus to a similar five days if they are vaccinated.

January 31, 2022 - The FDA grants full approval to Moderna’s Covid-19 vaccine for those ages 18 and older. This is the second coronavirus vaccine given full approval by the FDA.

March 29, 2022 - The FDA authorizes a second booster of the Pfizer/BioNTech and Moderna Covid-19 vaccines for adults 50 and older. That same day, the CDC also endorses a second booster for the same age group.

April 25, 2022 - The FDA expands approval of the drug remdesivir to treat patients as young as 28 days and weighing about seven pounds.

May 17, 2022 - The FDA authorizes a booster dose of Pfizer/BioNTech’s Covid-19 vaccine for children ages 5 to 11 at least five months after completion of the primary vaccine series. On May 19, the CDC also endorses a booster dose for the same age group .

June 18, 2022 - The CDC recommends Covid-19 vaccines for children as young as 6 months .

August 31, 2022 - The FDA authorizes updated Covid-19 vaccine booster shots from Moderna and Pfizer. Both are bivalent vaccines that combine the companies’ original vaccine with one that targets the BA.4 and BA.5 Omicron sublineages. The CDC signs off on the updated booster shots the following day .

Public health in Asia during the COVID-19 pandemic: global health governance, migrant labour, and international health crises

Sharon Tan, Swee Kheng Khor, Public health in Asia during the COVID-19 pandemic: global health governance, migrant labour, and international health crises, International Affairs , Volume 99, Issue 2, March 2023, Pages 863–865,

Any book on the topic of ‘public health in Asia during the COVID–19 pandemic’ must tick three boxes. It must be ambitious in scope; discuss the political, sociological and economic aspects of public health (not just the science of public health) at the national level; and examine Asia's role in global health governance. This book does indeed tick all three. In addition, it has some strong highlights. The edited volume brings together 15 chapters, which are arranged into four themes: health policies in Asia; Asia's role in global health governance; national-level responses of Asian countries; and the impact of the COVID–19 pandemic on migrants’ health in Asia. The contributors include scholars of Asia area studies, International Relations (IR), economics, political science and public policy. The three editors are specialists in IR, global health and the politics of modern China.

For context, the reviewers are specialists in health systems, public health and global health. We welcome other disciplines analysing health questions, especially as they shed light on social determinants and political economy dimensions, using IR theory to resolve global health commons problems, such as pandemics. These perspectives from other disciplines are especially welcome given the paucity of literature on the impact of the COVID–19 pandemic in Asia, from regional and interdisciplinary approaches. Therefore, we commend the book's three main strengths. First, there is a strong initial focus on the political and international relations in the context of past pandemics, such as the SARS outbreak in 2003 and the development of the International Health Regulations legal instrument in 2005. This focus is helpful because public health teaching tends to focus more on questions of epidemiology, science and the clinical impact of pandemics. Consequently, public health knowledge often downplays the international political, social and economic drivers and impacts. Second, the book demonstrates in-depth knowledge about the current governance structures, especially when applying the lenses of political science, IR and political economy to the study of pandemics. This is testament to the skills of the contributors and editors. Third and last, this book has an entire section on migrant health, which remains under-researched and under-discussed despite its importance to equity, justice and general public health common sense.

The Royal Institute of International Affairs members

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Did COVID-19 policies cause an increase in school violence?

Katie Smith

The side of a school bus with cordon tape that reads “CRIME SCENE DO NOT CROSS”.

( NewsNation ) — Recent acts of violence in classrooms are raising questions about safety and whether the pandemic might be contributing to student misconduct.

Earlier this month, a student was fatally stabbed  inside a classroom at a Northern California high school. Not long before that in Florida, a 17-year-old student with special needs attacked a school employee . Both incidents happened on the heels of an investigation in Virginia where officials say a  6-year-old boy shot and wounded his first-grade teacher .

A recent survey from the Institute of Education Sciences found that more than eight in 10 public schools have seen stunted behavioral and socioemotional development in their students relative to pre-pandemic levels.

Research into the pandemic’s effects on student behavior is far from complete, however.

“We’re not really able to capture whether COVID has a direct impact on school violence,” said Sarah Stilwell, a postdoctoral researcher at the National Center for School Safety. “We did, however, notice that there was an uptick in violent events after the pandemic … what we do need to do as researchers and as community in general is get a better sense of what is going on.”

How bad is the issue?

The majority of behavioral issues reported were minor — things like tardiness and classroom disruptions — according to a May 2022 survey from the Institute of Education Science (IES).

“When we talk about violence, it’s really important that we are making these distinctions because the way these trends are changing are really different,” Stilwell said.

Incidents like homicide and suicide seem to be stabilizing, or even decreasing, over time, Stilwell added, whereas “incidents of mass shootings or targeted violence seem to be increasing over time.”

Most schools across all regions said COVID-19 especially increased threats of physical attacks or fights between students, according to the IES survey. The teachers surveyed overwhelmingly agreed levels of bullying remained about the same as they were pre-pandemic while verbal abuse and general disrespect directed toward teachers increased.

“I do think the pandemic had a meaningful impact on kids’ behavior,” said Maurice J. Elias, a psychology professor and the director of the Social-Emotional and Character Development Lab at Rutgers University. “I don’t know that it’s just the lockdown aspect of it. I do think that many many kids experienced significant trauma because of COVID itself.”

Parents reported changes in their kids’ behavior as well, with 48% reporting the first year of the pandemic negatively impacted their children’s emotional well-being, according to a Pew Research Center survey from last fall.

Is COVID-19 to blame?

Teachers reported big changes because of the pandemic and an overwhelming majority agreed COVID-19 negatively impacted students’ behavioral and socioemotional development.

More than half of teachers believed increases in disruptive student misconduct were influenced by the pandemic.

But those studying behavioral changes say it’s too early to say definitively COVID-19 was the problem.

“We’re not really able to make any strong conclusions about the impact between COVID and these violent occurrences,” Stilwell said. “So what we know is that we don’t really know.”

The thick of the COVID-19 pandemic was so recent that research hasn’t caught up yet, and what does exist can’t tell the whole story. Still, researchers have identified some possible links between the pandemic and student behavior.

“Maybe they were feeling a little bit of a loss in the sense of community and a little bit of confusion around how to interact with peers or have a supportive figure in their life in that capacity,” Stilwell said.

The issue isn’t one-size-fits-all. Student and staff experiences with COVID-19, the lockdowns that took place and people who got sick were personal and possibly traumatic, Elias said.

On top of that, there may have been unrealistic expectations placed on schools to make up for significant learning losses in a short period of time, he added.

Children might not have the tools to articulate what they’re feeling while navigating trauma and added stress, sometimes causing them to act out.

“The violence that we’re seeing in schools is largely because the kids engaging in violence don’t know how to manage their strong emotions,” Elias said.

What needs to happen?

Making sure schools are supportive and compassionate spaces is the best chance for improved behavior, Elias said.

“Until kids walk into schools for 180 days a year that are supportive and understanding and not pressure cookers, we’re going to see continued problems,” Elias said.

That kind of social-emotional learning might vary by school, depending on the local community’s needs and resources, Stilwell said.

“It’s not just about paper and pencil and scoring well on particular tasks,” she said. “But really emotionally investing in the students beyond just the overall day-to-day, but their well-being and emotional safety in general.”

Children want to feel like they’re doing something meaningful, Elias added, emphasizing the importance of inspiring young people and not just correcting inappropriate behavior.

“We find that when we give kids the opportunity to be helpful to others, it is a very powerful source of mental health,” Elias said. “We keep figuring out treatment, but equal to that, we should be thinking about opportunity.”

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Anthony Fauci hid the truth about COVID, until now

Dr. anthony fauci went into overdrive to change the narrative around covid's origins. now he's been exposed by testimony at a house hearing.

Gregg Jarrett

Former NYT editor blasts Fauci for mishandling COVID origin theories

Former New York Times science editor Nicholas Wade told the House Select Subcommittee on the Coronavirus Pandemic on Wednesday that Dr. Anthony Fauci 'seriously' mishandled determining the origins of COVID-19.

Dr. Anthony Fauci had every reason to cover up the truth.  

Documents show he played a vital role in funneling through a third party roughly $600,000 in taxpayer money to the Wuhan laboratory in China where the deadly COVID virus may well have leaked. The funds were earmarked for dangerous gain-of-function research that can transform a virus into a lethal "superbug." 

On Wednesday, Dr. Robert Redfield, an experienced virologist who served as the director of the Centers for Disease Control and Prevention, testified at a hearing on Capitol Hill that "it is not scientifically plausible" that the virus somehow originated in animals or bats and then spread to humans.   

Fauci knew this because Redfield and four other knowledgeable experts told him so. But Fauci — an immunologist, not a virologist — feared that his suspected complicity in engineering the virus would be revealed. He was determined to suppress the lab leak evidence and, instead, peddle the natural origin theory to the public. He "wanted a single narrative," said Redfield. That "inaccurate" narrative appears to be an effort to absolve himself in the deadliest man-made catastrophe in history.     


Some 6.87 million people worldwide were killed as 760 million became infected. More than a million Americans have died. Did Fauci play a role in causing those deaths? His cover-up suggests he thought so.       

COVID-19 origin hearing witness slams China for continuing to 'stonewall'

Fauci was warned by fellow scientists at the outset of the pandemic in late January and early February of 2020 that the COVID-19 contagion contained unusual features that "(potentially) look engineered inside a laboratory," according to emails. Alarmed, Fauci kicked his deception into overdrive with a deliberate misinformation scheme.  


He covertly commissioned and edited a scientific paper that was published three weeks later that debunked the lab leak hypothesis. Then, while concealing how he instigated the analysis, Fauci publicly touted it as the definitive scientific verdict on COVID’s genesis.  

All the while, he hid his involvement and pretended not to know the co-authors with whom he had secretly worked. Citing the paper, Fauci emphatically told Americans that COVID "could not have been artificially or deliberately manipulated."      


The scientists who published the hasty study had previously confided to Fauci that the virus likely came from a lab but reversed themselves in a matter of three days. Dr. Redfield called that about-face "antithetical to science" and accused Fauci of "an attempt to misguide and redirect debate." 

It is curious that those same scientists became the beneficiaries of millions of dollars in funding from the National Institutes of Health (NIH) under Fauci after their reversal. 

But that’s not all. Recently revealed records show that Fauci colluded with social media platforms to suppress posts that raised the validity of the lab leak theory and discredit anyone who dared to question his contrived narrative.  

House to vote on declassifying COVID origin information

Two years ago,  I penned a column  for Fox News Opinion stating that Fauci should be criminally investigated into whether he lied to Congress when he flatly denied that his agency helped fund the Wuhan research.  

"The NIH has not ever and does not now fund gain-of-function research in the Wuhan Institute," he told a disbelieving Sen. Rand Paul, R-Ky.  Afterward, Sen. Paul declared that Fauci had lied. The documented evidence supports that conclusion. In his testimony Wednesday, Dr. Redfield said, "There is no doubt the NIH funded gain-of-function research" at the Chinese lab. 

In the past, Fauci described it as "reverse genetics," which he energetically endorsed despite its known hazards. He never understood the grave consequences of a leak that could kill millions of innocent people. Or perhaps he didn’t care.  

The NIH money sent to the Wuhan lab was specifically designated for "reverse genetics," according to the written grant. This is compelling evidence that Fauci was not truthful when he testified that the NIH did not fund gain-of-function research.     

Liberal late-night hosts dismissed COVID lab-leak theory, defended China

Intentionally lying while under oath to Congress about a material matter constitutes the felony of perjury (18 USC 1621). The giving of knowingly false and misleading statements during testimony (18 USC 1001) is an equivalent crime regardless of whether the person is under oath. Both offenses result in the same punishment of up to five years behind bars upon conviction.  


As I have argued before, there is more than sufficient evidence to justify an investigation by the Department of Justice as to whether Fauci gave deliberately deceptive or false testimony when he appeared before a Senate committee. 

As the evidence against him mounts, the chronicles of Dr. Anthony Fauci demand a sober reassessment. The man who was lionized as "America’s doctor" is not the saintly figure that he and a sycophantic media have long portrayed.   


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Opinions of Thursday, 9 March 2023

Columnist: JoyceWarren

The impact of COVID-19 on digital textile printing industry

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The COVID-19 pandemic

The COVID-19 pandemic has proved to be a serious social and economic crisis and led to a dramatic loss of human life worldwide. It presents an unprecedented challenge to all work of life. According to S&P Global Market Intelligence, the five industries most affected by COVID-19 over the period January 2, 2020, to January 15, 2022, included Airlines, Automobiles, Energy Equipment & Services, Hotels, Restaurants & Leisure, and Specialty Retail. Undoubtedly these sectors experienced the greatest disruption. However, some industries have undergone accelerated transformation due to the COVID-19 crisis, like digital textile printing. It is gaining more traction for its distinct features, compared to conventional textile printing. Here we will dig into the impact of COVID-19 on digital textile printing and give you a prospect of its future development. Basics of digital textile printing Digital Textile Printing is a process of printing textiles and garments using inkjet technology to print colorants onto fabric. Compared to conventional printing, it has no color limitations and makes it possible to produce customized products of creative designs and precise images. Digital textile printing offers more colors, patterns, accuracy, and efficiency than conventional printing. Click here to get detailed information about it. Impact of COVID-19 on application fields of digital textile printing Before we discuss the impact of COVID-19 on digital fabric printing, it’s crucial for us to know about its application fields. Undoubtedly apparel industry comes first. In addition, the other two majors are advertisement and décor. In the beginning, as the pandemic spread rapidly, a growing number of countries went into a complete lockdown. Retail stores shut down, factories closed and supply chains were disturbed. Some industry sources pointed out, “For fashion companies in Europe and North America, if stores remain shut for two months, they will be in financial distress.” In this regard, customers have made the greatest shift to online shopping. Following the pandemic, according to a survey of about 3,700 consumers in nine emerging and developed countries, which is entitled “COVID-19 and E-commerce”, over half of those surveyed buy goods online more frequently and rely on the internet more for news and various kinds of information. Moreover, the home décor and furnishing industry has seen some growth. As millions of consumers stayed at home, they wanted to decorate their homes differently and increase the roles of their homes as offices or meeting spots. Thus, the demand for pillows, blankets, and other textile gifts increased dramatically. In what ways digital textile printing was impacted by the pandemic? On-demand and fast printing Within this unprecedented challenge, parts of the fashion industry have gravitated towards an on-demand, digitized production model, that is only producing items when they are sold, to boost profitability. Digital textile printing features cost-effectiveness and shorter run lengths and is better suited to serve flexible, e-commerce-based garment producers. Thus, the textile industry saw increasing use of digital printing. Personalization Some analysts said consumers were more willing to personalize any aspect of their homes and lives. And indeed, digital printing gave the solutions. It can deliver detailed and precise designs in unlimited colors. In addition, it is very easy to produce a variety of options and adjust designs when it comes to designs and images. However, this isn’t the case with traditional printing methods. Fine management of inventory During outbreaks, there was a greater understanding of the importance of inventory management in a supply chain. Related management considered that inventory can be more flexible in terms of both minimum volume per design and having production closer to the consumer. When stores closed, the garments were not able to be sold through traditional channels. Inventory backlog was a very pressing question. Digital textile printing is just ideal for small batch output. Sustainability Digital textile printing is safer and more eco-friendly than conventional printing, which appeals to modern end-users who expect sustainable production practices. During the pandemic, some consumers and factories still cared about environmental issues. For that reason, pigment inks were getting a lot of attention. Pigment printing requires no post-washing or steaming process, and is, therefore, more eco-friendly than other inks like reactive and acid dye. Besides, its printing quality plus digital technology made pigment inks a great fit for home furnishing and garment applications. The potential of pigment inks is great, which in turn would accelerate the advancement of digital printing technology. Future of digital textile printing According to the report published by Allied Market Research, the global digital textile printing market was projected to reach $8.8 billion by 2027, that is four times the size by 2020. Developments in digital textile printing are constantly bringing in new possibilities for creative designs, high-quality images, and more efficient production models. In the world of fast fashion clothing to sportswear, from décor to furnishings, the boom in digital printing on textiles has contributed to the dynamics underlying these sectors in terms of productivity, creativity, and application. Let’s look forward to what this 'magic power' will bring us in the future.

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Everything you should know about the coronavirus pandemic

The latest information about the novel coronavirus identified in Wuhan, China, and advice on how pharmacists can help concerned patients and the public.

Sick man on subway wearing mask

Open access article

The Royal Pharmaceutical Society has made this feature article free to access in order to help healthcare professionals stay informed about an issue of national importance.

To learn more about coronavirus, please visit: .

A novel strain of coronavirus — SARS-CoV-2 — was first detected in December 2019 in Wuhan, a city in China’s Hubei province with a population of 11 million, after an outbreak of pneumonia without an obvious cause. The virus has now spread to over 200 countries and territories across the globe, and was characterised as a pandemic by the World Health Organization (WHO) on 11 March 2020 [1] , [2] .

As of 3 May 2021, there were 152,534,452 laboratory-confirmed cases of coronavirus disease 2019 (COVID-19) infection globally, with 3,198,528 reported deaths. The number of cases and deaths outside of China overtook those within the country on 16 March 2020 [3] .

As of 3 May 2021, there have been 4,421,850 confirmed cases of the virus in the UK and 127,539 of these have died (in all settings, within 28 days of the test).

This article gives a brief overview of the new virus and what to look out for, and will be updated weekly. It provides answers to the following questions:

What are coronaviruses?

Where has the new coronavirus come from, how contagious is covid-19, how is covid-19 diagnosed, what social distancing measures are being taken in the uk, what is happening with testing for covid-19, what should i do if a patient thinks they have covid-19, what can i do to protect myself and my staff, what about ‘business as usual’ during the pandemic, will the government provide financial help during the pandemic, how can cross-infection be prevented, there has been a lot of talk in the news and on social media about how certain medications can exacerbate the symptoms of covid-19, what is the current advice around these medications, where can i find information on managing covid-19 patients, is the coronavirus pandemic likely to precipitate medicines shortages, are there national clinical trials of potential drugs to treat covid-19, is there a vaccine for covid-19 and, if so, will pharmacy staff be involved in its roll out.

SARS-CoV-2 belongs to a family of single-stranded RNA viruses known as coronaviridae, a common type of virus which affects mammals, birds and reptiles.

In humans, it commonly causes mild infections, similar to the common cold, and accounts for 10–30% of upper respiratory tract infections in adults [4] . More serious infections are rare, although coronaviruses can cause enteric and neurological disease [5] . The incubation period of a coronavirus varies but is generally up to two weeks [6] .

Previous coronavirus outbreaks include Middle East respiratory syndrome (MERS ), first reported in Saudi Arabia in September 2012, and severe acute respiratory syndrome (SARS), identified in southern China in 2003 [7] , [8] . MERS infected around 2,500 people and led to more than 850 deaths while SARS infected more than 8,000 people and resulted in nearly 800 deaths [9] , [10] . The case fatality rates for these conditions were 35% and 10%, respectively.

SARS-CoV-2 is a new strain of coronavirus that has not been previously identified in humans. Although the incubation period of this strain is currently unknown, the United States Centers for Disease Control and Prevention indicate that symptoms may appear in as few as 2 days or as long as 14 days after exposure [6] . Chinese researchers have indicated that SARS-CoV-2 may be infectious during its incubation period [11] .

The number of cases and deaths outside of China overtook those within it on 16 March 2020

It is currently unclear where the virus has come from. Originally, the virus was understood to have originated in a food market in Wuhan and subsequently spread from animal to human. Some research has claimed that the cross-species transmission may be between snake and human; however, this claim has been contested [12] , [13] .

Mammals such as camels and bats have been implicated in previous coronavirus outbreaks, but it is not yet clear the exact animal origin, if any, of SARS-CoV-2 [14] .

Increasing numbers of confirmed diagnoses, including in healthcare professionals, has indicated that person-to-person spread of SARS-CoV-2 is occurring [15] . The preliminary reproduction number (i.e. the average number of cases a single case generates over the course of its infectious period) is currently estimated to be between 1.4 to 2.5, meaning that each infected individual could infect between 1.4 and 2.5 people [16] .

Similarly to other common respiratory tract infections, MERS and SARS are spread by respiratory droplets produced by an infected person when they sneeze or cough [17] . There is also some evidence that SARS-CoV-2 can spread by airborne transmission. Measures to guard against the infection work under the current assumption that SARS-CoV-2 is spread in the same manner.

As this coronavirus affects the respiratory tract, common presenting symptoms include fever and dry cough, with some patients presenting with respiratory symptoms (e.g. sore throat, nasal congestion, malaise, headache and myalgia) or even struggling for breath.

In severe cases, the coronavirus can cause pneumonia, severe acute respiratory syndrome, kidney failure and death [18] .

The case definition for COVID-19 is based on symptoms regardless of travel history or contact with confirmed cases. Diagnosis is suspected in patients with a new, continuous cough, fever or a loss or changed sense of normal smell or taste (anosmia). A diagnostic test has been developed, and countries are quarantining suspected cases [19] .

Box 1: Who qualifies as a suspected COVID-19 case?

Individuals with:

Individuals with any of the above symptoms but who are well enough to remain in the community should  stay at home for 10 days from the onset of symptoms and get tested. Households should all self-isolate for 10 days if one member shows symptoms.

Source: Department of Health and Social Care

The government launched its coronavirus action plan on 3 March 2020, which details four stages: contain, delay, mitigate, research [20] . On 12 March 2020, the UK moved to the delay phase of the plan and raised the risk level to ‘high’.

On 16 March 2020, Johnson announced social distancing measures , such as working from home and avoiding social gatherings, as well as household isolation for those with symptoms [21] , [22] .

Further social distancing measures were announced on 18 March 2020, including closing all schools in the UK except for vulnerable children and those of key workers, such as pharmacists and other health and social care staff, teachers and delivery drivers. Restaurants, cafes, pubs, leisure centres, nightclubs, cinemas, theatres, museums and other businesses were also told to close.

On 22 March 2020, Johnson announced that the most clinically extremely vulnerable people, including those who have received organ transplants, are living with severe respiratory conditions or specific cancers, and some people taking immunosuppressants, should stay in their homes for at least the next 12 weeks (see Box 2).

Since this date, shielding in England, Scotland and Wales has been eased and brought back in several times in line with lockdown restrictions. And on 16 February 2021, a new risk assessment model was introduced in England to help clinicians identify adults with multiple risk factors that make them more vulnerable to COVID-19, resulting in an additional 1.7 million people being added to the shielding list. Shielding ended in England and Wales on 1 April 2021 and in Scotland on 26 April 2021.

Box 2: Shielding from COVID-19

Those classed as “clinically extremely vulnerable” may include the following (disease severity, history or treatment levels will also affect who is in this group):

A strict lockdown started in the UK on 23 March 2020, with people told to stay at home except to buy essential food and medicines, one form of exercise a day, any medical need, and travelling to and from essential work. Gatherings of more than two people in public was not allowed and all shops selling non-essential goods, libraries, playgrounds, outdoor gyms and places of worship closed. All social events, including weddings, baptisms and other ceremonies, but excluding funerals were cancelled.

A relaxation of the lockdown was announced by Johnson on 10 May 2020. The government published a 60-page ‘ recovery strategy ’ on 11 May 2020, which sets out the next phases of the UK’s response to the virus, including easing some social restrictions, getting people back to work and reopening schools.

Local lockdowns were introduced at the end of June 2020 to try to control the spread of coronavirus in particular regions in England but cases continue to rise and a second national lockdown was imposed from 5 November 2020 for four weeks. A three-tier system of restrictions will follow the national lockdown in England. In Scotland, a five-level alert system was introduced on 2 November, which will allow different restrictions to be imposed in local areas depending on the prevalence of the infection. A fire-break lockdown came into force in Wales from 23 October 2020, and ran until 9 November 2020.

On 19 December 2020, new tier-four restrictions were imposed in London, Kent and Essex and other parts of the South East of England, meaning that individuals in those areas had to stay at home and not meet up with other households. On 31 December 2020, further areas of England including the Midlands, North East, parts of the North West and parts of the South West were also escalated to tier four.

A new national lockdown was imposed in England and Scotland from 5 January 2021, and similar restrictions were introduced in Wales shortly after. The lockdowns began to lift in steps from the end of March 2021.

Tests can now be accessed by anyone with symptoms via .

An NHS test and trace service was launched across England on 28 May 2020, with similar services starting in Scotland and Wales around the same time. Anyone who tests positive for the virus is contacted to share information about their recent interactions. People identified as being in close contact with someone who tests positive will have to self-isolate for 10 days, regardless of whether they have symptoms.

Testing is also now available to care home staff and residents in England, and NHS workers where there is a clinical need, whether or not they have symptoms.

Pharmacy staff in England and Scotland should book tests online via and they will be conducted at drive-through testing sites across the country, as well as via home testing kits.

Pharmacy staff in Wales with symptoms of COVID-19 are able to access testing through their Local Health Board.

The government has also announced the start of a new national antibody testing programme, with plans to provide antibody tests to NHS and care staff in England from the end of May 2020. Clinicians will also be able to request the tests for patients in both hospital and social care settings if they think it is appropriate.

Regular testing of asymptomatic patient-facing staff delivering NHS services using lateral flow antigen tests was introduced in NHS trusts in November and expanded to primary care services in December 2020.

Patients have been advised not to go to their community pharmacy if they are concerned that they have COVID-19. Those with a new, continuous cough or a high temperature or anosmia (a loss or changed sense of normal smell or taste) who live alone should self-isolate for 10 days from the onset of symptoms. Households should all self-isolate for 10 days if one member shows symptoms [22] . There is no need for people with minor symptoms to telephone NHS 111.

However, given the outbreak has coincided with the cold and flu season, it is likely that patients may present in the pharmacy with queries about the virus, or with concerns about their cold or flu symptoms.

Community pharmacies were told by NHS England and NHS Improvement on 27 February 2020 that, in the unlikely event that a suspected case does present, they must prepare a “designated isolation space” [23] .

If the pharmacy does not have a suitable room to isolate a suspected patient, an area that would keep a patient at least two metres away from staff and other patients in the pharmacy should be prepared so that it can be cordoned off.

Patients who present with a new, continuous cough or a high temperature or anosmia should be told to return home immediately and self-isolate. If, in the clinical judgement of the pharmacist, the person is too unwell to return home, they and any accompanying family should be invited into the designated isolation space where emergency services should be contacted.

The Royal Pharmaceutical Society is publishing ongoing guidance on contingency planning for COVID-19, which includes measures to protect the pharmacy team, such as limiting the number of people within the pharmacy at the same time, keeping at least two metres apart from staff and people coming into the pharmacy, and sectioning the pharmacy to encourage social distancing with floor markings (using tape) or barriers. The RPS has also produced a table to help pharmacists distinguish between COVID-19, a cold, the flu and hayfever.

Those with cold and flu symptoms that are not indicative of COVID-19 should be managed as usual, or using the pathway developed by The Pharmaceutical Journal .

The General Pharmaceutical Council said on 3 March 2020 that it recognises pharmacists may need to depart from established procedures in order to care for patients during the coronavirus outbreak and that regulatory standards are designed to be flexible and to provide a framework for decision-making in a wide range of situations.

In a  joint statement with ten other health regulators, the GPhC said: “Where a concern is raised about a registered professional, it will always be considered on the specific facts of the case, taking into account the factors relevant to the environment in which the professional is working”.

An  updated standard operating procedure (SOP) for community pharmacies, published on 22 March 2020, sets out measures to protect pharmacy staff, including advising customers to keep a distance of at least two metres from other people, limiting entry and exit to the pharmacy and installing full screens to protect members of staff from airborne particles (see Learning article section ‘Enforcing social distancing’ for further details).

Following some confusion early on in the pandemic about whether community pharmacists should wear personal protective equipment (PPE), Public Health England updated its guidance on 23 July 2020 to say that pharmacy staff, both in clinical and non-clinical roles, should wear a type I, type II or type IIR facemask if the environment is not COVID-19 secure, using social distancing, optimal hand hygiene, frequent surface decontamination, ventilation and other measures where appropriate.

This brings the PHE guidance in line with that from the RPS, which says that pharmacy staff working in community pharmacies and general practice should wear fluid-resistant surgical masks if they are unable to maintain a social distance of 2 metres from patients and staff, and emphasises that it is still important to try to maintain social distance when wearing surgical masks wherever possible. The RPS also advises that gloves, apron and surgical masks should be worn by staff in direct contact with a patient, for example, when a person is too unwell to go home and is being cared for in the designated isolation space.

PPE can be ordered for free via the government’s  PPE portal.

On 5 June 2020, the DHSC announced that all staff in hospitals in England will have to wear surgical masks from 15 June 2020, regardless of the clinical area in which they work.

Guidance has been issued by pharmacy organisations on how community pharmacies in England can accept patient returns of unwanted medicines while minimising risk to pharmacy teams. Since coronaviruses can survive on certain surfaces for up to five days, it recommends that all returns should be double bagged and placed directly in waste medicines bins. Controlled Drugs should be double bagged and placed in the CD cabinet for five days before denaturing. A suggested procedure is detailed within the guidance.

Staff who have symptoms of COVID-19 should stay at home and get tested as soon as possible. NHS England and Improvement confirmed in a letter to community pharmacies on 9 June 2020 that NHS staff “must self-isolate” for 14 days (reduced to 10 days from 14 December 2020) if the NHS test and trace service advises them to do so because they have come into close contact with a person with COVID-19. However, the letter adds that close contact “excludes circumstances where PPE is being worn”. If a member of the pharmacy team tests positive and there is a risk to the provision of pharmaceutical services then advice regarding the individual circumstances should be sought from the local Health Protection Team.

Staff who fall into one of the vulnerable groups at particular risk of complications from COVID-19 should not see patients face-to-face, regardless of whether the patient has possible COVID-19. Remote working should be prioritised for these staff.

NHS staff from a black, Asian or minority ethnic (BAME) background and others who who may be particularly vulnerable to COVID-19 — including those working in community pharmacies — should be risk assessed. In a letter dated 29 April 2020 , NHS England said that “emerging UK and international data” suggest that people from BAME backgrounds are “being disproportionately affected by COVID-19”.

The Faculty of Occupational Medicine later published a risk reduction framework — backed by NHS England — to assist with the risk assessments on 14 May 2020. This was updated on 28 May 2020 to include guidance from the Health and Safety Executive to “help organisations identify who is at risk of harm”.

All NHS staff can access free wellbeing support and frontline health and care staff can access NHS volunteer responders support for themselves by calling 0808 196 3646.

Pharmacies are on the frontline of the fight against coronavirus and demand for services is high. An updated standard operating procedure published on 27 October 2020 enables regional NHS England and NHS Improvement teams to notify pharmacies that they are able to adjust their opening hours to cope with increased demand. Pharmacies will be able to work behind closed doors for up to 2.5 hours a day before 10am, between 12 and 2pm or after 4pm.

A number of contractual services have been put on hold and others have been brought forward (see Learning article section ‘Adjusting opening hours and pharmacy services’ for further details). The Hepatitis C testing service in England will now launch on 1 September 2020 and the discharge medicines service is expected to start in February 2021.

During the first full lockdown in the spring of 2020, community pharmacies ensured that those who were shielding from COVID-19 (see Box 2) were able to receive their prescription medicines, either through friends and family, volunteers, or via pandemic delivery services but these were paused when cases dropped. The pandemic delivery service in England  resumed for four weeks from 5 November 2020 to 3 December 2020, and again from 5 January 2021 to 31 March 2021, owing to sustained community transmission of COVID-19; it was expanded to patients told to self-isolate by NHS Test and Trace on 16 March 2021 until 30 June 2021. In Scotland, a pandemic delivery service started on 18 January 2021 and will continue until the end of March 2021.

Another new advanced service, distributing COVID-19 lateral flow test kits, was announced on 29 March 2021 for community pharmacies in England. Pharmacies will be able to earn up to £972 per week by providing the test kits to asymptomatic patients as part of NHS Test and Trace.

The need for patients to sign the back of prescription forms has been  suspended until 30 June 2021 so as to reduce cross contamination and minimise handling of paperwork. Patients must still pay the prescription charge or prove their eligibility for exemption. Pharmacy staff should mark the relevant box for exempt patients and annotate all forms with COVID-19 in place of a signature.

Amendments to legislation to allow community pharmacies to close, with the permission of NHS England, “to focus on the delivery of flu or COVID-19 vaccinations” will come into effect on 9 November 2020 to allow for “flexible provision of immunisation services during the pandemic”. These changes follow the government’s decision to allow pharmacists to deliver unlicensed — in addition to licensed — vaccinations , such as a COVID-19 vaccine when one becomes available, with further work under way to expand the workforce able to deliver flu vaccines.

The amendments also allow community pharmacists in England to dispense COVID-19 treatments without a prescription under pandemic treatment protocols that will be issued by the government if a COVID-19 treatment became available that was suitable for distribution via community pharmacies and it was not found to be necessary for an authorised prescriber to decide to treat.

The General Pharmaceutical Council has stopped all routine inspections of pharmacies. Submission of revalidation records is postponed for registrants who were due to submit between 20 March 2020 and 31 August 2020, and requirements have been reduced for those due to submit between 1 September 2020 and 31 December 2020.

On 26 March 2020, the GPhC announced that the pharmacy registration assessments for June and September 2020 have been postponed. The GPhC confirmed on 30 November 2020 that online registration assessments would take place at centres around the UK on 17 and 18 March 2021.

More than 6,200 pharmacy professionals who left the register within the past three years have been given  temporary registration so that they can to return to work during the COVID-19 pandemic, if they wish to do so. And in guidance published on 9 April 2020, final year pharmacy students were told they can join their arranged preregistration workplace ahead of the scheduled start date to help deal with the COVID-19 pandemic.

The PSNC announced on 31 March 2020 that community pharmacies in England will be given cash advances totalling £300.0m over the next two months to help with cashflow during the pandemic, but no extra funding has been negotiated so far. Further advanced funding of £50m and £20m at the end of May 2020 and June 2020, respectively, has since been announced by the PSNC. As with the £300m previously announced, the £70m is not additional funding and will be reconciled in 2020/2021.

Advance payments have also been agreed for community pharmacies in Scotland and Wales.

Additional funding of an initial £5.6m was agreed in Scotland on 7 April 2020 to support unparalleled levels of activity within community pharmacy during the pandemic. The funding will cover equipment costs, adaptations to premises, additional staffing and locum fees. Further additional funding of £4.5m for staffing costs for May and June 2020 was announced on 27 November 2020.

On 2 April 2020, the government announced that it had written off £13.4bn of debt as part of a major financial reset for NHS providers.

The  WHO has created a range of infographics to illustrate how patients can protect themselves and others from getting sick; however, most of the advice is similar to what would be provided for colds and flu (see Figure) [24] .

feature article about covid 19 pandemic

Figure: Infographic – How to reduce the risk of coronavirus infection

Source: Source: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

There is no specific treatment for COVID-19. Although vaccines can be developed to treat viruses, owing to the novel nature of this infection, no vaccine has currently been developed and the process to develop one may take 12 to 18 months [18] . As an example, many antiviral agents have been identified to inhibit SARS in vitro , but there are currently no approved antiviral agents or vaccines available to tackle any potential SARS or SARS-like outbreaks, such as MERS or SARS-CoV-2 [25] .

On 16 March 2020, the British Cardiovascular Society and the British Society for Heart Failure published a statement saying that patients should continue treatment with angiotensin converting enzyme inhibitors and angiotensin receptor blockers unless “specifically advised to stop by their medical team”.

The advice was issued following concerns circulated on social media that these medicines could predispose them to adverse outcomes should they become infected with COVID-19.

Both societies recommended that patients taking these medicines who present as unwell, or with a suspected or known COVID-19 infection, should be assessed on an individual basis and their medication managed according to established guidance. Inappropriate cessation of therapy could lead to a decline in control of blood pressure, heart failure or any other condition the individuals takes these medicines for.

Similar concerns have also arisen around the use of ibuprofen following unverified claims, backed by Oliver Veran, France’s health minister, that ibuprofen may exacerbate symptoms of the virus.

On 14 April 2020, the Committee of Human Medicines (CHM) — an advisory body of Medicines and Healthcare products Regulatory Agency — and the National Institute for Health and Care Excellence both published reviews, which concluded that there is insufficient evidence to establish a link between use of ibuprofen, or other NSAIDs, and susceptibility to contracting COVID-19 or the worsening of its symptoms.

A rapid policy statement published by NHS England on the same date, highlighted that there had been some reports of possible adverse effects of the use of NSAIDs in acute respiratory tract infections more generally, which had led to suggestions to use paracetamol preferentially for fever/pain in such situations. However, it said that there was currently no evidence that the acute use of NSAIDs caused an increased risk of developing COVID-19 or of developing a more severe COVID-19 disease.

The Royal Pharmaceutical Society has collated resources for hospital pharmacists on the clinical management of patients with COVID-19, including treatments, use of experimental therapies, and evidence-based summaries.

The resources also include information on critical care services during the pandemic and guidance on COVID-19 in special populations, such as children, pregnant women, patients taking warfarin and those with cancer, respiratory conditions, diabetes, rheumatological conditions and HIV.

The National Institute for Health and Care Excellence has produced COVID-19 rapid guidelines covering a number of areas as well as rapid evidence summaries on COVID-19 treatments. NHS England and NHS Improvement has also published several specialty guides aimed at specialists working in hospitals during the pandemic. These resources have all been brought together on the NICE website .

NICE and the Scottish Intercollegiate Guidelines Network are working with the Royal College of General Practitioners (RCGP) to develop a guideline on the effects of long COVID on patients.

The government banned the parallel export of chloroquine, as well as the antiretroviral lopinavir/ritonavir, on 26 February 2020 because they are being tested as possible treatments for COVID-19. There has been a lot of attention in the media on the potential benefits of chloroquine and hydroxychloroquine in treating patients with COVID-19 but the Medicines and Healthcare Regulatory Agency has warned that these medicines are not licensed to treat COVID-19 related symptoms or prevent infection and, until there is clear, definitive evidence that these treatments are safe and effective for the treatment of COVID-19, they should only be used for this purpose within a clinical trial.

On 20 March 2020, the government banned from parallel export more than 80 medicines used to treat patients in intensive care units. The restrictions cover crucial medicines such as adrenaline, insulin, paracetamol and morphine and are designed to prevent medicines shortages. A further 52 medicines, including a number of respiratory medicines, antibiotics, analgesics and insulin products, were banned from export on 1 April 2020. And a further 33 medicines were banned from export on 24 April 2020, including further respiratory medicines and some drugs that are being trialled for COVID-19, such as azithromycin, dexamethasone, ruxolitinib, sarilumab and tocilizumab.

Community pharmacists have been experiencing huge demand for paracetamol and many have reported shortages of paracetamol tablets 500mg as pharmacy and general sales list packs. The National Pharmacy Association and the GPhC have both said that  pharmacies are able to break down larger packs to prepare supplies of a non-prescription items for retail sale.

Shortages of Chiesi’s Clenil and Fostair inhalers, along with inhalers from other brands, have been noticed by pharmacists as patients begin to panic and order inhalers they potentially do not need. The wholesaler AAH Pharmaceuticals placed 11 inhalers on its “out of stock” list on the 30 March 2020. NHS England wrote to healthcare professionals working in primary care on 31 March 2020, asking them not to overprescribe or over-order during this time, as this will create further pressures on the supply chain.

There are three major randomised controlled trials of medicines to treat COVID-19 being funded by the UK government: PRINCIPLE, RECOVERY and REMAP-CAP (see Feature and trials briefing ), and several other trials are being nationally prioritised .

Preliminary results from the RECOVERY trial suggest that low-dose dexamethasone offers significant reductions in mortality for those patients with COVID-19 who require oxygen or ventilation, and it has been approved for use on the NHS.

Results from the REMAP-CAP trial have suggested that  tocilizumab and sarilumab reduced the risk of death from COVID-19 by 24%  when administered in the first 24 hours of a patient entering intensive care, and these drugs should now be considered by the NHS for hospitalised patients.

Results from the RECOVERY trial also suggest that tocilizumab reduces deaths in patients hospitalised with COVID-19.

An interim analysis of the PRINCIPLE trial suggests the corticosteroid budesonide shortens recovery time from COVID-19 by a median of three days, compared with usual care, in older people treated in the community.

In addition, on 28 April 2020, the Accelerating COVID-19 Research & Development ( ACCORD ) platform was launched , a collaboration between government, industry and research organisations that aims to reduce the time taken to set up clinical studies for new COVID therapies from months to weeks. ACCORD will rapidly test potential drugs through early stage clinical trials and, if they show promise, will feed them into the UK’s large-scale COVID-19 studies, such as RECOVERY. Bemcentinib, an AXL kinase inhibitor, will be the first to begin phase II studies across the UK within the next few days.

Further potential treatments will be rapidly fed into ACCORD as the programme rolls out over the next few weeks.

A Yellow Card website dedicated to reporting side-effects or incidents from medicines being used to treat COVID-19 has been set up by the Medicines and Healthcare products Regulatory Agency (MHRA).

The UK has pre-ordered 357 million doses of different potential COVID-19 vaccines from seven manufacturers. The portfolio includes two adenoviral vector vaccines (Oxford/AstraZeneca and Janssen), two mRNA vaccines (BioNTech/Pfizer and Moderna), an inactivated whole virus vaccine (Valneva), and two protein adjuvant vaccines (GSK/Sanofi, Novavax) (see feature ).

Three of the vaccines being backed by the UK —BioNTech/Pfizer, Moderna and Oxford/AstraZeneca — released positive results from phase III trials in November 2020. The Pfizer/BioNTech vaccine was approved by the Medicines and Healthcare products Regulatory Agency (MHRA) on 2 December 2020 and the Oxford/AstraZeneca vaccine was authorised for use by the MHRA on 30 December 2020 and the Moderna vaccine was authorised on  8 January 2021 (see feature ).

Hospital pharmacists are overseeing ‘safe handling’ of COVID-19 vaccines in vaccination centres and hospital hubs as part of the mass vaccination programme, which started on 8 December 2020.

NHS England wrote to pharmacy contractors on 27 November 2020, saying that it is planning for designated pharmacy sites to be ready to administer COVID-19 vaccines under a local enhanced service from late December 2020 or early January 2021. However, “complex logistics” in the vaccine’s supply chain mean NHS England does not expect the majority of contractors’ sites will be able to meet a specific set of requirements, such as administering a minimum of 1,000 vaccines per week, with the fridge space, physical layout and staffing necessary to support that.

Community pharmacy contractors can also collaborate with their local primary care network to support them to deliver maximum vaccine uptake via the GP enhanced service or with vaccination centres, which started vaccinating patients on 14 December 2020.

Vaccination sites led by community pharmacies started administering COVID-19 vaccines to patients on 11 January 2021, with about 200 joining the first wave.

In a  letter to contractors  dated 16 February 2021, NHS England officials said it would reopen the application process to improve vaccination provision in a list of “priority locations”.

Community pharmacies able to administer up to 400 COVID-19 vaccines per week can now apply to become designated vaccination sites.

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Living through uncertainty: a qualitative study on leadership and resilience in primary healthcare during COVID-19

BMC Health Services Research volume  23 , Article number:  233 ( 2023 ) Cite this article

Metrics details

Resilience is often referred to when assessing the ability of health systems to maintain their functions during unexpected events. Primary healthcare forms the basis for the health system and thus its resilient responses are vital for the outcomes of the whole system. Understanding how primary healthcare organisations are able to build resilience before, during, and after unexpected or sudden shocks, is key to public health preparedness. This study aims to identify how leaders responsible for local health systems interpreted changes in their operational environment during the first year of COVID-19, and to elucidate how these views reflect aspects of resilience in healthcare.

The data consist of 14 semi-structured individual interviews with leaders of local health systems in Finland representing primary healthcare. The participants were recruited from four regions. An abductive thematic analysis was used to identify entities from the viewpoints of the purpose, resources, and processes of resilience in the healthcare organisation.

Results were summarised as six themes, which suggest that embracing uncertainty is viewed by the interviewees a basis for primary healthcare functioning. Leading towards adaptability was regarded a distinct leadership task enabling the organisation to modify its functions according to demands of the changing operational environment. Workforce, knowledge and sensemaking, as well as collaboration represented what the leaders viewed as the means for achieving adaptability. The ability to adapt functioned to comprehensively meet the population’s service needs built on a holistic approach.


The results showed how the leaders who participated in this study adapted their work during changes brought on by the pandemic, and what they viewed as critical for maintaining organisational resilience. The leaders considered embracing uncertainty as a principal feature of their work rather than viewing uncertainty as aberrant and something to avoid. These notions, along with what the leaders considered as critical means for building resilience and adaptability should be addressed and elaborated in future research. Research on resilience and leadership should be conducted more in the complex context of primary healthcare, where cumulative stresses are encountered and processed continuously.

Peer Review reports

Resilience in healthcare

In assessing how healthcare can maintain its essential functions in a crisis, the concept of resilience is often raised [ 1 ]. Several frameworks conceptualising resilience have been suggested but a consistent definition for resilience has proved difficult to attain [ 2 , 3 , 4 , 5 , 6 ]. This may be because of the complex nature of both the phenomenon itself as well as the context of healthcare [ 7 ]. There are also several overlapping concepts that have been used to refer to when resilience is discussed in the context of health systems and healthcare [ 2 , 5 ]. Concepts such as the health system or healthcare resilience address the topic from a broad system-wide perspective, while resilience in healthcare describes the phenomenon within the boundaries of an organisation or otherwise more restricted part of the health system. In this paper, we define, conceptualise, and analyse resilience according to Wiig et al. as “the capacity to adapt to challenges and changes at different system levels, to maintain high quality care” [ 8 ].

Crises affecting health systems have inspired an abundance of studies on resilience, especially after the Ebola virus or COVID-19 outbreaks [ 4 , 9 ]. In a conceptualisation of organisational resilience Duchek [ 10 ] depicts the various dynamic connections between different resilience capabilities during the phases of unexpected events. According to this definition, resilience is a meta-capability consisting of a set of organisational capabilities and routines that allow for the successful accomplishment of the three resilience stages (anticipation, coping, and adaptation), which cannot be clearly separated. Elsewhere, researchers have argued that the study of resilience should take a broader view to account for both shocks and cumulative stresses to appreciate its complexity and context dependency [ 11 ]. In the field of quality improvement research, resilience is considered to be needed for longer periods and in the daily operation of healthcare units. Often referred to as everyday resilience, this approach is a rising research area [ 7 , 12 ].

While a considerable amount of literature on resilience in healthcare is published at the system or hospital level, research in the context of primary healthcare is less commonplace [ 13 ] (see however, [ 14 , 15 , 16 , 17 , 18 , 19 ]). This is an omission, given that primary healthcare forms an important building block for strong national health systems [ 20 ] and most national health policies are brought to life in primary healthcare. Many of the core services of health systems are provided through primary healthcare such as health promotion and treatment for acute and chronic illnesses. Primary healthcare is also community-based care and often provides the first contact point in the whole healthcare system [ 21 ]. As a first point of contact, primary healthcare often engages with a substantial portion of the consequences of unexpected events. For instance, in the case of COVID-19, diagnostics, contact-tracing, and vaccinations have been a primary healthcare responsibility in many countries [ 22 , 23 ]. Finally, service needs in primary healthcare are less defined and more outstretched than in specialised care [ 24 ] forming reasonable complexity in the operational environment.

Healthcare is commonly argued to be a complex adaptive system (CAS) [ 25 , 26 ]. Typical characteristics of complex systems such as context specificity, ambiguousness, and their holistic nature set specific requirements for leadership [ 27 , 28 , 29 ]. Adopting a CAS approach emphasises that leadership needs to see and shape the system as a whole, that is, as a combination of different interacting and intertwined parts [ 26 , 28 ]. This is contrary to traditional managerial thinking that considers organisations as a set of roles and easily defined parallel processes and solely as objects of management actions [ 30 ]. Due to its fundamental role for the whole healthcare system and the complexity it entails, it is important to understand better how crises are governed and managed in primary healthcare, i.e., what leadership entails in a complex adaptive system such as primary healthcare. This emphasises the need for health system leaders and scholars to understand a range of complexity issues, such as non-linear interactions and emergent behaviour and phenomena that affect leadership in primary healthcare organisations especially in uncertain circumstances [ 31 , 32 , 33 ].

Leadership and management are essential components and facilitators of resilience in healthcare [ 1 , 5 , 6 , 13 , 34 ]. According to previous research, resilient organisations are not managed hierarchically [ 10 ]. Instead, they employ decentralisation, self-organisation, and shared decision-making to allow for flexibility and adaptation [ 10 ], which are typical manifestations of CAS. Leadership focussing on complexity has been raised as one approach to nurturing resilience in healthcare [ 7 , 28 ]. Khan Y. et al. [ 35 ] state that adopting a complexity lens can support leaders in managing change and transformation, which in turn, are fundamental elements of resilience. In summary, leadership approaches discussed in the resilience literature concerning healthcare usually include elements of participation, engagement, and collaboration. The connection between leadership and organisational resilience requires more empirical research and this would also be relevant to the healthcare sector [ 36 , 37 ].

Against the presented background, this study contributes to the growing area of research on resilience in healthcare by studying how resilience in local health systems, including primary healthcare, was facilitated by leadership during the first year of the COVID-19 pandemic in Finland. More specifically, in this study we ask how leaders responsible for local health systems interpreted changes in their operational environment during the first year of COVID-19, and the role that leaders themselves viewed as important in building organisational resilience during a prolonged health crisis. Drawing upon interview data, we focus on leaders’ perceptions of local, primary healthcare level resilience and on the role of leadership in building resilience to maintain services in answer to population needs during an unexpected health system shock.

Setting and data collection

The context of the study is the Finnish healthcare system, which is a decentralised, universal health system. At the time of the interviews, primary healthcare was organised by municipalities. At the regional level, 20 hospital districts were responsible for organising specialised healthcare. In some areas, joint municipal authorities were responsible for organising both primary level healthcare and social services as well as specialised health services for the region [ 38 , 39 ]. Municipalities have had a large amount of autonomy to decide on how they provide the services, but primary healthcare has been mostly organised through municipal health centres, which utilise a broad variety of professionals and services, including many public health functions such as the detection and treatment of communicable diseases, and vaccinations. Additionally, diverse chronic and acute illnesses are treated in primary healthcare instead of hospital settings. In Finland the integration of healthcare and social services has been one of the leading policy tools to develop the system [ 38 , 40 ]. As of January 2023, a large-scale health and social services reform has taken place in Finland reducing the number of organisers of these services from over 300 municipalities to 22 wellbeing services counties. As a result of the reform, the responsibility for financing has recently been transferred to the state level [ 41 ].

To acknowledge the broadness of functions in the Finnish primary healthcare system, we use the term primary healthcare instead of primary care, the latter being usually understood as consisting of medical care for individuals provided by a family doctor or a general practitioner [ 42 ]. During the COVID-19 pandemic, municipalities in collaboration with primary healthcare were responsible for many public health activities, such as public communication, monitoring of case numbers, mitigation measures, quarantines, and isolation, as well as individual health needs (e.g., diagnosis, patient information, treatment of mild cases, and vaccination) providing the essence of the local health system response. During epidemics, hospital districts and the Finnish Institute for Health and Welfare (THL) support municipalities with their medical expertise [ 43 ].

The analysed data of this qualitative study were derived from 14 semi-structured interviews which were chosen from a larger data set (53 interviews) of a study focusing on resilience in the Finnish health system [ 44 ]. The interviewees of the larger data set represented health system actors at different levels of the health system. From that data set we were able to choose those informants who had a leadership role in local health systems and/or responsibility for leading the pandemic response in their organisation. The study participants were recruited from four regions in Finland, which differ based on their geography, demographics, and level of integration in health and social services, as well as their epidemiological situation during the point of data collection. At the time of the data gathering, the roll-out of vaccinations was only just beginning to accelerate. The regions are described in more detail in Table 1 . The organisations are described according to the situation at the time of the study in 2021. One person asked to be interviewed for this subsample did not respond to the invitation, while all others agreed to participate. In order to ensure the confidentiality of the respondents, we have not combined information on the interviewees’ positions or other descriptions with the region they are representing. In a small country such as Finland the connection between a person and information given in the publication could be readily made.

The 14 interviewees represent middle and upper-level leaders responsible for local healthcare and social services, including primary healthcare. The responsibilities and positions of the informants varied depending on the area in question. We also included city managers among the interviewees since the municipalities played a key role in pandemic governance in the Finnish context. The positions of the participants included city managers ( n  = 3), directors of joint municipal health care and social service authorities ( n  = 2), heads of social and health services in municipalities ( n  = 5), directors of health services ( n  = 3), and an administrative head nurse ( n  = 1). Due to the variety of positions and professional backgrounds of the participants, we use the term ‘leaders responsible for local health systems’. Primary healthcare is understood as part of the local health system. The term corresponds with the overall roles of the interviewees as they all are members of high-level boards or groups which are responsible for primary healthcare organisation and for the responses to the crisis. Purposive sampling was used to recruit key persons responsible for pandemic governance in each region. Potential interviewees were identified from public resources (e.g., media, organisations’ websites) and asking previously interviewed participants to name people in positions described above in their region. The research adhered with the ethical guidelines for responsible research completed with human subjects, and the participants provided verbal informed consent at the beginning of the interview. No compensation was offered to the participants.

The study tool used in the interviews was a flexible interview guide which built upon the shock cycle framework [ 1 ]. Accordingly, the interview guide included three main themes: preparedness for the pandemic, leadership and decision-making, and health system resilience including the themes of learning and adaptation. The interviews were conducted in March-June 2021 via Microsoft Teams and they were audio recorded and transcribed. Each interview lasted from 60 to 90 min and at least two researchers were present to ensure successful recording and other technical issues. The quotations from the interviews included in this study have been translated from Finnish to English by the research team.

In this qualitative study, we used an abductive thematic analysis approach to reach an in-depth understanding of the leaders’ perceptions and interpretation on resilience in healthcare [ 45 ]. Whereas the coding was conducted utilising a former framework [ 8 ], the formation of themes was as inductive as possible, bearing in mind that a researcher always relates one’s thinking to previous knowledge. The analysis consisted of iterative rounds of familiarisation with the data and coding with ATLAS.ti version 22. The coding and theme generation were both conducted by the first author. During the analysis and coding phase, the first author met regularly with the research team to receive feedback and critical commentary on the coding scheme.

To identify primary health care leaders' experiences regarding resilience in healthcare, our coding was guided by the four core questions suggested by Wiig et al. [ 8 ]. These investigate the different aspects of resilience in healthcare and are resilience ‘for what’, ‘to what’, ‘of what’ , and ‘through what’ . This four questions approach was chosen as it helps to focus on the processes and meanings of building resilience during crises and challenges. The questions also allow a broad consideration of resilience components on different system levels and contexts.

Against this background, the coding scheme was guided by the following questions and domains. The question concerning ‘ resilience for what’ elaborates on the purpose of resilience and asks: What goals and objectives does resilience support? The second question addressing ‘resilience to what ’ seeks to identify what is needed for resilience to become activated and asks: What are the triggers of resilience? The third question covering the ‘resilience of what ’, zooms in on which resources, material or immaterial components or participants that are used to build resilience in healthcare, while the last question concerning ‘resilience through what ’ uncovers what actions are taken to build resilience. In our analysis, we concentrate on two of the core questions: the resilience ‘of what’ and ‘through what’ . We consider the COVID-19 pandemic as a self-evident trigger of resilience and thus the core question of ‘resilience to what’ is less discussed in this paper although two triggers embedded in the pandemic situation were identified. As the aspects ‘resilience of what’ and ‘through what’ , include descriptions of resources and actions used to safeguard important services, they also indirectly illuminate the purpose of resilience ( ‘resilience for what’ ), the mentions of which were as such less frequent. We also included a fifth category in our analysis to address the deficiencies of resilience. This code group was named ‘insufficient or absent components of resilience’ allowing for reporting the leaders’ ideas on resilience in healthcare as a whole, acknowledging those aspects of resilience that were lacking or insufficient in their local health system context. In other words, the interviewees described several elements that they suggested were important elements of the healthcare organisation’s resilience, but which were not at hand or which they were unable to use.

The two aspects (resources or ‘resilience of what’ and actions or ‘ resilience through what’ ) represented the vast majority (40 out of 45) of codes as well as quotations in the data. This can be partly explained by the questions presented to the interviewees, which concerned processes and resources used during the pandemic, as well as by the acuteness of the crisis which was still going on at the time of the interviews. At times, drawing a line between the question of ‘resilience through what’ and ‘resilience of what’ was challenging. For example, this was the case when communication or information flows were discussed, because information as a resource is so closely connected to the actions taken for effective information flows or public communication. Often an excerpt of text included both, and even insufficient or absent components of resilience. A systematic classification was followed to differentiate between processes (doing something) and resources (using something). In some cases, multiple codes were added to the same quotation. For example, the interviewees described that some information such as epidemiological indicators were readily collected and shared ( ‘resilience of what’), but knowledge about social care demands was more difficult to attain ( ‘insufficient or absent components of resilience’ ). When possible, a quotation from the interviews was divided into smaller sections and grouped into corresponding categories. If division was not possible without losing the association with the context, the same section was coded into all categories which it represented. The co-authors, who were also profoundly familiar with the data, commented on the formation and grouping of codes throughout the process in order to build a coherent code book.

The first author formed, assessed, and further developed the themes in close collaboration with the co-authors. A total of 45 codes were grouped under each core question addressing the aspects of resilience. The code groups of resilience components (' resilience of what ') and processes supporting the organisations’ resilience (' resilience through what' ) had the most mentions in the data and these groups also included the majority of the codes (22 and 18 respectively). The six themes identified as conceptual entities from the codes were organised hierarchically as they represent different levels and components of leadership and resilience. One of the main themes, leading towards adaptability, has three individual sub themes while the other two form more comprehensive entities themselves. The connections between the themes are illustrated in Fig.  1 and explained in the next section in a “bottom-up” manner.

figure 1

Themes and their hierarchical connections

In the results section, we present especially illustrative quotations from the interview data as examples of each theme. While the quotations selected for each theme represent a single interview, they have been selected based on their ability to illustrate aspects of the theme as a whole. Taken together, the themes represent what leaders responsible for local health systems viewed as essential to building resilience during COVID-19 ( ‘resilience of what’ ) and what actions they took ( ‘resilience through what’ ) [ 8 ].

Leading towards adaptability

The study participants predominantly identified organisational adaptation as one of their major leadership tasks. According to the interviewees, the hierarchically governed Finnish public sector and using familiar modes of organising work were argued to be good grounds for building an adjustable crisis governance system. The constituents of early-stage adaptability also included using habitual modes of operation and organisation as well as the availability of material resources, although a lack of personal protective equipment for instance, was reported. Many organisations utilised the same management teams as usual to be able to make quick decisions, although these groups were soon complemented by new members and meetings were held more frequently.

In practice, adaptability meant changing modes of service or managerial activities to meet the new requirements in the operational environment caused by the COVID-19 pandemic. These modifications included, for example, meeting agendas, information gathering, as well as shifting resources back and forth between contact tracing, pandemic wards, and other tasks. These actions mirrored leaders’ needs to adjust operations for alternating demands in the course of the pandemic: the emphasis shifted between pandemic governance and giving the workforce (including the leaders) “some time to breathe and recover”. This was illustrated by one of the interviewees as follows:

“So, we shifted, we’ve been several times in a contingency plan mode and then again in non-contingency mode. So, we’ve had the principle that when we need an elevated alert level, we raise our alertness and as soon as the situation allows, we drop it again back to normal.” (informant 6, director of joint municipal authority)

Although the abovementioned example reflects the general need to adapt during the crisis mode of the first year of COVID-19 in Finland, we identified three sub-themes of adaptability. These were: leading the workforce, knowledge and sensemaking, and collaboration form the basis of primary healthcare organisations’ adaptability. These sub-themes of leading towards adaptability are addressed in the next sections.

The leaders identified the healthcare workforce as a crucial resource and a key actor to achieve resilient responses. One way of ensuring an adequate workforce was the reallocation of staff, which was carried out also across sectoral boundaries at the municipal level. The reallocation generated the need to introduce new tasks and to ensure continuous support for the employees in the changing working environment. Mostly the experiences were positive, as described by one of the interviewees:

“But I have to say that from the viewpoint of the whole city, for example the staff from cultural services like libraries, museums, the city orchestra, and from other places, they have been ready to come and do really different kinds of jobs on a short notice when their operations were closed (due to COVID-19). It has in a sense opened the eyes of some in those sectors but also in social and healthcare services that we don’t have to limit ourselves solely to the workforce representing social and health care. That it is worth taking a broader perspective in crises, looking at the resources society has to offer.” (informant 5, head of social and health services (municipality))

The high morale and motivation of the workforce during the first months of the pandemic was praised, and some organisations even experienced reduced absenteeism. However, the leaders also questioned whether the support for the employees was sufficient. They acknowledged that the organisations had not prepared well enough for the strain on workforce, and that measures to support the employees were not included in the contingency plans of their organisations. All this was further emphasised as the pandemic and thus extraordinary circumstances were prolonged. One of the informants noted:

“But people get tired when the situation lasts for a long time, that’s for sure. It happens to the leaders, to the managers, and to everyone who is involved. We are trying to implement a COVID exit at this stage, so that people can have their vacations, and that they get feedback on their work, and all. It is a big question.” (informant 4, director of joint municipal authority)

In sum, the leaders acknowledged the importance of a motivated workforce for resilience in healthcare. Simultaneously, they considered that the personnel had not always been supported well enough and were concerned about the long-term effects of the pandemic and various other stresses on the workforce.

Knowledge construction and sensemaking

Collecting, combining, and analysing information from different sources are a cornerstone for resilience in healthcare. A common view amongst the interviewees was that the staff competencies and knowledge accumulated prior to the crisis were pivotal, especially at the beginning of the pandemic. Different preparedness activities, such as contingency planning, exercises, and simulations, which are organised regularly, were regarded helpful although examples of insufficient preparedness or experience were cited as well:

“Somehow at this moment I think even more, if we talk about preparedness planning, that working on different scenarios should have been done more, that before this situation sketching, outlining scenarios could have been made. Now we have been leaning on the experiences from previous pandemics a bit too much and it would probably have been useful to carry out more planning and preparations with other actors.” (informant 5, head of social and health services (municipality))

As stated by the interviewees, knowledge management including analysing information was seen as central in crisis governance and thus accessible, although often incomplete, information was described as a foundation for decision-making. One of the interviewees noted:

“It has been really successful in the sense that the situational awareness that we have at hand at any time, it’s been accessible as frequently as daily or several times a day. Each time we went through the situation and after that we could propose if something needed to be done or not. I don’t remember any occasion that something that was well argued hadn’t been carried out.” (informant 7, director of health services (joint municipal authority))

Collecting and combining information was also seen as important for learning from the previous phases of the pandemic and preparing for the next phase. Sharing information, analysing and sensemaking tasks were often carried out in different groups or networks which are discussed under the next theme.


New collaborative practices were introduced during the pandemic to enforce coordination and pandemic governance. These included the creation of new expert groups, but also complementing existing ones or adding to the frequency of regular meetings. Communication through these groups often functioned to combine stakeholder views and sensemaking. One of the interviewees explained this as follows:

“We’ve been aware of their (the local hospital district) situation at all times, and they’ve been aware of ours. Together, we resolved issues such as where to set up the infection wards and how the patient flows would be organised. This still goes on. We meet two times per week and keep each other on track.” (informant 4, director of joint municipal authority)

Trust and prior familiarity between stakeholders appeared as facilitators for collaboration during the pandemic. Representatives from organisations with integrated social and healthcare services estimated that pandemic governance was more effective since both sectors “sat around the same table” and were under the command of the same leader, which exemplifies one structure that promoted collaboration between sectors. The clarity of stakeholder roles and responsibilities was an important benefit, enabling timely and effective organisational responses. However, the interviewees expressed that this clarity was often missing, thus, undermining the ability to adapt quickly to the new situation.

In addition to collaboration between the sectors of the same organisation, collaborative groups and networks played an important role in pandemic governance on the regional level (i.e., collaboration between municipalities and between municipalities and other key organisations such as hospital districts). The foremost aim of inter-organisational collaboration was to find a consensus on decisions to be made throughout the region. One of the informants described the collaboration:

“First, between our people, and then with the municipal leaders and leaders of the education sector, we communicate about what we think of any issue at hand. Then, it may be that they think in one way and we in another, but we don’t go with that mindset to the meeting, we work out our opinion and then we want to hear what THL (Finnish institute for health and welfare) thinks. But the starting point in these COVID-coordination groups is that from THL’s point of view they too want to know what the region’s opinion is. And then it’s good that the region has an opinion. We can discuss that ”we have these viewpoints, but this is our solution.” (informant 11, director of health services (joint municipal authority))

In a large-scale health crisis such as COVID-19, municipalities and local health systems were naturally part of a larger system for pandemic governance. This increased the demand for leaders to participate in several networks. Different mentions on collaboration were notably frequent in the interview data underlining its significant role in the leaders’ work during the pandemic.

Embedding a holistic approach

The leaders described their view of the crisis and population in many ways that emphasised their holistic approach to the situation. They underlined the need to have a comprehensive picture of the diverse population needs and the effects of the crisis on the population and services. The overall well-being of the population can be interpreted as the evident purpose of resilient responses and activities to maintain population trust. This includes adequate services and clear public communication, which were considered critical by the interviewees as explained here:

”Regardless of the situation, we discuss issues beyond healthcare. I think that an integrated healthcare and social service organisation like this is very fruitful, because in the same steering group we can always look at the situation from the viewpoint of child welfare to intensive care. It’s a broad perspective, and it enables us to discuss a wider array of issues than one would if you only look at it from the angle of healthcare.” (informant 6, director of joint municipal authority)

Balancing the multifaceted needs of the population and the realities of service production, such as financing and availability of workforce, were recurring themes in the interviews, often declared as insufficiently managed. Some services were scaled back during the first months of the pandemic to secure the capacity in other parts of the health system. However, the informants felt that these adaptations could not be prolonged as the pandemic went on and they also reprehended some other societal mitigation measures, such as school closures, as they held the potential to aggravate citizens’ overall wellbeing. As one of the informants reflected:

“I think this is a good lesson, an observation, for us that if everyone just does their business, then this thing will not work out. So, we need to recognise the pressures and situations that arise when the health authority decides or recommends something, that what kind of a chain starts from there and how that will be handled. For me the acknowledgement and understanding of these cascading impacts has been an essential observation. They are highlighted in this situation and it’s something that we all have probably learnt.” (informant 13, city manager)

This balancing is an important task for leaders, in order to ensure both sufficient adaptability and stability. Embedding the holistic approach is reflected in the three categories: the purpose of resilience (' resilience for what' ), the immaterial resources of resilience (e.g., financing and understanding the multifaceted effects of the crisis), and processes of resilience (e.g., building a holistic view of the service needs) all aiming at supporting the wellbeing of the population.

Embracing uncertainty

The final theme covers uncertainty as characteristic to the local level health services and leadership. The interviewees stated that the key persons should be able to make decisions and work effectively during uncertain times. This seemed to have succeeded well with very few exceptions. Every crisis or shock was acknowledged to be of a different kind and only partial preparation for the next one is possible since no one has the certainty as to what the next crisis will be. Multiple shocks and cumulative stresses, such as questions of workforce availability and the future health and social services reform taking place as of January 2023, were also mentioned. Functioning as an interpreter of uncertain situations is a principal endeavour for leadership, and the interviewees believed leaders to be more apt at this skill than front-line workers. One of the informants illustrated this as follows:

“It can be easier for senior level leaders to live under uncertainty and to put up with the world turning into 24/7 reality. But I think we should have thought more about the staff coping on that level. It doesn’t help much if you’re told that this is what it’s like now and let’s just work it out when there are so many uncertainties out there. When you’re in a leading position you possibly better tolerate the uncertainty and that you don’t know what tomorrow brings. But it’s so important for people to know about their days off and holidays and what they’re allowed to do." (informant 10, head of social and health services (municipality))

The undoubtedly significant role of instability was stressed by the leaders on many occasions, such as in relation to preparedness plans, the epidemiological situation, national instructions, and the sufficiency of workforce. However, the interviewees also listed several uncertainties that were present before the pandemic started and portrayed the constant change as a prevailing circumstance in their operational environment. The leaders would like the workforce to be able to adapt to continuous change. Hence, it can be interpreted that “living with uncertainty” instead of just tolerating it, is an important part of resilience in primary healthcare.

In this study we analysed the interpretations of the leaders at the local health system level on the changes in their operational environment during the COVID-19-pandemic and, furthermore, how these interpretations reflected aspects of resilience in healthcare. We detected that leading towards organisational adaptability, embedding a holistic approach in operations, and embracing uncertainty are essential aspects of building resilience in healthcare. Our results also highlighted the importance of considering absent or insufficient components of resilience in healthcare in operationalising the concept. Wiig et al. [ 8 ] have defined resilience in their study context as “the capacity to adapt to challenges and changes at different system levels, to maintain high quality care”. In the light of our data and analysis, resilience in primary healthcare expands to signify a capacity to adapt to unforeseen events and changes at different system and organisational levels, and in different sectors regardless of uncertainties, to maintain services to answer to population needs and to support the population’s overall wellbeing.

Local governance has been identified as an important part of resilience in healthcare and for the pandemic response [ 6 , 46 , 47 ]. The Finnish decentralised and publicly funded healthcare system serves as an example of the role of local governance in the context of the pandemic response, which can generally be regarded as one of the strengths of Finland’s pandemic response [ 43 ]. This paper contributes to the literature of resilience in healthcare by studying how resilience is interpreted by leaders at the local health system level, which, in turn, increases the understanding of how to strengthen health system resilience overall [ 48 ].

In the context of primary healthcare, the need for horizontal and vertical collaboration are accentuated especially during a crisis—our interviewees participated in several collaborative groups with stakeholders on different health system levels. Those participants who represented joint municipal authorities in our study worked in the type of organisations where different levels of healthcare and social services are integrated. These participants declared clearly to be in favour of an integrated structure as it facilitated collaboration between sectors and health system levels. The same structure of organisation has been formed in other Finnish regions as well as part of a major health and social services reform from January 2023 on. While these participants’ notions supported the integration of healthcare and social services in Finland, it is important to bear in mind that the benefits of local governance should not be lost when services are being centralised. Equal attention should be paid to ensure that primary healthcare is recognised as playing a key role in preventive functions and public health interventions [ 6 ].

Leadership is a critical building block of health systems and pivotal in supporting resilience in healthcare, yet it is rarely explicitly centred in resilience studies [ 6 , 13 ]. Several frameworks portray resilience as a process or a collection of capacities or capabilities incorporating a considerable degree of dynamics and interdependencies [ 1 , 10 , 49 ]. According to our results, leaders responsible for local health systems played an active role in building resilience during the COVID-19 pandemic in Finland. Our analysis complements the notion that different components and aspects of resilience are not only strongly interdependent, but also entwined [ 10 , 37 ]. The results support the findings by Lyng et al. [ 34 ] who articulate that resilience in healthcare requires a holistic awareness of a wide array of resilience capacities, which have to be maintained simultaneously, instead of concentrating on just a few of them. The presence of the future health and social services reform in Finland also caused considerable cumulative stress and uncertainty in the healthcare organisations and put pressure especially on the leaders.

The non-linearity of the chain of events triggered by the COVID-19 pandemic is another evident observation derived from the data. The results illustrate how steps were taken back and forth during the pandemic in healthcare organisations, and the crisis held unexpected events within itself, such as pandemic waves and challenges of healthcare workforce availability. The stages of the resilience process (anticipation, coping, and adaptation) could not be clearly separated in the data, as Duchek also presents in her conceptualisation [ 10 ].

As the present study also illustrated, the need to embrace uncertainty is pronounced during crises and in complex surroundings such as local health systems and primary healthcare [ 26 , 50 ]. In order to nurture resilience in healthcare, the interviewees adopted a holistic approach and described attempting to incorporate uncertainty as an existential orientation of the system they were leading. They also used several means of promoting adaptability by leading the workforce, striving for sensemaking of the knowledge that was gathered, and collaborating in various networks. These endeavours reflect leadership focussing on complexity, also referred to as complexity leadership, in which the leader’s role is more about building connections for emergent adaptability, as well as sensing opportunities and challenges than trying to control the “messiness” of the complexity [ 26 , 51 ].

Furthermore, our results illustrated how the interviewees reported insufficiency or absence of several aspects in their organisational environment that restricted or challenged their ability to respond to the crisis, such as scant resources, inability to support the workforce, insufficient information flows and the deficient quality of preparedness plans. We interpreted these as representations of missing parts of resilience in healthcare. Based on this finding, we argue that acknowledging the missing aspects of resilience is as crucial from the perspective of a comprehensive crisis response as an awareness of those aspects of resilience that are present. In this study we concluded a fifth category of ‘insufficient or absent components of resilience’ to our analysis in addition to the core questions introduced by Wiig et al. [ 8 ] answering the question ‘What does the healthcare organisation’s resilience lack?’. However, the insufficient or absent components of resilience in healthcare that we were able to identify were the same as those that the informants identified as present components. Thus, we suggest that the aspect of possibly absent or insufficient components of resilience in healthcare be actively considered in study designs of future research. It is noteworthy that our results represent only those insufficient components of resilience that were explicitly identified by the interviewees. Therefore, it is an important task for further studies to continue to investigate other potential shortcomings of crises responses that could be identified by using alternative data collection methods and research designs. The interviewee selection may also have affected the identification of lacking components. The resources or capabilities that have not been identified should be of high interest for both scholars and the leaders of health systems and healthcare organisations in the tasks of anticipation and learning and will likely require multimethodological approaches, including observational studies in healthcare settings [ 52 , 53 ].


Our data consisted of 14 interviews which were utilised to conceptualise leaders’ experiences of resilience in healthcare in the context of local health systems and primary healthcare in Finland. Primary healthcare and public health crises, as well as leadership and resilience, are complex issues with an abundance of variance in different contexts. However, our study protocol addressed this pitfall by including interviewees from four different regions and, at least in the Finnish context, the findings were analogous.

Because of the relatively limited number of participants in the study, generalisations of findings must be made with caution. Nonetheless, the study provided a deeper understanding of leaders’ perceptions of resilience in a local health system setting, as well as conceptual considerations of resilience in healthcare, which can be used in further research. Furthermore, it is important to note that assessing the extent of the achieved resilience in healthcare is beyond the scope of this study, and therefore remains an important research task for further studies [ 54 ]. The themes of the semi-structured interviews naturally had an impact on the contents of our data. For example, questions on preparedness and workforce were asked which might have led the interviewees to contemplate these aspects more carefully and therefore also to identify the shortcomings in these sectors. A study protocol with a more open narrative inquiry could confirm or challenge the results of this study.


The practical implications of this study arise from the finding that different aspects of resilience in healthcare, leadership roles, and stages of the crisis cannot be separated, nor lines strictly drawn between their components. Before, during, and after a crisis, leaders should think and act with a broad mindset, which can be facilitated by inviting other members of the organisation as well as other stakeholders to sensemaking discussions to build a comprehensive understanding of the operational environment and pressures directed to the organisation. Health workforce and their low turn-over rate, along with other resources that support resilience, are key in achieving agility of the organisation and ensuring the continuance of services for the population. Future research should ensure that resilience is explored with a broad view, also investigating whether same issues are of importance in leadership and managerial tasks in everyday resilience as in resilience triggered by exceptional shocks.

In Finland, the Ministry of Social Affairs and Health has provided guidance for operators in the healthcare and social welfare sectors for preparedness planning and continuity management in 2019 [ 55 ]. The guidance aimed at providing practical instructions for developing preparedness plans at the operational level. However, based on our results, although preparedness plans were made, they were not in all respects feasible for the COVID-19 pandemic. For instance, inter-organisational collaboration and scenario work played a much larger role during the pandemic than had been taken into consideration in the preparedness plans, and workforce issues had scarcely been addressed. Thus, there is an essential need for developing the national guidance for preparedness planning at operational level and providing practical instructions for primary healthcare leaders. For example, the results of this study emphasise the importance of planning how the workforce will be supported during crises, especially long-lasting ones.

The findings of this study accentuate the importance of a holistic approach and ability to work under uncertain conditions at the local level of a health system and in primary healthcare in particular, especially during a crisis. This broad and multifaceted mindset seemed to be intrinsic to the study participants who were leaders responsible for local health systems in Finland. It is apparent that leaders are in a key position in building and maintaining resilience before, during, and after a crisis. Complexity leadership can provide beneficial approaches to both leaders and researchers in operationalising resilience in healthcare. Our findings confirm that the governance of unexpected events should accommodate different aspects, such as the workforce and other resources as well as processes that support resilience and stages of a crisis simultaneously. This entwinement should be emphasised in research and policy recommendations. Simplifying the complex nature of resilience in healthcare should be avoided.

Availability of data and materials

The datasets generated and analysed during the current study are not publicly available due to European provisions on data protection, of which the interviewees were assured.


Complex adaptive system

Finnish institute for health and welfare

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We wish to thank all the interviewees for providing a rich data set with valuable insights.

Open access funding provided by Tampere University including Tampere University Hospital, Tampere University of Applied Sciences (TUNI). This study was conducted as part of the “Resilience, crisis preparedness and security of supply of the Finnish health system RECPHEALS” research project. RECPHEALS project is funded by Academy of Finland, Grant nr 340501 and Grant nr 340503, and Strategic Research Council, Academy of Finland, Grant nr 345300.

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Soila Karreinen, Henna Paananen, Marjaana Viita-aho & Liina-Kaisa Tynkkynen

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LKT, MV and to a smaller degree SK and MH participated in the data gathering, together with other members of the RECPHEALS project. LKT was the PI of the project. SK planned and designed this study. SK performed the data analysis whilst LK, HP, and LKT provided advice on the process. The first and final drafts of the manuscript were written by the lead author (SK). The manuscript was commented on and edited by all other authors at different stages of the writing process. All authors have proofread and approved the final version. All authors had access to the dataset.

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Karreinen, S., Paananen, H., Kihlström, L. et al. Living through uncertainty: a qualitative study on leadership and resilience in primary healthcare during COVID-19. BMC Health Serv Res 23 , 233 (2023).

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Oregon sees COVID-19 receding, but pandemic lingers

The good news: COVID-19 information in Oregon has been mostly upbeat in recent weeks. Oregon case numbers are improving, hospitalization rates are dropping, and the winter triple threat of COVID-19, flu and RSV have been retreating.

“A welcome sign,” wrote Sen. Michael Dembrow, D-Portland, whose weekly newsletter has delved deeply into the pandemic in Oregon over the past two years.

Not so good news: Astoria, Medford, Sunriver, Forest Grove, Grants Pass, Hillsboro and Port Orford were showing “sustained increases” in the presence of omicron in local wastewater according to Oregon Health Authority tests.

With the rise of home COVID-19 test kits, the percentage of positive cases that get reported to health officials isn’t as strong an indicator of current trends, OHA has said.

Epidemiologists have leaned on sewers and septic tanks to tell a more accurate story. Data compiled by testing sewage water indicates how prevalent the virus has become in nearby homes, schools and businesses.

Getting better is good enough Statewide, the trends were enough for OHA to announce hospitals and other health facilities could choose to no longer require masks on their premises.

Dr. Dean Sidelinger, the Oregon health officer, said data showed COVID-19 test positivity rates at 10% and falling. Influenza test positivity is 1.2%, while Respiratory Syncytial Virus — known by its acronym RSV — had test positivity at or under 3.5%.

But there is daily evidence that COVID-19 is still very much among the population in the form of more contagious but less virulent infections from omicron subvariants.

The Johns Hopkins Coronavirus Resource Center reported this week that there have been 676 million cases worldwide, and more than 6.87 million deaths. The United States has had 103.6 million cases and 1.12 million deaths.

Rising wastewater numbers could be a harbinger of a wider spread, or an anomaly, Sidelinger said.

“So it’s possible that we may well see the numbers rise again in the coming weeks,” Sidelinger said. “However, the combination of vaccines and prior infections seems to be keeping Oregonians from being sick enough to need serious treatment.”

Mix of familiar and new names at OHA Sidelinger remains the main holdover on the state’s team monitoring COVID-19. While Dr. Steven Graven and his virus forecasting team at Oregon Health & Science University also remain, both the OHA and OHSU reports on the status of the virus have become less frequent.

New Gov. Tina Kotek asked for and received the resignation of Oregon Health Authority Director Pat Allen, who has taken a public health position with the state of New Mexico.

Kotek on Tuesday had to announce the second interim OHA director since she was sworn in as governor on Jan. 9.

David Baden, OHA’s chief financial officer, will take over for the previous interim director, James Schroeder, who resigned after only about two months on the job.

Schroeder is the former CEO of Health Share Oregon, the state’s biggest Medicaid insurer. Kotek’s office said the governor had not sought Schroeder’s resignation.

Baden was responsible for helping bring over 2,000 staff members to Oregon, Kotek said. He also oversaw a successful vaccine-distribution program, even if the level of anti-vaccination sentiment in many areas saw inoculations slow, then stall.

The announcement on Baden noted that Oregon had the second-lowest COVID-19 case rate and eighth-lowest death rate in the nation.

Oregon has reported 961,523 positive cases since February 2020, resulting in 9,361 cases. There are currently 232 patients with COVID-19 in state hospitals.

Oregon ranks 18th in the nation in terms of hospitalizations with COVID-19, with a daily average of 338 cases over the past two weeks. But the numbers are dropping. The state is in the middle of the pack on vaccinations, with a report of 71% considered fully vaccinated.

Masks are still a good way to avoid becoming infected — Oregon reported 2,025 new cases over the past week.

OHA underlined that it issued the mask order a month ahead of time to give managers, workers and facilities involved in health care time to prepare for the change — and opt out of the rules if they wish. Individual medical care facilities could continue to require masks past April 3. Individual health care workers can make the decision to continue to wear masks. It is not a “no masks” mandate.

The new policy covers hospitals, mobile clinics, ambulances, outpatient facilities, dental offices, urgent care centers, counseling offices, school-based health centers, and complementary and alternative medicine locations.

The trend is likely for fewer restrictions around COVID-19 if overall numbers stay low. There are no plans for going back to mandatory statewide restrictions on the statewide level, OHA has said.

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No, masks don't help, but let's deny the lack of science showing they work, to keep this myth alive. Also, the public is far ahead of our political health care leaders as to when the pandemic was over.


Out of interest, who/what is the source of your information that there is no scientific evidence that masks are effective? Here is what I am seeing – I am happy to send you the citations if requested:

1) A large, well-designed cluster-randomized trial in Bangladesh in late 2020 found that surgical or cloth mask distribution, role-modeling, and active mask promotion tripled mask use to 42.3% in intervention villages compared to 13.3% in comparison villages. In villages receiving mask interventions, symptomatic seroprevalence of SARS-CoV-2 was statistically significantly reduced by approximately 9% relative to comparison villages. In villages randomized to receive surgical masks, symptomatic seroprevalence of SARS-CoV-2 was statistically significantly lower (relative reduction 11.1% overall). The results of this study show that even modest increases in community use of masks can effectively reduce symptomatic SARS-CoV-2 infections (COVID-19).

2) A study of an outbreak aboard the USS Theodore Roosevelt, an environment notable for congregate living quarters and close working environments, found that use of face coverings on-board was associated with a 70% reduced risk of infection.

3) A study examining SARS-CoV-2 secondary attack rates among eight public K-12 school districts in Massachusetts (70 schools with >33,000 enrolled students) during the 2020–21 school year found an unadjusted secondary attack rate of 11.7% for unmasked versus 1.7% for masked interactions.

4) During July 15–August 31, 2021, when Delta was the predominant strain circulating in the U.S., about one in five K–12 public non-charter schools open for in-person learning in Maricopa and Pima Counties, Arizona, experienced a school-associated outbreak. Outbreaks were three and a half times more likely (adjusted odds ratio 3.5, 95% confidence interval 1.8-6.6) in schools without mask mandates.

5) In a nationwide analysis of data collected during July 1-September 4, 2021, U.S. counties without school mask requirements experienced larger increases in pediatric COVID-19 case rates (18.53 per 100,000 per day more cases) after the start of school compared with counties with school mask requirements.

6) An investigation of a high-exposure event in the U.S., in which 2 symptomatically ill hair stylists interacted for an average of 15 minutes with each of 139 clients during an 8-day period, found that none of the 67 clients who subsequently consented to an interview and testing developed infection. The stylists and all clients universally wore masks in the salon as required by local ordinance and company policy at the time.

7) Investigations involving infected passengers aboard flights longer than 10 hours strongly suggest that masking prevented in-flight transmissions, as demonstrated by the absence of infection developing in other passengers and crew in the 14 days following exposure.

8) Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis of 172 various study designs, which included 25,697 patients with SARS-CoV-2, SARS, or MERS, concluded masks were effective in preventing transmission of respiratory viruses

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  1. 'Incalculable loss': New York Times covers front page with 1,000 Covid-19 death notices

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  2. Questions hang over regional newspapers in COVID-19 pandemic shutdown

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  1. Feature Article: Here's What We've Learned About COVID-19

    Cough is also likely as well as fatigue and shortness of breath, which commonly persist for weeks to months. Most individuals infected with COVID-19 show evidence of lung damage. You could also have chills, muscle pain, headache, sore throat, and loss of taste or smell.

  2. The Covid-19 Pandemic

    The Covid-19 Pandemic. With the acute phase of the Covid-19 pandemic fading even as the coronavirus persists and evolves, a new normal is taking shape around the world. Highlights.

  3. Feature Article: Here's What We've Learned About COVID-19 ...

    Feature Article: Here's What We've Learned About COVID-19—An Update Release Date: September 21, 2021 Much has been said about the pandemic. Scientists all around the world have been laser-focused on studying SARS-CoV-2, the virus that causes COVID-19, for nearly two years and the flood of information can be overwhelming.

  4. All COVID-19 Articles

    COVID-19 can damage the brain in many ways. Initially, it can cause brain inflammation that causes confusion, difficulty concentrating, and memory problems. COVID also can cause new psychological disorders such as depression or anxiety. It can even cause people to see and hear things that aren't there and to believe things that aren't true.

  5. Articles about COVID-19

    COVID-19 makes living with a rare disease even harder Ongoing uncertainty, being alone, and not being able to get treatment. In many ways, the widespread challenges the COVID-19 pandemic... Rare Diseases, COVID-19 February 24, 2022 New decision-support tool for COVID-19 testing can help you get back to your life, safely

  6. Feature Article: Wondering about Coronavirus?

    The virus, now called COVID-19, first sickened people in Wuhan, China, in late 2019. Since then, many thousands of people around the globe have fallen ill, and some have died. What is coronavirus? Coronaviruses are a family of viruses that contain RNA (instead of DNA, like people have).

  7. COVID-19

    Misinformation about COVID-19 is still spreading almost as fast as the coronavirus itself. People are understandably anxious for news about how to stay safe amid the pandemic, but many are turning to two fonts of misinformation: social media and their immediate personal networks.

  8. COVID-19 in 2022: controlling the pandemic is within our grasp

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  9. Covid lawsuits weakened public health, U.S. pandemic preparedness

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  10. Feature stories

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  11. Science takes back seat to politics in first House hearing on origin of

    Some scientists and legislators might have hoped this morning's U.S. congressional hearing on the origin of the COVID-19 pandemic would move beyond partisan politics and seriously investigate what has become a deeply divisive debate.But members of the House of Representatives's Select Subcommittee on the Coronavirus Pandemic mostly hammered home long-standing Republican or Democratic ...

  12. How the pandemic might play out in 2021 and beyond

    The world has been in pandemic mode for a year and a half. The virus continues to spread at a slow burn; intermittent lockdowns are the new normal. An approved vaccine offers six months of...

  13. Coronavirus news: the latest on the global pandemic

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  14. To end this pandemic, we must trust science

    (8) Shortly after July's coronavirus surge in the U.S., Pew found that just 46% of Republicans thought COVID-19 was a "major" public health threat, compared with 85% of Democrats.

  15. COVID lab leak theory for coronavirus debated by Congress

    1:31. While there's no "smoking gun," experts called by Congressional Republicans at the first national-level hearing into the origins of the coronavirus pandemic say the United States should ...

  16. Seven Charts That Explain the COVID-19 Pandemic in 2021

    COVID-19 continued its worldwide spread in 2021, spurred by more contagious variants. Vaccines are highly effective, though have been unevenly distributed. Follow the pandemic's story over the ...

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  18. Covid-19: The history of pandemics

    As of 26 March, there were more than 470,000 confirmed cases of Covid-19 around the world and more than 20,000 deaths, touching every continent save Antarctica. This was a pandemic, in reality,...

  19. What has the pandemic revealed about the US health care system

    The Covid-19 pandemic is the single most important health event of the past 100 years, and as such has enormous implications for our health care system. Most significantly, it highlights the importance of universal, non-discriminatory health insurance coverage in the United States.

  20. Republicans prepare for first COVID-19 origins hearing

    House Republicans' subcommittee to probe the COVID-19 pandemic is holding its first hearing on Wednesday amid renewed scrutiny of the pandemic's origins. Wednesday's hearing will feature ...

  21. Covid-19 Pandemic Timeline Fast Facts

    Covid-19 Pandemic Timeline Fast Facts. Link Copied! Workers at the Inhauma cemetery in Rio de Janeiro, Brazil, carry the coffin containing the remains of 89-year-old Irodina Pinto Ribeiro on ...

  22. Public health in Asia during the COVID-19 pandemic: global health

    The chapter assumes that the lessons learned during the SARS episode in 2003 can be extrapolated to the COVID-19 pandemic. While SARS can provide a background to understand the effectiveness of collaborations and COVID-19 responses, this is unreliable because the latter have been much greater in both scale and duration.

  23. Did the COVID-19 pandemic worsen student behavior?

    Teachers reported big changes because of the pandemic and an overwhelming majority agreed COVID-19 negatively impacted students' behavioral and socioemotional development. More than half of teachers believed increases in disruptive student misconduct were influenced by the pandemic. But those studying behavioral changes say it's too early ...

  24. Anthony Fauci hid the truth about COVID, until now

    Fauci was warned by fellow scientists at the outset of the pandemic in late January and early February of 2020 that the COVID-19 contagion contained unusual features that "(potentially) look ...

  25. The impact of COVID-19 on digital textile printing industry

    The COVID-19 pandemic has proved to be a serious social and economic crisis and led to a dramatic loss of human life worldwide. It presents an unprecedented challenge to all work of life.

  26. Everything you should know about the coronavirus pandemic

    How is COVID-19 diagnosed? As this coronavirus affects the respiratory tract, common presenting symptoms include fever and dry cough, with some patients presenting with respiratory symptoms (e.g. sore throat, nasal congestion, malaise, headache and myalgia) or even struggling for breath.

  27. One Year Into The COVID-19 Pandemic, Six Stories That Inspire Hope

    With the onset of COVID-19 and decreased tourism, the artisans of Phailom — like other small- and medium-sized enterprises (SMEs) across Lao PDR — have been hit hard. The pandemic has created new challenges for these enterprises, many of which were already struggling for other reasons. Despite their highly-refined skills and popularity with ...

  28. Living through uncertainty: a qualitative study on leadership and

    The non-linearity of the chain of events triggered by the COVID-19 pandemic is another evident observation derived from the data. The results illustrate how steps were taken back and forth during the pandemic in healthcare organisations, and the crisis held unexpected events within itself, such as pandemic waves and challenges of healthcare ...

  29. Oregon sees COVID-19 receding, but pandemic lingers

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