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Today the Centers for Disease Control (CDC) said at least 15 people in nine states have been sickened with Salmonella linked to pet bearded dragons. Four people have required hospitalization, but no deaths have been reported.
New York has reported four cases, Ohio and California have each reported three cases, and Iowa, Texas, Oklahoma, Tennessee, North Carolina, and Georgia have each reported a single case.
"The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses," the CDC said. The outbreak strain is Salmonella Cotham.
Illnesses started on dates ranging from January 8, 2024, to May 16, 2024. Of the 12 people interviewed, 7 (58%) reported contact with a bearded dragon before getting sick. At least one child did not report contact, suggesting he or she was likely exposed indirectly at home.
"60% of sick people are children under 5 years old," the CDC said in an email to reporters. "Bearded dragons are not recommended as pets for children younger than 5, adults aged 65 or older, and people with weakened immune systems because these people are more likely to get a serious illness from germs that reptiles carry."
"Bearded dragons are not recommended as pets for children younger than 5, adults aged 65 or older, and people with weakened immune system
The CDC warned that pet dragons can shed Salmonella through feces even when appearing healthy. Contact between pet dragons and children 5 and under should be avoided if possible because of the risk of illness.
Over the course of the pandemic, weve learned that the COVID-19 virus changes rapidly, producing many variants, similar to the flu. As a result, COVID-19 vaccines like flu vaccines must be updated to align with dominant viral strains currently circulating. While public awareness of the need for an updated flu vaccine has been established for many years, low COVID-19 vaccine uptake rates over the past year suggest a potential gap in knowledge around the need for updated protection against COVID-19.
To help journalists cover these changes, the National Press Foundation will host an online briefing, COVID Vaccine Updates Explained, 11 a.m.-12 p.m. ET, July 24.
July 24, 2024, 11 a.m. - 12 p.m. ET
This free webinar, sponsored by CVEEP, will explore the basics of virology as well as the latest CDC Advisory Committee on Immunization Practices (ACIP) recommendations for the latest COVID-19 vaccine.
NPF wants to help journalists and their audiences better understand the future of COVID-19 in a post-pandemic world. Given the continued risk of severe infection and long COVID, journalists must be able to explain to the public the timing, availability and need for this updated vaccine ahead of the 2024-2025 respiratory illness season.
This is the third webinar supported by CVEEP, a partnership of more than 250 organizations established to serve as a trusted source of information and discussion among organizations representing a variety of communities that face challenges from infectious respiratory illness, particularly diverse communities that have been most harmed by the effects of respiratory illness. The most recent briefing on COVID antiviral treatments can be watched here:
Speakers for the July 24 briefing will be listed here as they are confirmed.
This webinar is sponsored by CVEEP. NPF is solely responsible for its content.
(Precision Vaccinations News)
The U.S. Biomedical Advanced Research and Development Authority (BARDA) today announced up to $500 million in Project NextGen funding formultiple Phase 2b clinical trials to evaluatenovel vaccines administered as a nasal spray or as a pill to protect against symptomatic COVID-19.
While currently approved COVID-19 vaccines are administered intramuscularly, they are limited in their capacity to induce a robust immune response in mucosal areas such as the mouth, nose, and gut, where the SARS-CoV-2 coronavirus first enters people.
Successful development of intranasal and oral vaccines would provide safe, effective, needle-free, easier-to-administer options with the potential to improve vaccine access.
We learned a lot during the COVID-19 pandemic that we can use to better prepare for future public health crises. That includes finding new ways to administer vaccines to make it even easier for everyone to protect themselves from illness, U.S. HHS Secretary Xavier Becerra said in a press release on June 13, 2024.
The project awards were made to:
Up to $453 million to Vaxart of San Francisco, California, developing an oral pill vaccine candidate, adenovirus serotype 5. BARDA will provide an initial $65.7 million for early trial milestones, with remaining funds provided as the effort successfully advances toward trial execution. Vaxart will execute its own Phase 2b clinical trials.
Approximately $34 million was donated to Castlevax, part of the Mount Sinai Health System in New York City, to develop an intranasal vaccine candidate, CVAX-01.
Approximately $40 million will go to Cyanvac of Athens, Georgia, to develop an intranasal vaccine candidate, CVXGA.
Castlevax and Cyanvac Phase 2b trials are in partnership with BARDAs Clinical Studies Network.
These awards are just one component of BARDAs Project NextGen medical countermeasures portfolio.To date, BARDA has leveraged more than $2 billion in Project NextGen funding to support the development of next-generation vaccines, treatments, and enabling technologies.
As of June 14, 2024, the U.S. government has approved three COVID-19 vaccines, while the World Health Organization has qualified 13 vaccines.
Earlier this week, Moderna announced positive results for its phase3 clinical trial of a combined vaccine against COVID and influenza.
So what exactly did the trial find? And what sort of impact would a two-in-one COVID and flu vaccine have on public health? Lets take a look.
Combination vaccines have been successfully used for several decades in Australia and around the world.
For example, the DTP vaccine, a shot that combines protection against diphtheria, tetanus and pertussis (whooping cough), was first administered in 1948.
The DTP vaccine has since been further combined to offer protection against other diseases. A hexavalent vaccine, which protects against six diseases diphtheria, tetanus, pertussis, polio, hepatitisB and Haemophilus influenzae typeb (an infection that can cause brain swelling) is today part of routine childhood immunisation programs in Australia and elsewhere.
Another important combination vaccine is the MMR vaccine, given to children to protect against measles, mumps and rubella.
Modernas phase 3 trial included roughly 8,000 participants across two age groups. Half were adults aged 50 to 64. The other half were aged 65 and up.
In both age groups, participants were randomised to either receive the combined vaccine (called mRNA-1083) or a control. The control groups received a COVID vaccine and a suitable flu vaccine delivered separately.
The control group in the 50-to-64 age category were given the Fluarix flu vaccine, as well as Modernas mRNA COVID vaccine, Spikevax. The over-65 control group received Spikevax alongside Fluzone HD, an enhanced flu vaccine designed specifically for older adults.
The study evaluated safety, including any reactions after vaccination, and the protective immune response the vaccines produced.
Moderna reported the combined vaccine elicited a higher immune response in both age groups against COVID and three influenza strains, compared to the co-administered shots.
From a safety perspective, the combined vaccine was well tolerated. Adverse reactions were similar across the experimental and control groups. The most common side effects included muscle aches, fatigue and pain at the injection site.
While the trial results are promising, they are yet to be published in a peer-reviewed journal, which means independent experts havent yet verified them. And further research may be required to test how the combined vaccine works in younger age groups.
We cannot overstate the importance of vaccines. Each year they prevent up to 5million deaths around the world from a range of life-threatening infections.
At the same time, we can always do more to boost vaccination uptake, especially in areas with fewer resources and among vulnerable populations.
Combination vaccines have a variety of advantages. For example, the need for fewer injections reduces costs for health systems, decreases storage requirements and reduces the burden on parents. All of these things can be especially valuable in low-income countries.
Notably, research shows combination vaccines make it more likely people will take up routine vaccinations.
Every year, particularly during the winter months, millions of people contract respiratory infections. Indeed, parts of Australia are reported to be facing rapid increases in flu cases at the moment.
According to the World Health Organization, globally, roughly 3million to 5million people experience severe influenza annually, and around 650,000 people will die from the disease.
COVID has resulted in more than 7million deaths around the world to date.
As the COVID pandemic has continued, weve seen pandemic fatigue setting in, as some people appear to have become complacent about their COVID shots. A 2023 study in Australia found 30% of the surveyed population were hesitant about and 9% were resistant to taking COVID boosters.
Uptake of the flu vaccine, which many people are in the habit of getting annually, may be higher. That said, in Australia the current flu vaccine rates for 2024 are still fairly low: 53% for adults over 65 years, 26% for those aged 50 to 65, and lower for younger age groups.
A two-in-one COVID and flu vaccine could be an important public health tool to increase vaccine coverage against these two important diseases. Beyond protecting individuals health, this would have flow-on benefits for the economy and our health system.
Moderna said it will present its trial data at an upcoming medical conference and submit it for publication. The company has also said it will soon apply for regulatory approval, with the possibility of supplying the combined vaccine in 2025.
At the same time, Pfizer and BioNTech also have late-stage trials in progress for a combined COVID and flu vaccine. We will await further developments with interest.
Rise and shine, everyone, another busy day is on the way. We can tell because the pace of motor vehicles passing by our window is picking up and the official mascots are busy foraging for snacks on the campus grounds. As for us, we are engaged in the usual ritual of brewing cups of stimulation. Our choice today is strawberry cream. As always, you are invited to join us. The neurons could use all the help they can get. Meanwhile, here is the latest menu of tidbits for you to digest as you embark on your journey, which we hope is satisfying and rewarding. On that note, time to get cracking. Best of luck, and do keep in touch.
Pfizer reported that its gene therapy for Duchenne muscular dystrophy failed to slow disease progression in a Phase 3 trial, STAT notes. This is the second large, randomized, placebo-controlled trial of a Duchenne therapy to fail to reach its primary endpoint, a composite scale of muscle function designed specifically for the rare disease. A similar study of a Sarepta therapy failed last year, although the company cited secondary measures as evidence its treatment still slowed the fatal, muscle-wasting condition. Pfizer said that in its study, which enrolled 99 boys between ages 4 and 7 and followed them for a year, its therapy did not show any difference on those key secondary endpoints.
U.S. Secretary of Agriculture Tom Vilsack says that 24 companies are working to develop an avian flu vaccine for cattle, as the virus spreads among U.S. dairy herds, Reuters says. Bird flu has infected 95 dairy herds across 12 states since late March and three dairy farm workers have been infected, according to the U.S. Department of Agriculture. A vaccine could curb the risk of bird flu spreading to new species and lessen potential economic losses for dairy farmers, but may take years to develop. In addition to the two dozen companies working at varying stages of vaccine development, the USDA is conducting its own preliminary research into a vaccine at its laboratory in Ames, Iowa.
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The first shipments are headed to Finland
The European Unionwill sign a contract on Tuesday to secure over 40 million doses of a preventative avian flu vaccine for 15 countries with the first shipments heading to Finland, Reuters reported, citingEU officials on Monday.
The deal secures up to 665,000 doses from vaccine manufacturer CSL Seqirus and includes an option for a further 40 million vaccines for a maximum of four years. The vaccines will be jointly procured by the Commission's emergency health arm HERA and 15 countries in the EU and the European Economic Area.
The doses are intended for those most exposed to the virus, such as poultry farm workers and veterinarians. The United States, Canada and Britain are also in the process of securing preventative vaccine doses.
"When it comes to avian influenza we are continuously and actively monitoring the situation...and tomorrow, with our Member States, we are ensuring access to over 40 million doses of avian influenza vaccine to protect those most exposed. Deliveries to countries that have immediate needs are already on their way," EU health commissioner Stella Kyriakides told Reuters.
The H5N1 virus has spread across most of the US states affecting primarily poultry and in recent months over 80 dairy farms.
So far, there have been no confirmed human-to-human transfers though three people in the US were infected after exposure to infected cattle since April 1.
There are no active cases in humans or in cattle in the EU, as of early June according to the European Centre for Disease Prevention and Control (ECDC).
"Transmission to humans remains a rare event and no sustained transmission between humans has been observed so far," the ECDC said in a weekly report for June 1-7.
"The risk of zoonotic influenza transmission to the general public in EU/EEA countries is considered to be low."
The Commission, through HERA, has already secured 111 million doses from GSK and Seqirus of pandemic influenza vaccines, which can be adapted to any prevailing flu strain.
The origin of the Covid virus remains the pandemics biggest mystery. Did the virus jump to human beings from animals being sold at a food market in Wuhan, China? Or did the virus leak from a laboratory in Wuhan?
U.S. officials remain divided. The F.B.I. and the Department of Energy each concluded that a lab leak was the more likely cause. The National Intelligence Council and some other agencies believe that animal-to-human transmission is more likely. The C.I.A. has not taken a position. The question remains important partly because it can inform the strategies to reduce the chances of another horrific pandemic.
A recent Times Opinion essay by Alina Chan, a biologist refocused attention on the issue by making the case for the lab-leak theory. In todays newsletter, Ill try to lay out the clearest arguments for each side to help you decide which you consider more likely.
1. Its the norm.
Covid is part of the coronavirus family, so named because the virus contains a protein shaped like a spike. (Corona is the Latin word for crown.) In recent decades, the main way that coronaviruses have infected people is through animal-to-human transmission, which is also known as natural transmission.
The SARS virus, for example, appears to have jumped from civet cats, a relative of the mongoose, to humans in Asia in 2002. MERS seems to have jumped from camels to people in the Middle East around 2012. There is no previous example of a major coronavirus originating with a lab leak.
When youre trying to choose between a historically common explanation for a phenomenon and an unusual explanation, the common one is usually the better bet.
Before she got sick with long COVID, Vivien* was at the top of all of her classes at school. She loved playing basketball and netball and running around with her dogs she'd even take herself for runs around her family's sprawling property in regional New South Wales, just for fun. She's still only 12 but for the longest time Vivien has dreamed of being a vet when she grows up. "And she was so social," her mother Katie* says. "My husband and I are both introverts. Not V she would party every day if she could."
Now, two years since she caught SARS-CoV-2 for the first time, a "good day" for Vivien looks nothing like it used to. She's always exhausted, but her achy limbs might feel less tingly and weak; perhaps her upset stomach is calm, and her brain fog has cleared enough that she can do some school work or call a friend. On a really good day, she can manage a visit with her grandparents, so long as she's prepared to spend the evening in bed. "Long COVID makes my body feel weak," Vivien says. "But I tell myself I am still powerful."
She's strong because she has to be. Like many kids with long COVID Vivien has seen a dizzying number of doctors, not all of whom have believed or helped her. She's made the tricky transition to homeschooling, learned to manage her turbulent symptoms with pacing and medication, cried fat tears of frustration after doing too much and wiping herself out.
"I want people to know that I'm not lying, [long COVID] is real and can happen to anyone," Vivien says. "I want people to know I'm not just trying to get out of doing school or sport I wish I could do sport I wish they understood I am just trying to save myself from being stuck in bed in pain for days afterwards."
More than four years after the first COVID patients began raising the alarm that they weren't getting better, scientists are still racing to unravel the mystery of why a significant minority of people develop debilitating chronic symptoms while others seem to recover just fine. But if the plight of adults with long COVID remains poorly understood, the millions of children who have it worldwide are practically invisible, their suffering and the formative years they're losing to this disease obscured by the myths that COVID is "harmless" for kids and the pandemic is "over".
In Australia, the lack of awareness is biting in shocking ways. Too many children with long COVID are being dismissed by doctors who say there's nothing they can do to help or worse, that their pain and fatigue is "all in their head". They're being pushed out of school by teachers who don't understand why they can't come to class or run around with their peers. Their parents have been gaslighted and blamed, too, not just by medical professionals but their closest friends and family. And experts are concerned that all this ignorance and apathy and the unwillingness of governments to do more to curb COVID transmission is exposing a generation of children to the same chronic illness and disability, with potentially devastating consequences.
"These kids' worlds just get very small, very quickly," says David Putrino, who runs a long COVID clinic as director of rehabilitation innovation for the Mount Sinai Health System in New York. "We see kids missing school, being unable to participate in sports, we see social isolation." Long COVID is "a lot more complicated and more brutal" for young people, he says adults tend to be better able to navigate the medical intricacies and politics of their illness. "I don't like comparative suffering as a concept but I do know that kids are having a harder time with it because people seem to be less understanding of it."
A crucial reason paediatric long COVID has been overlooked is that children generally suffer less severe acute infections than adults. Governments and public health agencies have also been "pushing the narrative" that the only negative possible outcome of catching COVID is death, Dr Putrino says. "We looked at the acute phase and said, 'This doesn't seem so bad for kids', and we forgot about the cumulative risks over time." It doesn't matter how mild your acute COVID infection is, he says: "You have the same risk of developing long COVID. And I say 'cumulative' because the latest data shows us that with every reinfection, your risk of long COVID increases."
Getting a handle on the scale of the problem is difficult because prevalence estimates of long COVID in children vary widely, though many researchers believe it likely affects 15 per cent of kids who catch the virus. While some experts have argued it is "rare" and not a concern for most families, others insist even 1 per cent is significant given huge swathes of the population are getting (re)infected and the impacts of long COVID are so severe. In the UK, for instance, the number of children reporting they have long COVID almost doubled in the year to March 2024, with nearly one in five revealing their symptoms limited their ability to undertake day-to-day activities "a lot".
As for what it looks like, long COVID can affect multiple organ systems and trigger a constellation of symptoms that can last for months or years: the most common are fatigue, including post-exertional malaise (PEM) or "crashing" after even light activity; cognitive dysfunction and headaches; gastrointestinal issues and allergic reactions; nerve and muscle pain; dysautonomia; and shortness of breath. These symptoms overlap with those of myalgic encephalomyelitis/chronic fatigue syndrome, to the extent that many long COVID patients meet ME/CFS diagnostic criteria, their fatigue and PEM stopping them from living their normal lives well beyond six months.
And if the causes of long COVID sound complex, it's because they are. Researchers have zeroed in on several likely mechanisms, including viral persistence; inflammation and immune dysregulation; blood clotting and coagulation issues; organ damage; autoimmunity; reactivation of latent viruses like Epstein-Barr; and disrupted brainstem signalling.
Still, there is a serious lack of research on long COVID in children, particularly in Australia, which is concerning because, as a parliamentary inquiry last year heard, young people may be at greater risk of repeated infections as they spend so much time in crowded spaces like schools, and they have lower rates of vaccination than adults.
But identifying these kids in the first place can be challenging, raising concerns many are being missed or misdiagnosed. Doctors say it's common for children to present initially with gastrointestinal issues complaints of an upset stomach, usually and only with careful questioning does the full picture of their illness become clear. "It's surprising how profoundly long COVID can impact a child's life, and how much inquiry you have to do to actually work that out," says Michelle Scoullar, a Melbourne-based paediatrician at Clinic Nineteen, a specialist practice that sees long COVID patients by telehealth.
Because Dr Scoullar's patients are so resilient, she says, they'll often tell her at the start of an appointment that they're "doing okay", maybe even improving. But with deeper probing she'll discover that "okay" is anything but: they're not just struggling to get to school, they don't have the energy to get to the bathroom by themselves. "Improving" by their standards might mean they were able to spend 20 minutes at the dinner table one evening, but pretty much the rest of the week on the sofa or in bed. "We've got kids missing out on large chunks of their childhood," she says. "And the social, developmental and educational impacts of that can last years."
One of the things that shocks Dr Scoullar most, though, is how many of her patients have struggled with other doctors, especially paediatricians. Instead of kindness and support, she says, "They get judgement, ignorance and not just unhelpful advice, but incorrect and harmful advice. Many of the children I have seen have been told to just rest up, try a bit harder, get back to exercise. They're told, 'You're not doing enough and that's why you're feeling so tired'," she says. "And that's just completely unacceptable."
Katie learned that the hard way, riding a "rollercoaster of GPs" in the months after Vivien fell ill. The "biggest problem" is that many GPs don't understand what long COVD is, she says, and some are reluctant to refer to specialists.
The first GP they saw told Katie that "kids don't get long COVID" so she should just keep an eye on Vivien. Another listened as she explained her daughter's symptoms and insisted there was nothing wrong, it was "just a bad respiratory season". "We need to educate GPs because they're gatekeepers," Katie says. "Once we found a GP who was humble enough to admit she didn't know what was happening, things got better."
But specialists weren't much help, either. One of the two times Katie has cried about a doctor was after an appointment with a paediatric neurologist in Sydney, who she hoped would have answers for Vivien's headaches and lost sense of smell. Instead, the doctor shrugged and said there was nothing much she could do, just give it more time. Katie was stunned; she'd waited eight months and paid nearly $800 for the appointment she didn't need counselling on patience. "That was the day that broke me," she says. "We were walking back to the car, four hours from home, and I just could not stop crying. I desperately wanted that neurologist to be part of the solution. If we could just fix the headaches"
Mark Donohoe hears stories like these every week. An integrative GP who has been treating people with ME/CFS for 40 years, Dr Donohoe says a common stumbling block for kids with long COVID is that standard blood tests will often come back normal and many GPs and paediatricians don't know to check for postural orthostatic tachycardia syndrome (POTS), a type of dysautonomia common among long COVID patients that can cause a rapid increase in heart rate on standing, dizziness, headaches and fatigue. Delays in getting diagnosed can be costly, he says. "The longer you've been sick, the longer it takes to recover function."
But because research on long COVID is still emerging, time-poor doctors can lose their curiosity about what's happening for their patients, Dr Donohoe says, not realising supplements, medication and lifestyle interventions can dramatically improve their quality of life. They'll say, "It's long COVID, the official answer is there's nothing to do," he says. "And they tell the parents, 'Just get them up and get them active' and that's the advice that really exacerbates things." Because if a child who suffers from post-exertional malaise (PEM) is pushed beyond their capacity, they can deteriorate rapidly.
Crucially, PEM isn't "normal" fatigue; it's not just feeling tired after a big day or a sign a child is out of shape. It's a worsening of symptoms after physical or cognitive activity a failure of the immune system and metabolism to meet energy demands. It also looks different in every patient: some can't brush their teeth without triggering it, while others might be able to get to school but then suffer a crash that lasts for days as a result. And for many people with long COVID and ME/CFS, exercise is a sure-fire way to provoke PEM, which is why clinical guidelines in the US and UK advise doctors not to recommend it without strict supervision.
Australian guidelines seem to be stuck in the past. The current clinical guidelines have faced sustained criticism for promoting graded exercise therapy since they were published in 2002. And the Royal Australian College of General Practitioners' new guidance on incremental physical activity for ME/CFS points to the controversial PACE trial a 2011 study that claimed patients who did graded exercise and psychotherapy made impressive recoveries but does not mention its methodology was found to be flawed and its findings exaggerated.
RACGP President Nicole Higgins says the guide clearly states that "this approach will not be suitable for all patients" and "does not purport to be a guideline for the comprehensive management" of ME/CFS. But patients and advocacy groups have argued it ignores the science of PEM and downplays the risk of harm to people who suffer it.
Graded exercise therapy can be appropriate for some children with long COVID and ME/CFS, says Todd Davenport, a physical therapist and exercise scientist at the University of the Pacific in California. But "it really takes a clinician who is familiar with long COVID to first determine when working out will not work out".
Instead of guiding patients to exercise, Dr Davenport says, GPs should first establish whether PEM is a problem, then look at treating its underlying causes. "I always suggest referring to experts who are in the best position to help the patient and also to support the GP," he says. If they determine that exercise could be helpful, he says, it should be closely monitored to avoid triggering PEM.
Aside from prescribing unqualified exercise, Dr Donohoe says one of the "worst" decisions a doctor can make about a child with long COVID is that there's nothing wrong with them and "they need to see a psychologist". For one thing, it ignores the thousands of peer reviewed studies documenting the disease processes of long COVID. But it's a pivotal moment, he says, "where what we're really saying in medicine is, 'We haven't got a clue what's going on but this may make you feel better'. I think that's the point where [conditions like long COVID and ME/CFS] get converted into a psychological or psychiatric disorder."
Sometimes that conversion happens terrifyingly fast. For three months after Jack* caught COVID last May he was in and out of the emergency department at a Perth hospital with 10 out of 10 stomach pain and fatigue so crushing he couldn't walk.
Now aged 13, Jack was a fit and talented athlete whose life revolved around sports, especially cricket, rugby and tennis. It's a major reason his father Brett* was so shocked when, during one of their visits to the hospital, a neurologist performed a few reflex tests on Jack, concluded his nerves were fine, then announced his symptoms were psychological.
"He said, 'Listen, it's all in your son's head, he has something called FND functional neurological disorder'," says Brett. "I said, 'Is that psychosomatic?' and he said, 'Well, we don't call it that anymore'." Brett now knows that FND is a controversial diagnosis that should only be made after excluding other possible medical conditions. Numerous long COVID patients have reported being misdiagnosed with FND a precarious situation, experts say, because it can block their access to testing and treatment. But Jack was devastated. "He was crying because he's the kid who goes to rugby with a migraine he'll push through anything," Brett says. "So for the neurologist to say it was all in his head, I think that broke him a bit."
A couple of months later, having dug deep into the research on long COVID, Brett took Jack to Europe, where he underwent several cycles of an expensive blood filtering treatment called H.E.L.P. apheresis. The enormous cost about $30,000 all up should have ruled the trip out, but with the generous support of family and friends, they raised enough money to go.
Brett felt sure it was the best next step; taking vitamins and supplements helped Jack to a point, but his progress had stalled, and local doctors weren't offering anything other than paracetamol. "We were reaching the six-month mark and I knew we had to act quickly," Brett says. "[Jack] is a really, really good sportsman, I didn't want him to live with a disability."
For long COVID patients, apheresis involves removing the blood, filtering it of SARS-CoV-2 spike proteins and so-called microclots that may be clogging capillaries and stopping oxygen from getting to tissues, then returning it to the body. The microclot hypothesis as a driver of long COVID remains just that, and some experts have warned there is little published evidence showing apheresis is an effective treatment. While some patients say it has helped them almost fully recover, others have reported it made no difference or in some cases made them worse, so those who decide to have it are gambling that it will work.
Jack made a remarkable recovery. "I got a lot better like, 90 per cent better," he says. "I was able to play tennis and go surfing and all of that." He's since suffered a disappointing relapse but his symptoms aren't as bad as they were before apheresis. In all, it was a positive experience, says Brett, who is "seriously considering" another trip overseas.
Still, he's frustrated that he felt forced to pursue an unapproved treatment on the other side of the world and that most doctors' understanding of long COVID lags so far behind the science. "It's been really tough to sit on the margins of what people think is conspiracy and what is science and logic," he says. "Even some of my closest friends have been fighting me on it unwilling to engage in the conversation, simply because it went against the narrative."
But then ignorance and judgement can often be found in the most unlikely places. Leah's* son Sam* had been struggling with long COVID and POTS for about six months when his Sydney public high school rang her to say he wasn't meeting attendance requirements and would need to switch to distance education.
At that point Sam was pushing himself to get through two or three classes a day, even though it seemed to be making him sicker he was desperate not to fall behind academically and, like most teenagers, loved spending time with his friends. "His number-one goal is just to be back at school," Leah says. But although his doctors have provided medical certificates, "the whole way along the school has acted suspiciously, as if he's just avoiding school for the sake of it."
One complicating factor is that Sam often appears fine there's a reason complex chronic conditions like long COVID and ME/CFS are called "invisible" illnesses. Other people don't realise that basic activities drain his energy and flare his symptoms, says Leah, who quit her full-time job to look after him. "Just going up the stairs is hard, he can't shower every day, and when he's not at school he spends most of his time in bed. But if someone comes for a quick visit he can still be pretty witty he masks his symptoms so well so they assume he's fine."
Even close family and friends don't truly get it. "We've been told that COVID is over and everyone just wants to ignore it and pretend it's not there," Leah says. "If it was cancer, people would be checking in and have some level of understanding. But long COVID is this slightly difficult topic that everyone avoids."
After deciding that distance education wasn't going to suit Sam and that his school's attempt to push him out was "totally inappropriate" Leah was on the phone to one of the principals one day when she casually mentioned that she'd sought legal advice to better understand their options. "It was like I'd dropped a bomb," she says. They were suddenly happy to make accommodations and allow Sam to keep coming on a reduced schedule, she says one lesson a day.
Things have since calmed down, but for a while Sam's teachers kept pushing him to try harder, to do more, Leah says, which just piled on even more pressure. "They also didn't properly brief all his teachers. At one stage one suggested in front of the whole class that he was just acting like a bit of a rebel."
Accounts like these are disturbingly common: parents in several states say kids are being made to do vigorous exercise in PE class, urged to stay at school longer than their doctors advise, and refused special provisions for exams. In Dr Donohoe's experience, public schools are generally better than private schools at supporting young people with long COVID and ME/CFS, even in simple ways like finding them quiet spaces to lay down and rest when they need to.
Dr Scoullar has noticed similar patterns. Too often her long COVID patients tell her that their inability to get to school or stay for a full day is "a barrier that schools are very unwilling to work around", she says. "And I have heard of at least a few children who have been asked to leave because they are no longer meeting the school's requirements."
For some students, shifting to distance education is a positive change because it gives them more control over their time and energy. But Sam wouldn't have coped well with the social isolation. "The whole thing has been utterly devastating on so many levels," Leah says of her son's illness. "I'm grieving for the life that he's lost and the life he should be living, because he's missing his teenage years. And I try to be positive; I do believe he can recover. But there are just so many unknowns and so many battles I'm constantly in battles with the school, to get medical letters, and continually having to advocate for him."
It's one of the greatest challenges children with long COVID and their families are grappling with: not knowing when or if they'll recover. Tied to that is the financial pressure so many parents are under: between healthcare appointments, medication and supplements, some are stretching their budgets to spend hundreds or thousands of dollars every month in hopeful bids to get their kids well.
For others who can barely afford to buy groceries, just getting to a GP is out of the question, so thinking about the future is frightening. "You live with this fear of, what's going to happen? What if I have a heart attack or lose more function," says Amy*, who has two kids with ME/CFS and long COVID and also has long COVID herself. "Probably my biggest fear is that this is life from now on."
Some children do recover over time, says Dr Putrino, whose clinic recommends various different therapeutic approaches: autonomic rehabilitation strategies like breathwork and gentle exercise to calm and regulate the nervous system, pacing to manage energy levels, and medication and supplements to target particular symptoms. "In other cases we struggle. Unfortunately, we have a handful of bed-bound patients that no matter what we try, we just can't seem to move the needle," he says. "And so we just do what we always do with any patient whether it be a stroke, or a traumatic brain injury or a long COVID adult we say, 'We're here with you, and we're going to keep trying different things, there's lots of different things to try, and we're just going to try and find the balance'."
While the world waits for clinical trials to shed light on effective treatments, patients say doctors must get up to speed on long COVID at a minimum, GPs need comprehensive guidelines and training on how to diagnose and help patients manage their illness. The final report of Australia's parliamentary inquiry into long COVID recommended the same.
In its response, however, the government merely acknowledged the critical role of primary care providers and did not commit any additional resources for addressing the issues raised. RACGP President Nicole Higgins says funding for the National Clinical Evidence Taskforce's COVID guidelines has also been discontinued. "The RACGP has advocated for government funding for the establishment of living guidelines across a range of topics," she says, "and this is a case study for why such funding is so necessary."
Some experts are also concerned about Australia's COVID vaccine strategy given evidence suggests that vaccination reduces the risk of long COVID, including in young people. The Australian Technical Advisory Group on Immunisation (ATAGI) has previously recommended children aged five and over receive a primary course but now recommends that those under 18 not be vaccinated unless they are at increased risk of severe disease.
"ATAGI's current recommendations acknowledge that overall, severe COVID-19 in children is extremely rare, even among unvaccinated children and those with underlying conditions," a spokesperson for the Department of Health told ABC News. "ATAGI will continue to monitor and review all emerging evidence on the use of COVID-19 vaccines, including the emerging evidence on long COVID as appropriate."
For Dr Putrino, one of the biggest hurdles remains the misconception that children don't suffer long-term consequences after catching the virus. "I think that there's an enormous amount of education that needs to happen to inform parents that yes, your kid can get long COVID. Yes, it could be the reason why they're struggling in school right now," he says. "Get it checked out don't sit around and just assume that they're going through puberty or they're just extra moody; don't sleep on it. Make sure that a doctor evaluates them. Make sure it's a doctor that's knowledgeable and educated about long COVID."
He also worries that not enough is being done to prevent COVID transmission in the community, particularly in schools. Governments could be scrambling to improve indoor air quality with good ventilation, air purifiers and far UV light, he says. But for the most part their approach has been to just let the virus rip and watch the numbers of people with long COVID rise. "I just worry we're going to have a generation of kids who have a post-acute infection syndrome because we failed to protect them," Dr Putrino says, "because we told this lie over and over again that kids have nothing to worry about with COVID."
It's one of the things Katie is most angry about: that Vivien caught COVID at school before she was able to be fully vaccinated. Her quality of life has improved "out of sight" in the two years since then, she says, largely because they finally found a compassionate paediatrician and a couple of other specialists who understand her illness, who want to help.
"But I can see a world where I'd have to be a full-time carer," she says. "That's the thing that's really starting to scare me, is: what does the future look like? All V wants to do is be a vet that's all she's wanted since she was five. But what if she can't? I'm trying to make decisions about our finances now so that we can help her in the future, because I can't imagine that she's ever going to get back to 100 per cent, at least not at this trajectory."
And that, she says, is what most people fail to understand about long COVID: how serious it is, how much is at stake how fast a healthy girl with boundless energy and big dreams can lose it all. "They think it's incredibly rare, or they don't understand that just because you had one 'nice' bout of COVID doesn't mean the next one isn't going to do permanent damage," Katie says. "People just underestimate it; they assume it won't happen to them and if it does, that someone will be there to help them."
*Names have been changed at families' request so they could speak frankly without fear of reprisal.
To Washingtons alarm, Chinas offers of assistance were tilting the geopolitical playing field across the developing world, including in the Philippines, where the government faced upwards of 100,000 infections in the early months of the pandemic.
The US relationship with Manila had grown tense after the 2016 election of Mr Duterte.
A staunch critic of the US, he had threatened to cancel a key pact that allowed the US military to maintain legal jurisdiction over American troops stationed in the country.
Mr Duterte said in a July 2020 speech that he had made a plea to Mr Xi for the Philippines to be at the front of the line as China rolled out vaccines.
He vowed in the same speech that the Philippines would no longer challenge Beijings aggressive expansion in the South China Sea, upending a key security understanding Manila had long held with Washington.
China is claiming it. We are claiming it. China has the arms, we do not have it. Mr Duterte said. So, it is simple as that.
Days later, Chinas foreign minister announced Beijing would grant Mr Dutertes plea for priority access to the vaccine, as part of a new highlight in bilateral relations.
Chinas growing influence fuelled efforts by US military leaders to launch the secret propaganda operation Reuters uncovered.
We didnt do a good job sharing vaccines with partners, a senior US military officer directly involved in the campaign in South-east Asia told Reuters. So what was left to us was to throw shade on Chinas.
US military leaders feared that Chinas Covid-19 diplomacy and propaganda could draw other South-east Asian countries, such as Cambodia and Malaysia, closer to Beijing, furthering its regional ambitions.
A senior US military commander responsible for South-east Asia, Special Operations Command Pacific General Jonathan Braga, pressed his bosses in Washington to fight back in the so-called information space, according to three former Pentagon officials.
The commander initially wanted to punch back at Beijing in South-east Asia.
The goal: to ensure the region understood the origin of Covid-19 while promoting scepticism towards what were then still-untested vaccines offered by a country that they said had lied continually since the start of the pandemic.
A spokesperson for Special Operations Command declined to comment.
At least six senior State Department officials responsible for the region objected to this approach.
A health crisis was the wrong time to instil fear or anger through a psychological operation, or psyop, they argued during Zoom calls with the Pentagon.
Were stooping lower than the Chinese and we should not be doing that, said a former senior State Department official for the region who fought against the military operation.
While the Pentagon saw Washingtons rapidly diminishing influence in the Philippines as a call to action, the withering partnership led American diplomats to plead for caution.
The relationship is hanging by a thread, another former senior US diplomat recounted. Is this the moment you want to do a psyop in the Philippines? Is it worth the risk?
In the past, such opposition from the State Department might have proved fatal to the programme.
Previously in peacetime, the Pentagon needed the approval of embassy officials before conducting psychological operations in a country, often hamstringing commanders seeking to counter Beijings messaging, three former Pentagon officials told Reuters.
But in 2019, before Covid-19 surfaced in full force, then-Secretary of Defence Mark Esper signed a secret order that later paved the way for the launch of the US military propaganda campaign.
The order elevated the Pentagons competition with China and Russia to the priority of active combat, enabling commanders to sidestep the State Department when conducting psyops against those adversaries.
The Pentagon spending Bill passed by Congress that year also explicitly authorised the military to conduct clandestine influence operations against other countries, even outside of areas of active hostilities.
Mr Esper, through a spokesperson, declined to comment. A State Department spokesperson referred questions to the Pentagon.
In spring 2020, special ops commander Gen Braga turned to a cadre of psychological-warfare soldiers and contractors in Tampa to counter Beijings Covid-19 efforts.
Colleagues say Gen Braga was a long-time advocate of increasing the use of propaganda operations in global competition.
In trailers and squat buildings at a facility on Tampas MacDill Air Force Base, US military personnel and contractors would use anonymous accounts on X, Facebook and other social media to spread what became an anti-vax message.
The facility remains the Pentagons clandestine propaganda factory.
Psychological warfare has played a role in US military operations for more than a hundred years, although it has changed in style and substance over time.
So-called psyopers were best known following World War II for their supporting role in combat missions across Vietnam, Korea and Kuwait, often dropping leaflets to confuse the enemy or encourage their surrender.
After the Al-Qaeda attacks of 2001, the US was fighting a borderless, shadowy enemy, and the Pentagon began to wage a more ambitious kind of psychological combat previously associated only with the CIA.
The Pentagon set up front news outlets, paid off prominent local figures, and sometimes funded television soap operas in order to turn local populations against militant groups or Iranian-backed militias, former national security officials told Reuters.
Unlike earlier psyop missions, which sought specific tactical advantage on the battlefield, the post-9/11 operations hoped to create broader change in public opinion across entire regions.
By 2010, the military began using social media tools, leveraging phony accounts to spread messages of sympathetic local voices themselves often secretly paid by the United States government.
As time passed, a growing web of military and intelligence contractors built online news websites to pump US-approved narratives into foreign countries.
Today, the military employs a sprawling ecosystem of social media influencers, front groups and covertly placed digital advertisements to influence overseas audiences, according to current and former military officials.
Chinas efforts to gain geopolitical clout from the pandemic gave Gen Braga justification to launch the propaganda campaign that Reuters uncovered, sources said.
By summer 2020, the militarys propaganda campaign moved into new territory and darker messaging, ultimately drawing the attention of social media executives.
In regions beyond South-east Asia, senior officers in the US Central Command, which oversees military operations across the Middle East and Central Asia, launched their own version of the Covid-19 psyop, three former military officials told Reuters.
Although the Chinese vaccines were still months from release, controversy roiled the Muslim world over whether the vaccines contained pork gelatin and could be considered haram, or forbidden under Islamic law.
Sinovac has said that the vaccine was manufactured free of porcine materials. Many Islamic religious authorities maintained that even if the vaccines did contain pork gelatin, they were still permissible since the treatments were being used to save human life.
The Pentagon campaign sought to intensify fears about injecting a pig derivative.
As part of an internal investigation at X, the social media company used IP addresses and browser data to identify more than 150 phony accounts that were operated from Tampa by US Central Command and its contractors, according to an internal X document reviewed by Reuters.
Can you trust China, which tries to hide that its vaccine contains pork gelatin and distributes it in Central Asia and other Muslim countries where many people consider such a drug haram? read an April 2021 tweet sent from a military-controlled account identified by X.
The Pentagon also covertly spread its messages on Facebook and Instagram, alarming executives at parent company Meta who had long been tracking the military accounts, according to former military officials.
One military-created meme targeting Central Asia showed a pig made out of syringes, according to two people who viewed the image. Reuters found similar posts that traced back to US Central Command.
One showed a Chinese flag as a curtain separating Muslim women in hijabs and pigs stuck with vaccine syringes. In the centre is a man with syringes; on his back is the word China.
It targeted Central Asia, including Kazakhstan, Kyrgyzstan and Uzbekistan, a country that distributed tens of millions of doses of Chinas vaccines and participated in human trials.
Translated into English, the X post read: China distributes a vaccine made of pork gelatin.
Facebook executives had first approached the Pentagon in the summer of 2020, warning the military that Facebook workers had easily identified the militarys phony accounts, according to three former US officials and another person familiar with the matter.
The government, Facebook argued, was violating Facebooks policies by operating the bogus accounts and by spreading Covid-19 misinformation.
The military argued that many of its fake accounts were being used for counterterrorism and asked Facebook not to take down the content, according to two people familiar with the exchange.
The Pentagon pledged to stop spreading Covid-19-related propaganda, and some of the accounts continued to remain active on Facebook.
Nonetheless, the anti-vax campaign continued into 2021 as Mr Biden took office.
Angered that military officials had ignored their warning, Facebook officials arranged a Zoom meeting with Mr Bidens new National Security Council shortly after the inauguration, Reuters learnt. The discussion quickly became tense.
It was terrible, said a senior administration official describing the reaction after learning of the campaigns pig-related posts. I was shocked. The administration was pro-vaccine and our concern was this could affect vaccine hesitancy, especially in developing countries.
By spring 2021, the National Security Council (NSC) ordered the military to stop all anti-vaccine messaging.
We were told we needed to be pro-vaccine, pro all vaccines, said a former senior military officer who helped oversee the programme.
Even so, Reuters found some anti-vax posts that continued through April and other deceptive Covid-19-related messaging that extended into that summer.
Reuters could not determine why the campaign didnt end immediately with the NSCs order. In response to questions from Reuters, the NSC declined to comment.
The senior Defence Department official said that those complaints led to an internal review in late 2021, which uncovered the anti-vaccine operation.
The probe also turned up other social and political messaging that was many, many leagues away from any acceptable military objective. The official would not elaborate. The review intensified the following year, the official said, after a group of academic researchers at Stanford University flagged some of the same accounts as pro-Western bots in a public report.
The high-level Pentagon review was first reported by the Washington Post, which also reported that the military used fake social media accounts to counter Chinas message that Covid-19 came from the United States.
But the Post report did not reveal that the programme evolved into the anti-vax propaganda campaign uncovered by Reuters.
The senior defence official said the Pentagon has rescinded parts of Mr Espers 2019 order that allowed military commanders to bypass the approval of US ambassadors when waging psychological operations.
The rules now mandate that military commanders work closely with US diplomats in the country where they seek to have an impact.
The policy also restricts psychological operations aimed at broad population messaging, such as those used to promote vaccine hesitancy during Covid-19.
The Pentagons audit concluded that the militarys primary contractor handling the campaign, General Dynamics IT, had employed sloppy tradecraft, taking inadequate steps to hide the origin of the fake accounts, said a person with direct knowledge of the review.
The review also found that military leaders didnt maintain enough control over its psyop contractors, the person said.
A spokesperson for General Dynamics IT declined to comment.
Nevertheless, the Pentagons clandestine propaganda efforts are set to continue.
In an unclassified strategy document in 2023, top Pentagon generals wrote that the US military could undermine adversaries such as China and Russia using disinformation spread across social media, false narratives disguised as news, and similar subversive activities weaken societal trust by undermining the foundations of government
And in February, the contractor that worked on the anti-vax campaign General Dynamics IT won a US$493 million (S$667.5 million) contract. Its mission: to continue providing clandestine influence services for the military. REUTERS
SINGAPORE An article in a reputable journal that media outlets around the world have reported as linking Covid-19 vaccines with excess deaths has drawn flak from doctors and scientists, and has resulted in the journal tweeting a statement that the media have misinterpreted the article.
The piece, which appeared on June 3 in BMJ Public Health, one of the titles published by The BMJ, said the 47 Western countries the authors looked at had the highest number of excess deaths in 2021, when both containment measures and vaccines were used.
The article was submitted by three paediatric oncologists from the Princess Maxima Centre for paediatric oncology in the Netherlands and an independent researcher.
They also spoke of the lack of transparency when batch-dependent levels of toxicity were discovered in the mRNA vaccines in Denmark, a well as the simultaneous onset of excess mortality and Covid-19 vaccination in Germany.
The BMJ posted on X on June 7 to say that while various news outlets have claimed the research implies the vaccines had caused excess deaths, the study does not establish any such link.
On June 11, the childrens cancer centre said on its website: The Princess Maxima Centre distances itself from the publication Excess mortality across countries in the Western World since the Covid-19 pandemic: Our World in Data estimates of January 2020 to December 2022.
It said serious questions have arisen regarding the publication, so it will further investigate the scientific quality of this study and it regrets the impression that the importance of vaccinations was being questioned.
It said the focus of the piece had shifted from the original, which was to look at the impact of Covid-19 measures on deaths in children with cancer in low-income countries in a direction that we felt was too far from our expertise: paediatric oncology. We are not experts in epidemiology, nor do we want to give that impression.
It added: We should have been more alert to the formation and results of this publication and will further investigate the way it was created. If it turns out that carelessness was involved in the realisation of this publication, it will of course be withdrawn.
The Straits Times had run an article on the piece on June 8 quoting several experts here who said it was unbalanced and had pointed out that correlation is not the same as causation.
The Ministry of Health had also weighed in to say: Numerous studies have demonstrated how Covid-19 vaccination had lowered the risk of death as compared with not being vaccinated.
Retraction Watch, a blog that reports on retractions of scientific papers, said that scientists had critiqued the studys methodology.
It quoted Mr Ariel Karlinsky, an economist at the Hebrew University of Jerusalem in Israel, whose work the study cited, saying on X: The onus here is on BMJ Public Health, which published a really bad paper with a misleading title.
Professor Hsu Li Yang, an infectious diseases consultant who is vice-dean of global health at the NUS Saw Swee Hock School of Public Health, wrote to Professor Helena Legido-Quigley, chair of the advisory board of BMJ Public Health, expressing his unease with the piece.
In an e-mail sent on June 10, parts of which ST has seen, he said: I am somewhat surprised and dismayed that the BMJ Public Health editorial team allowed the article to be published as it currently stands... The discussion is replete with misleading statements and conclusions that the data and results do not strongly support (or even support).
He pointed out several such statements, including the claim that scientific consensus on the effectiveness of non-pharmaceutical interventions in reducing viral transmission is currently lacking. He said: This is so clearly wrong, given the plethora of original research and meta-analyses.
He added that the researchers also quoted articles that have been debunked.
On why he sent the e-mail to the journal, Prof Hsu said: I felt the authors written conclusions were not supported by the data and authors own analyses, and also because the article given the high publicity by major news outlets could potentially further undermine confidence in vaccines both specific to Covid-19 and in general.
