Test results, case totals and wastewater analysis all show that San Diego County, like much of the country, is experiencing an increase in coronavirus activity.But experts say the trend looks like the typical summer uptick that has occurred, to one extent or another, since COVID-19 arrived in 2020.
In its latest respiratory report released Thursday, the county shows that 8 percent of lab-performed COVID-19 tests came back positive in the first week of June, a number that is about double what it was in May. And the amount of coronavirus material detected at the Point Loma sewage plant has also increased, from an estimate of about 1.9 million copies of viral genetic code in late May to 3.9 million in early June.
But those moves come nowhere near hitting highs set during the COVID-19 pandemic and, thus far, hospitals report that they are taking the increase in stride.
Dr. Craig Uejo, chief quality officer at Scripps Health, said this week that while the organizations five hospitals do have more patients with COVID-19 admitted, the increase has been a blip.
We were running in the low single digits for quite a few weeks there since the winter ended, and were up to about 16 now, Uejo said. So, its a slight increase but those numbers would have to be much, much higher to scare us.
As hospitals are no longer required to report daily COVID-19 patient totals to public health departments, it is not clear whether Scripps experience is the case at other providers, though officials with Sharp HealthCare and UC San Diego Health said this week that their admission totals have been essentially flat.
We have seen an uptick in COVID cases in the community, but hospitalizations have remained low even lower than this time last year, said Dr. Chris Longhurst, chief medical officer at UC San Diego Health.
According to the countys monthly COVID-19 tracking report, the region averaged 58 confirmed COVID-19 cases per day in the first full week of June compared to 25 per day in the first full week of May. That average case volume, noted Dr. Wilma Wooten, the countys public health officer, is actually slightly lower than it was during the same week June 2 through June 8, last year. Indeed, county records that track cases by date of symptom onset, show that the county average was 63 cases per day during the same week last year.
For the past four years weve had summer surges of COVID-19 and, while we will have a surge this year, it may not be as high as last year just as last year was not as high as the prior summers surge, Wooten said.
Virologists say a new coronavirus subvariant dubbed PK.3 is driving the current increase in activity due to a fresh set of mutations to its spike protein, the structure on the viruss surface that controls its ability to enter human cells.
Computational biologist Karthik Gangavarapu, an expert who works with immunologist Kristian Andersen at San Diegos Scripps Research, noted that just like the subvariants that have caused surges in previous summers, PK.3 is a stepwise evolution of the original Omicron strain that caused the pandemics biggest surge in cases in late 2021 and early 2022.
I think this is what we would expect from a new variant, two mutations primarily in the spike region that are sort of conferring this variant to evade immunity better than the previously, but this is not a dramatic shift, he said.
This falls booster shot, which is still being formulated, he said, is likely to confer significant protection even if the type of virus circulating in the fall is not a perfect match to the genetic fingerprints used to make the vaccine.
The protective antibodies that vaccines cause a persons immune system to produce, he noted, are not binary. Those that are a close but not perfect match still help.
In a recent study published in the International Journal of Impotence Research, a group of researchers assessed the relationship between Coronavirus Disease-19 (COVID-19) and ischemic priapism in patients treated at three university hospitals in Egypt between April 2020 and June 2022. Ischemic priapism is a rare condition where blood gets trapped in the erection chambers of the penis.
Study:The relationship between Coronavirus Disease-19 (COVID-19) and ischemic priapism: a case-control study. Image Credit:Design_Cells/ Shutterstock
On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. The disease has profoundly impacted medical, social, economic, and environmental aspects of life, leading to widespread lockdowns. By March 24, 2024, the WHO reported 775,132,086 confirmed cases and 7,042,222 deaths. COVID-19 symptoms vary widely, with fever, cough, and anosmia being common. Severe cases often exhibit hypercoagulability, increasing the risk of thromboembolic complications, including ischemic priapism, a urological emergency caused by sinusoidal thrombosis. Further research is needed to determine whether the association between COVID-19 and ischemic priapism is causal or merely coincidental.
The present study retrospectively reviewed patients with priapism at three university hospitals from April 2020 to June 2022. During the COVID-19 pandemic, all emergency department patients were assessed for COVID-19 using chest computed tomography (CT), complete blood count (CBC), C-reactive protein (CRP), and D-dimer tests, followed by polymerase chain reaction (PCR) for suspicious cases. A positive PCR test confirmed COVID-19 positivity.
Priapism patients were evaluated for duration, pain, drug history, trauma, systemic disease, and recurrence. After informed consent, cavernosal aspiration was performed by inserting a needle into the penile cavernosal tissue, aspirating blood, and irrigating with saline and Ephedrine hydrochloride until detumescence. Blood samples were analyzed, and a distal shunt procedure was performed if detumescence was not achieved within an hour.
Data collected included age, co-morbidity, priapism type, episode duration, cavernous blood gases, chest CT findings, lymphocyte percentage, CRP, D-dimer levels, COVID-19 course, priapism management, and follow-up erectile function. Patients were classified into two groups based on COVID-19 presence, and criteria were compared, including erectile function assessed using the International Index of Erectile Function-5 (IIEF-5). Statistical analysis used the Kolmogrov-Smirnov Z, t-tests, Mann-Whitney U, and Chi-square tests, with significance at p 0.05.
During the study period, 43 patients with ischemic priapism were diagnosed, with a median age of 36 years and a median priapism duration of 8 hours. Among these patients, 2.3% had chronic kidney disease, 6.97% had hypertension, and 16.3% had diabetes. The patients were divided into two groups: 30 patients with ischemic priapism only (Group I) and 13 patients with both ischemic priapism and COVID-19 (Group II).
Cavernosal aspiration was successful in 83.3% of patients in Group I and 92.3% in Group II, showing no significant difference (P = 0.4). Recurrence of priapism occurred in 16.7% of patients in Group I, while no recurrences were observed in Group II (P = 0.1). At the last follow-up, moderate erectile dysfunction (ED) developed in 6.7% and severe ED in 13.3% of patients in Group I. In Group I, those with severe ED were managed with a distal shunt and prepared for penile prosthesis placement, except for one patient who developed moderate ED after the distal shunt. In Group II, one patient (7.7%) developed severe ED after distal shunting and was also prepared for penile prosthesis implantation. The median duration of ischemic priapism was significantly longer in patients with severe ED compared to those without (19 vs. 7 hours, P = 0.01).
There were no statistically significant differences between the two groups in terms of age (P = 0.8), required priapism management (P = 0.4), priapism recurrence (P = 0.1), and ED severity (P = 0.5).
In Group II, priapism was the main presenting symptom in 30.8% of patients, leading to the incidental diagnosis of COVID-19. Other patients presented with varying degrees of COVID-19 symptoms: mild in 5 patients, moderate in 2 patients, and severe in 2 patients. Patients with priapism and mild COVID-19 symptoms were treated with home isolation and supportive care, including vitamin C, zinc, lactoferrin, acetylcysteine, paracetamol, and ivermectin. Those with moderate symptoms received similar treatment along with intravenous ivermectin, anticoagulants, and steroids, while severe cases were referred for hospital isolation. All COVID-19 patients recovered completely after treatment.
Patients with mild and moderate COVID-19 symptoms responded well to cavernosal aspiration, maintained erectile function, and did not experience priapism recurrence. Those with severe COVID-19 symptoms also responded well to cavernosal aspiration, with one patient developing mild ED.
To summarize, this study, the largest on ischemic priapism in COVID-19 patients, found that priapism occurred across all COVID-19 severity levels. COVID-19 did not alter priapism treatment protocols or post-treatment erectile function. The findings suggest a coincidental rather than causal relationship between COVID-19 and ischemic priapism.
Journal reference:
Stigmatising vaccination will lead to a series of consequences, such as a lower inoculation rate, the outbreak and spread of disease, social panic and insecurity, as well as crises of confidence in science and public health, Sinovac spokeswoman Yuan Youwei told Chinese media.
She said that Sinovacs corporate goal is to provide vaccines that can eradicate viruses and contribute to the health of people.
Currently we have overcome Covid, but the world is still not in peace, Yuan added.
Sinovac will continue to help people live good and prosperous lives by preventing disease. We reckon that each profession should focus on their specialities, which is the right attitude.
Edward Snowden, the American whistleblower famous for revealing his countrys surveillance and intelligence collection practices, wrote on his own X account that the US disinformation campaign is going to be taught in history classes.
If the government ever so much as breathes the word disinformation again, every journalist in the room had better turn their backs on the podium. Theyre stealing hundreds of millions of dollars from taxpayers (at a minimum!) to poison the internet, Snowden wrote in another post.
In December 2021, the Philippines received an additional shipment of Sinovac vaccines donated by the Chinese government to help the Southeast Asian country recover from the pandemic.
The US Department of Defence and State Department did not immediately respond to questions about the Reuters investigation.
The US programme started under the administration of former US president Donald Trump and continued several months into Joe Bidens presidency, according to Reuters.
According to the report, social media executives warned the Biden administration the Pentagon was trafficking in Covid-19 misinformation. The White House issued an order to ban the anti-vax effort in the spring of 2021, according to Reuters, and the Pentagon initiated an internal review.
Lu Xiang, a research fellow at the Chinese Academy of Social Sciences, said that the US would continue to use sophisticated operations to spread disinformation aimed at making up information to weaken an adversarys credibility and integrity.
The US chooses geopolitics over public health, he added. Whether the Democrats or Republicans, they will both do the same.
Lu added that at the time of the campaign, the US wasnt happy with Dutertes good relationship with China.
Wang Zichen, a research fellow at the Beijing-based Centre for China and Globalisation think tank, said that the campaign reflected a zero-sum mentality.
Washington viewed China providing life-saving vaccines to other developing countries, which had been neglected by the Trump administrations America First approach, as somehow detrimental to US interests, he said.
There can be positive outcomes from US-China competition for the world, he added.
A more constructive approach should have been for the US to respond to Chinas provision of a global public good by contributing more to the Global South in public health and other domains such as infrastructure.
Tao Lina, a Shanghai-based vaccine expert, noted that the US attempts to discredit Chinese vaccines did not create substantive damages because China was still one of the countries that recorded the highest vaccination rate.
Meanwhile, the behaviour by the US will deal a big blow to its own image, Tao added.
NEW DELHI: During the peak of the Covid-19 pandemic, the US military undertook a covert operation to counter China's increasing influence in the Philippines, a country severely impacted by the virus. This clandestine mission, which had not been previously disclosed, aimed to create doubt about the safety and efficacy of vaccines and other life-saving aid provided by China, according to a Reuters investigation. Utilising fake internet accounts that impersonated Filipinos, the military's propaganda turned into an anti-vaccine campaign. Social media posts criticised the quality of face masks, test kits, and Chinas Sinovac vaccine, which was the first available in the Philippines. The program was initiated under former President Donald Trump and continued for several months into Joe Bidens presidency. This was despite concerns expressed by social media executives to the new administration, warning that the Pentagon was spreading Covid misinformation. In spring 2021, the Biden administration issued a directive to halt the anti-vaccine effort, which also targeted vaccines made by other rivals, and the Pentagon commenced an internal review. Reuters claimed to have found at least 300 accounts on X (formerly Twitter) that fit descriptions given by former US military officials familiar with the operation in the Philippines. Most of these accounts were created in the summer of 2020 and revolved around the hashtag #Chinaangvirus, which means 'China is the virus' in Tagalog. COVID came from China and the VACCINE also came from China, dont trust China! one tweet from July 2020 read in Tagalog. The message was next to a photo of a syringe beside a Chinese flag and a rising chart of infections. Another post stated, From China PPE, Face Mask, Vaccine: FAKE. But the Coronavirus is real. After Reuters informed X about the accounts, the social media platform removed them, determining they were part of a coordinated bot campaign based on activity patterns and internal data. The US military's anti-vaccine effort began in the spring of 2020 and spread beyond Southeast Asia before being terminated in mid-2021, Reuters revealed. The campaign adapted its propaganda to local audiences across Central Asia and the Middle East, using fake social media accounts on multiple platforms to incite fear of Chinas vaccines among Muslims. A significant part of the strategy was to amplify the controversial claim that, because some vaccines contain pork gelatin, Chinas shots might be considered forbidden under Islamic law. The US military is prohibited from using propaganda to target Americans, and no evidence was found that the Pentagon targeted US citizens. Officials for both Trump and Biden did not respond to requests for comments regarding the clandestine program. A senior Defense Department official confirmed the US military engaged in secret propaganda to discredit Chinas vaccine in the developing world but refused to provide more details. A Pentagon spokeswoman stated that the US military 'uses a variety of platforms, including social media, to counter those malign influence attacks aimed at the US, allies, and partners. She added that China had started a 'disinformation campaign to falsely blame the United States for the spread of Covid-19.' In an email, the Chinese Ministry of Foreign Affairs claimed that the US government has a long history of manipulating social media and spreading misinformation. The Philippine embassy in Washington did not respond to Reuters' inquiries, including whether it was aware of the Pentagon's operation. A spokesperson for the Philippines Department of Health, however, commented, Findings by Reuters deserve to be investigated and heard by the appropriate authorities of the involved countries. Some aid workers in the Philippines reacted with outrage upon learning about the U.S. militarys propaganda effort. Upon being briefed by Reuters about the Pentagons secret anti-vaccine campaign, some American public health experts condemned the program, arguing it jeopardized civilian lives for potential geopolitical gains. They noted that a campaign designed to win hearts and minds ultimately endangered lives. I dont think its defensible, said Daniel Lucey, an infectious disease specialist at Dartmouths Geisel School of Medicine. Im extremely dismayed, disappointed, and disillusioned to hear that the US government would do that, added Lucey, a former military physician who assisted in the response to the 2001 anthrax attacks. Pandemic had hit Philippines especially hard In the wake of the US propaganda efforts, then-Philippines President Rodrigo Duterte expressed frustration over the low vaccination rates among Filipinos and threatened to arrest those who refused to get vaccinated. You choose, vaccine or I will have you jailed, Duterte said in a televised address in June 2021, wearing a face mask. There is a crisis in this country Im just exasperated by Filipinos not heeding the government. When Duterte made these remarks, the Philippines had one of the lowest vaccination rates in Southeast Asia. Only 2.1 million out of its 114 million citizens were fully vaccinatedfar below the governments target of 70 million. By this time, Covid-19 cases had exceeded 1.3 million, and nearly 24,000 Filipinos had died from the virus, contributing to the highest death rate in the region. Some Filipino healthcare professionals and former officials were shocked upon learning about the US anti-vaccine effort, which they believe exploited an already vulnerable population. Public concerns about a Dengue fever vaccine introduced in the Philippines in 2016 had already led to widespread skepticism towards vaccinations in general, said Lulu Bravo, executive director of the Philippine Foundation for Vaccination. The Pentagon campaign, she said, preyed on these fears. Why did you do it when people were dying? We were desperate, stated Dr. Nina Castillo-Carandang, a former adviser to the World Health Organisation and the Philippines government during the pandemic. We dont have our own vaccine capacity, she said, and noted that the US propaganda effort 'contributed even more salt into the wound.' The campaign also played into longstanding suspicions of China, exacerbated by Beijings aggressive actions in disputed areas of the South China Sea. Due to these suspicions, Filipinos were reluctant to trust Chinas Sinovac vaccine, which first became available in the country in March 2021, said Esperanza Cabral, a former health secretary under President Gloria Macapagal Arroyo. Cabral mentioned that she was unaware of the US militarys secret operation.
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Metro
By Vaughn Golden and Jorge Fitz-Gibbon
Published June 14, 2024
Updated June 14, 2024, 8:56 p.m. ET
A scathing new report slams former Gov. Andrew Cuomo for botching the states COVID-19 response saying he erred by bumping state health officials out of the way so he could micromanage the pandemic from the executive office.
Cuomo made an a significant and unnecessary mistake. when he ignored established health department protocols set up to address the virus and took the initiative away from local communities, according to the 262-page report by The Olson Group, a consulting firm.
The state had the plans but did not follow them because the executive chamber wanted to do their own thing, said one official interviewed by the authors. If the state had used the plans that were available and written, then, yes, they would have had the proper plans in place.
But instead we were stuck with all these executive orders.
The report said the Cuomo administration simply abandoned preparedness plans already in place which called for the state health department to take the lead.
For example, the departments long-planned system for providing community-based vaccination sites was thrown out the window, with Cuomo instead dictating that hub hospitals would offer the shots despite not having the capability to do so effectively.
The structures developed through hard-won experience from events including 9/11 and Hurricane Sandy were largely ignored and the states chief executive office served as the central point of the response.
Although decisive actions were widely praised during the early stages of the pandemic, his failure to shift to full incorporation of the states established institutions in coordinating the ongoing response operation resulted in unnecessary confusion at a time when New Yorkers needed clarity.
While the report raps Cuomo for alleged micromanaging, it does not say if his approach led to extra cases for deaths. The Empire State suffered 77,000 deaths during the pandemic.
The report also chided the states reporting of nursing home fatalities, calling it lacking in transparency hitting on one of Cuomos biggest controversies during the health crisis.
While the pandemic overwhelmed the states health and educational systems and brought the business and retail community to its knees, Cuomo didnt help things, the report said.
The state did not consider the appearance of impropriety related to how it was reporting COVID-19 nursing home deaths until the public was already upset, having noticed and reported the discrepancies.
Cuomo spokesman Rich Azzopardi defended his former boss in a statement Friday, saying the former governor brought the unified force of government to bear during the deadly pandemic.
His daily press briefings were internationally recognized for providing the facts amid a chaotic lack of a national response to this pandemic where 1.2 million Americans lost their lives, Azzopardi said.
While this report cuts through the political garbage that has consumed the nursing home issue and points out how circumstances were consistent nationwide, its ridiculous to suggest that this pandemic response be treated the same as H1N1 or Legionnaires outbreaks, he said.
The truth is in the numbers, he added. In 2020 New York was number 39 in terms of pro rata nursing home deaths, according to federal stats, and and we went from having the second most deaths because New York was hit first and hardest to 30th.
The release of the report which cost $4.3 million comes on the heels of Cuomos grilling by the House Select Subcommittee on the Coronavirus Pandemic, with the GOP majority on the panel accusing him of deflecting responsibility for the order that shuffled sick patients into senior care facilities in 2020.
The report said the scandal was a part of the theme of mistrust in the handling of the pandemic.
However, Ken Girardin, director of research at the Empire Center for Public Policy, called the Olson report little more than a high school term paper about the states handling of the COVID crisis.
The biggest cost incurred by state government was the theft from the unemployment system, Girardin said. There appears to have been zero investigation into the warning signs and failures at NYS DOI.
Asked about the report at a briefing Friday. Gov. Kathy Hochul said she had not yet read it but took her own shot at Cuomos handling of the pandemic.
We knew that things had to be done differently, they had to be done better and we had to prepare for the possibility that this would happen again, Hochul said.
She said steps have been taken to better prepare the state, including a bump in funding for the state Office of Emergency Management and a $1.7 billion investment in a new research lab.
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The trial of Senator Robert Menendez was paused on Thursday after the judge announced that one of the senators co-defendants, Fred Daibes, a New Jersey real estate developer, had tested positive for Covid-19.
The judge, Sidney H. Stein, said it was the expectation and the hope of the court that the trial could resume Monday, given revised federal Covid guidelines and depending on how quickly Mr. Daibes begins to recover.
The Centers for Disease Control and Prevention no longer recommends that people isolate themselves if they have been free of fever for at least 24 hours without the aid of medications and if their symptoms are improving.
Mr. Daibes is on trial with the senator and another defendant in a sprawling bribery conspiracy case in which prosecutors say Mr. Menendez, 70, and his wife, Nadine Menendez, 57, accepted gold, cash and a luxury car in exchange for the senators agreeing to dispense political favors at home and abroad. Ms. Menendezs trial was postponed until at least August because she is being treated for breast cancer. All four defendants have pleaded not guilty.
The delay comes near the end of the trials fifth week in Federal District Court where, one day earlier, Mr. Daibes, who is in his late 60s, could be heard coughing loudly throughout the proceeding. Then, on Thursday, Judge Stein said in court that Mr. Daibess lawyers had emailed him at 8:18 a.m., notifying him that their client was feeling clearly much worse.
I dont think we have much choice, Judge Stein said Thursday morning. I cannot proceed without a defendant being present.
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Indias large informal non-agricultural sector was badly hit by the second wave of the COVID-19 pandemic, but has recovered gradually since then, with the number of unincorporated firms and their employees rising almost 6% and 8%, respectively, by the latter half of 2022-23, according to findings of an official survey.
Gross Value Added (GVA) by such enterprises grew by 9.83% at current prices during the period October 2022 and March 2023, in comparison with the financial year 2021-22, as per a fact sheet on the Annual Survey of Unincorporated Sector Enterprises (ASUSE) conducted by the National Sample Survey Office (NSSO) in 2021-22 and 2022-23.
It appears that the unincorporated manufacturing, trade and other service activities were hit by the second wave of the pandemic badly; however, the situation improved gradually from July 2021 onwards, the NSSO noted.
During April-June 2021, at the peak of the most fatal COVID wave, the number of estimated informal enterprises were pegged at 50.32 lakh, with 85.6 lakh workers. By contrast, surveys carried out between January and March 2022 estimated 1.91 crore such firms with 3.12 crore employees. The NSSO said the lower reporting in the first quarter affected the overall annual estimates for 2021-22 of 5.97 crore firms with almost 9.8 crore workers, to a great extent.
Between October 2022 and March 2023, the number of estimated informal firms had risen to 6.5 crore with 11 crore employees. This 7.84% annual growth [in jobs] demonstrates the sectors capacity to generate employment, the NSSO said, adding that the maximum growth in employment during the period was observed in other services (13.42%) followed by manufacturing (6.34%).
The survey data, released by the Statistics Ministry on Friday, is used in compiling national account statistics as the countrys unincorporated non-farm sector plays a key role in generating jobs, creating economic value and the overall socio-economic landscape.
Jun 14, 2024, 07:05 PM IST
A new coronavirus variant is rising to dominance across the U.S. as experts warn of a potential summer wave of COVID-19 cases. The new FLiRT variant, named KP.3, began spreading in June. Heres all you need to know about it.
The KP.3 variant is a sub-lineage of the JN.1, the major viral lineage circulating since December 2023, which arises from the Omicron variant.
The common symptoms associated with KP.3 include fever or chills, cough, sore throat, congestion or runny nose, headache, muscle aches, difficulty breathing, fatigue, loss of taste or smell, brain fog and gastrointestinal symptoms such as upset stomach, mild diarrhoea and vomiting. These may appear two to 14 days after exposure.
Currently, it is estimated that KP.3 viruses make up between 16% and 37% of all SARS-CoV-2 virus cases in the United States.
Most key COVID-19 indicators in the U.S. show low levels of activity of KP.3; therefore, experts believe that the total number of infections this variant may cause is likely low. However, it is very similar in terms of disease severity and can evade the immune system.
Experts suggest that everyone who is 6 months and older should get vaccinated for COVID-19 and maintain hygiene. The vaccine will help to protect against any serious illnesses from the virus. Disclaimer: The content provided on the website is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment.
According to a new investigative report by Reuters, the Pentagon ran a year-long vaccine disinformation campaign using social media bots all part of an anti-China political play built on problematic COVID-19 disinformation.
One part of a larger, locally-targeted anti-vax campaign around the world, the propaganda efforts sought to discredit the validity of Chinas Sinovac COVID-19 vaccine among internet users in the Philippines, where the vaccine had been deployed. Messaging included the phrase #Chinaangvirus, reportedly Tagalog slang for "China is the virus."
Reuters reports that the campaign was reportedly run to "undermine Chinas growing influence in the Philippines," after the vaccines and other public health interventions were made readily available. The efforts "aimed to sow doubt about the safety and efficacy" of such aid. The strategy was greenlit by a secret order signed by then-Secretary of Defense Mark Esper elevating China and Russia to the priority of "active combat" and allowing for non-State Department-sanctioned psyops.
At least 300 fake accounts impersonating Filipinos were active on X/ Twitter between spring 2020 and mid-2021, right before a period of record deaths in the country the platform later removed all of the accounts after being asked about their existence by Reuters.
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"We werent looking at this from a public health perspective. We were looking at how we could drag China through the mud," an anonymous senior military officer told the publication.
A wider network of bots and fake accounts created by the U.S. military ran to local audiences across Central Asia and the Middle East, proliferating misinformation such as the idea that vaccines were not halal according to Islamic law. Some accounts had tens of thousands of followers.
Spanning across both the Trump and Biden administrations, former military officials told the publication that there were also accounts spreading such claims on Facebook and Instagram. Meta reportedly alerted the Pentagon that the accounts would be removed for violating platform policies, but they remained.
In 2021, the National Security Council ordered an end to the propaganda campaign in favor of an entirely pro-vaccine messaging push.
