During the first wave of the Covid-19 pandemic, cities were in general affected worse than smaller conurbations or rural areas. Yet in Italy, Rome was relatively spared while the villages of Lombardy experienced very high rates of sickness and death. Then again, one Lombard village Ferrara Erbognone stood out for not recording a single case of Covid-19 at the height of the wave. Nobody knows why.
The puzzle is not just Italian. From the beginning, Covid-19 struck unevenly across the globe, and scientists have been trying to understand the reasons. Why are some populations or sectors of a population more vulnerable than others? Or to turn the question around, why are some groups relatively protected?
In the Observer last weekend, neuroscientist and Covid-19 modeller Karl Friston of University College London suggested on the basis of his comparison of German and British data that the relatively low fatality rates recorded in Germany were due to unknown protective factors at play. This is like dark matter in the universe: we cant see it, but we know it must be there to account for what we can see, he said.
While this is a novel view most experts praise Germanys lockdown and systematic testing regime others are working hard to identify factors which are modulating the spread of Covid-19 and in doing so could explain other puzzles such as why Japan seems to have avoided a lethal first wave despite its relatively old population and lacklustre public health response, or why Denmark, Austria and the Czech Republic have reported no surge in cases despite their early easing of lockdown measures. That could shape how governments manage the risks of a second wave.
One thing seems clear: there are many reasons why one population is more protected than another. Theoretical epidemiologist Sunetra Gupta of the University of Oxford thinks that a key one is immunity that was built up prior to this pandemic. Its been my hunch for a very long time that there is a lot of cross-protection from severe disease and death conferred by other circulating, related bugs, she says. Though that cross-protection may not protect a person from infection in the first place, it could ensure they only experience relatively mild symptoms.
Guptas hunch has remained just that, because of the lack of data on immunity to Covid-19. Antibody testing, as we know, was slow to get going and unreliable to begin with, and the results to date suggest that the proportions of populations carrying antibodies to the Covid-19 virus are often in single or low-double digits. New, more sensitive antibody tests that have become available in recent weeks could soon provide a much more accurate picture if deployed widely enough, but there are already hints that the results to date may be underestimates.
First there was evidence based on diagnostic testing of postmortem samples from patients who died in December that the virus was circulating in western countries notably France and the US about a month earlier than was initially thought. New research shows that another component of the human immune response T cells, which help orchestrate the antibody response show memory for coronavirus infection when exposed to Sars-CoV-2, the virus that causes Covid-19.
In a paper published in Cell on 14 May, researchers at the La Jolla Institute for Immunology in California reported that T cells in blood drawn from people between 2015 and 2018 recognised and reacted to fragments of the Sars-CoV-2 virus. These people could not have possibly seen Sars-CoV-2, says one of the papers senior authors, Alessandro Sette. The most reasonable hypothesis is that this reactivity is really cross-reactivity with the cousins of Sars-CoV-2 the common cold coronaviruses which circulate very broadly and generally give rather mild disease.
The finding supported an earlier one from a group at the Charit hospital in Berlin, detecting T cell reactivity to proteins in the Sars-CoV-2 virus in 83% of Covid-19 patients but also in 34% of healthy volunteers who had tested negative for the virus itself.
David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine who advises the World Health Organization on Covid-19, says these results are important, but cautions that cross-reactivity doesnt necessarily translate into immunity. To determine whether it does would involve following a large number of people who show such cross-reactivity to see if they are protected, if not from infection with Covid-19, then at least from severe forms of the disease.
It is, however, a reasonable hypothesis that exposure to other coronaviruses could confer protection, Sette says. Weve seen it before, for example with the 2009 H1N1 flu. Older people fared well compared to other age groups in that pandemic, he says, probably because their immune systems had been primed by exposure to similar flu strains from decades before. That could be the reason the 2009 pandemic was less lethal than other flu pandemics in history, killing an estimated 200,000 people globally.
If exposure to other coronaviruses does protect against Covid-19, Gupta says, then variability in that exposure could explain much of the difference in fatality rates between countries or regions. Exposure to the related virus that caused the epidemic of severe acute respiratory syndrome (Sars) in 2002-4 might have afforded some protection to east Asians against Covid-19, for example.
In late March, Guptas group published a paper that drew attention because it generated very different forecasts from those of epidemiologist Neil Ferguson of Imperial College London and his colleagues to whom the UK government was listening most closely. The Oxford group suggested that up to half of the UK population could already have been infected by Sars-CoV-2, meaning the infection fatality rate (IFR) the proportion of infected people who went on to die was much lower than Fergusons group was indicating, and the disease was therefore less dangerous. Neither group had much data at that point, and Gupta says that her intention was to highlight that, in the absence of data, a wide range of scenarios should be considered.
Two months on, she stands by her model, but wishes that she had made its implications clearer. The truth is that the IFR is not a hardwired property of the virus or of our interaction with the virus, she says. Its the vulnerable fraction [of the population] that is determining the average overall risk of dying. Once an elderly care home is infiltrated by the virus, for example, the virus spreads rapidly through it and is often lethal, pushing up the IFR. This means it is critical to understand why some people are resistant and others are not, so that those who are vulnerable can be protected.
We know some of those vulnerability factors. Age is the most obvious one. Unlike with the 2009 flu, elderly people are particularly vulnerable to Covid-19 a fact that might reflect the history of exposure to coronaviruses of different age cohorts. Comorbidity is another, and a third is being male. According to Garima Sharma of Johns Hopkins University School of Medicine in Baltimore, who with colleagues recently published a paper on sex differences in Covid-19 mortality, women are protected by virtue of having a backup X chromosome. X chromosomes contain a high density of immune-related genes, so women generally mount stronger immune responses, she says.
Socioeconomic status, climate, culture and genetic makeup could also shape vulnerability, as could certain childhood vaccines and vitamin D levels. And all of these factors can vary between countries. The Japanese might have been afforded some protection, for example, by their custom of bowing rather than shaking hands. And though most of the disparity between the sexes is down to biology, Sharma says some of it is due to social and behavioural factors, with women being more likely to wash their hands and seek preventive care.
It is also becoming clear that protecting the vulnerable has made a big difference to outcomes so far. Italy and Germany, for example, have similar proportions of over-65-year-olds just over 20% of the population in both cases and yet the two have reported strikingly different fatality rates. The case fatality rate (CFR) the proportion of the sick who go on to die is less informative but easier to measure than the IFR, because sick people are more visible than merely infected ones, and as at 26 May the CFR in Italy was about 14%, compared to 5% in Germany.
Italy is more densely populated than Germany, and Italian homes tend to be smaller than German ones. Many Italians in their 20s and 30s live at home with their extended families, which meant that transmission to the elderly was high and, when critical care units were overwhelmed, so were deaths. This is rarer in Germany, where many elderly care homes also enacted a strict isolation regime. In Germany, says Heymann, they did a better job in keeping the elderly protected. Some estimates suggest that only 20% of German Covid-19 cases were over 60, as compared to more than 90% in Italy.
The UK, which has recorded the second highest death rate from Covid-19 after Spain, has not looked after its elderly so well deciding at one point to discharge patients from hospitals back to care homes without testing them for the disease. The governments advice to 1.5 million UK citizens with underlying health conditions to self-isolate for three months from late March may have helped protect those people, but for Gupta the UKs high death rate reflects a deeper problem years of erosion of community support services that provided pastoral care. There is just not enough investment in the NHS and in that GP or other frontline individual who advises the vulnerable person, she says.
Holding to her hunch, she believes that lockdown was an overreaction and that frontline care and protection of the vulnerable which should have been a priority from the beginning should be prioritised now. She also thinks that the worst is behind us, and that while subsequent waves cant be ruled out, they will probably be less bad than what we have experienced so far. The disease will settle into an endemic equilibrium, in her view, perhaps returning each winter like a seasonal flu.
Fristons models also suggest that immunity in the population is higher than data indicates, but for him its not clear how long that immunity will last and he argues that test-and-trace protocols should be put in place now, ahead of any possible second wave that might erupt once that immunity drops off. Heymann remains wary of models, which he says have too often been mistaken for reality in this pandemic, and he awaits more data: I dont think anybody can predict the destiny of this virus at this point in time, he says.
Voter disapproval of Donald Trumps handling of the George Floyd protests and the Covid-19 pandemic, plus the accompanying economic meltdown, have undoubtedly hurt the presidents re-election chances.
But its unclear whether the damage is fatal. Could Trump, despite everything, still stage a comeback and beat the Democratic nominee, Joe Biden?
Things are looking bad for Trump right now. His job approval rating has dipped sharply in recent days. Based on an average of 12 polls taken since 25 May the day Floyd was killed, it stands at about 43%, with 54% disapproving.
Trumps loyalist base is said to comprise 25-30% of voters. The remainder of the 46% who backed him in 2016 will not necessarily do so again. There are signs that key voter groups are less committed or more fiercely opposed.
A recent survey of white Christian evangelicals showed a 15% drop in support for Trump support. Among white Catholics, it dropped by 27%.
Many white suburban women deserted the Republicans in the 2018 mid-terms. This group may be further alienated by the health crisis, economic uncertainty, and Trumps divisiveness.Older voters suffering the brunt of the pandemic are said to feel abandoned while the electorate as whole is getting younger. And for the first time, a third of eligible voters are non-white.
Revived fury over racial injustice may galvanise the black vote a crucial 12.5% of the electorate against the president. In 2016, black turnout declined for the first time in 20 years.
Bidens appeal among African-Americans, demonstrated in the primaries, could reverse that trend and provide winning margins in swing states. Among all voters, Bidens current lead is 11%.
Yet Trump has been written off before. He has the advantage of incumbency and an enormous war chest. He plays dirty. By autumn, the economy may have revived, and the pandemic subsided. And gaffe-prone Biden carries much baggage.
The protests may have scared as many Middle America voters as they energised. Nobody knows how Trumps Nixonian appeals to the silent majority and law and order will play in Peoria.
One thing is certain: hes a long way from beaten.
William Christoffersen, a tireless advocate for Utahs veterans who served more than 70 years with the American Legion, has died from complications of COVID-19, in the Salt Lake City veterans home named for him.
Christoffersen died Sunday, May 31 six days before his 94th birthday, which would have been Saturday, the anniversary of D-Day.
No one in my lifetime has done more for veterans in Utah than Bill Christoffersen, said Terry Schow, former executive director of the Utah Department of Veterans Affairs, and Christoffersens successor representing Utah on the American Legions National Executive Committee, on Saturday.
As state veterans officials announced Christoffersens death, the Utah Department of Health reported the largest one-day number of new confirmed COVID-19 cases in the state 546 with many of them coming from an ongoing outbreak at a meatpacking plant in Cache County.
The Bear River Health Department, which covers Cache, Box Elder and Rich counties, reported 197 new cases Saturday. The states tally of new cases in the Bear River jurisdiction was up 216 cases from Friday to Saturday, which reflects cases reported late Friday by the local department after the states daily report.
Last week, UDOH tested some 1,400 employees at the JBS meat processing facility in Hyrum. A department spokesman said Friday that a significant number of new positive cases were discovered in that round of testing.
Utah has seen 11,798 confirmed cases of COVID-19 since the pandemic began. Saturday is the 10th day in a row in which the state has had 200 or more new cases, in what Dr. Angela Dunn, the states epidemiologist, this week called a sharp spike in the diseases spread in Utah.
Utahs death toll from COVID-19 is at 121, with one new death reported Saturday: A man, older than age 85, living in a long-term care facility in Weber County.
Twenty more Utahns were hospitalized for COVID-19 in the last day, UDOH reported, bringing the total number of hospitalizations to 890 with 116 still in the hospital Saturday. The state said 2,952 people were tested for COVID-19 since the last report, for a total of 235,149 tested since the pandemic began.
Christoffersen is one of two residents of the Salt Lake Veterans Home who have died from COVID-19. As of Thursday, the home has had 51 residents and 24 staff members test positive for COVID-19, according to Kelsey Price, spokeswoman for the Utah Department of Veterans and Military Affairs.
Born on June 6, 1926, in the Cache Valley, Christoffersen marked his 18th birthday, the day he became eligible for the draft, on the day Allied forces stormed the beaches at Normandy in 1944. He enlisted in the Army, and served in the infantry in the Pacific.
As a World War II veteran, William Christoffersen embodied the Greatest Generation and its commitment to service, personal responsibility and hard work, Utah Gov. Gary Herbert said in a statement, issued through the Utah VMA.
Standing over 6 feet tall, Christoffersen was an imposing guy, Schow said. He liked to wear cowboy boots, bolo ties and American Indian jewelry, so he struck a presence when you saw him, Schow said.
Christoffersen was an active member of the American Legion for 75 years. For nearly 50 of those years, he was a member of the groups National Executive Committee elected by Utahs Legionnaires for multiple, successive two-year terms from 1963 to 1973, and again from 1975 to 2013.
Christoffersen lobbied state legislatures and Congress on behalf of veterans issues, Schow said. According to Schow, Christoffersen was instrumental in establishing the U.S. Department of Veterans Affairs Transition Assistance Program, or TAP, which gives information and tools to the 200,000 service members returning to civilian life every year.
Schow said Christoffersen, a very patriotic man, also lobbied repeatedly for a constitutional amendment to ban burning of the American flag. Sen. Orrin Hatch, R-Utah, carried that legislation several times, Schow said. The last time, in 2006, the Senate voted 66-34 in favor of the resolution one vote short of the two-thirds needed for a constitutional amendment.
In March 2013, the Salt Lake Veterans Home was renamed for Christoffersen, a move Schow championed. Christoffersen didnt know about the honor in advance, Schow said; Christoffersen thought he was giving a tour to a visiting American Legion dignitary, and the renaming ceremony was held as a surprise.
Christoffersen had been living in the veterans home for about a year. He was humble about living in a building with his name on it, Schow said, and always thanked the nurses and staffers who helped him and other veterans.
Christoffersen is survived by his wife of 47 years, Elaine; nine children: Dixie Schwartz, Clair Christoffersen, Janet Douglass, Jill Cox, Scott Christoffersen, Mark Jones, Becky Guyre, Jeff Jones and Britt Jones; three sisters: Linda, Jeanine and Barbara; 19 grandchildren and many great-grandchildren. A private memorial service for family and friends will be scheduled for a later date. In lieu of flowers, the family suggests donations to the charity of ones choice.
O
n Instagram, a friend posts a photograph of a male nurse in an intensive care ward of an American hospital. He is wearing full protective clothing and holding up a patient questionnaire on which he has scrawled a message for his colleagues. It reads: Just going to hold his hand for a while, I dont think he has long.
On an Irish radio station, a woman reads a poem she has written for a loved one lost to the virus. It is called My Sister Is Not a Statistic. It begins:
Tomorrow, when the latest Deathometer of Covid is announced in sonorous tones,Whilst all the bodies still mount and curl towards the middle of the curveHeaped one atop and alongside the otherMy sister will be among those numbers...
On Radio 4s Womans Hour, a critical care nurse from Sierra Leone, who works in a hospital in the south of England, describes the frantic chaos of the first few weeks of the pandemic. We didnt have equipment at all, but our ordinary aprons and gloves Id go in there praying and hoping I dont get infected. Then Id go home, praying and hoping, and trying to isolate myself from my daughters so I am not passing it on to them.
Amid the prolonged stasis imposed by lockdown, as the days drift into one another, the unreal magnitude of what is unfolding is momentarily undercut by acutely personal testimonies from the eye of the storm. These are just three examples of ordinary people who have responded in extraordinary ways. Their actions speak of selflessness, defiance and bravery in the face of the invisible threat that hovers around us in the very air that we breathe. But they also provide us with glimpses of the immense human cost of the pandemic, the great well of loss, fear, sadness and grief beneath the mounting statistics.
In Britain, as I write, 37,000 people have lost their lives to the Covid-19 virus, while 267,000 have experienced and survived the terrible uncertainty of infection. As a fragile normality slowly returns, many mental health experts are asking the inevitable questions: what will be the long-term emotional and psychological cost of such a sudden and seismic disruption of our way of life?
How the outside impacts on the inside is something that people like me think about all the time, says psychotherapist and author Susie Orbach. But now we are seeing it on a grand scale. The pandemic has been a prolonged assault from outside on our community. The state of uncertainty and unsafety it has created is new and utterly unfamiliar. Unless you are a refugee who has risked their life to get here, or a survivor of childhood abuse that could not be escaped, there is simply nothing to compare it to.
Even in the early stages of the lockdown, the World Health Organization issued a statement that noted elevated rates of stress or anxiety in the general population, before warning that, as new measures and impacts are introduced especially quarantine and its effects on many peoples usual activities, routines or livelihoods levels of loneliness, depression, harmful alcohol and drug use, and self-harm or suicidal behaviour are also expected to rise.
On 21 April , it was announced that 42 researchers from around the world had formed the International Covid-19 Suicide Prevention Research Collaboration amid growing concern about the longer-term mental health consequences of the virus. Leaving aside the probability of another spike, the aftershock of the pandemic is likely to last a long time and leave yet more casualties in its wake.
Jo Stubley, a consultant psychiatrist and clinical psychoanalyst at the Tavistock and Portman clinic in London, is a specialist in trauma who has worked with survivors of the London terrorist attacks and the Grenfell Tower disaster. Those kinds of emergencies, she explains, are classed as single events that occur within a limited time-frame and affect a defined population. A global pandemic does not fit that model.
The word most often used is unprecedented, she says, and it looks increasingly likely that the long-term consequences will also be unprecedented in scale. Given that mental health services have been starved of resources for years, one can only imagine the impact that a deep recession will have on an already beleaguered sector. So there is a lot of concern among health care professionals like myself about what will happen next.
It is in the coming months and even years, then, that the psychological effects of the pandemic will become most apparent. Trauma occurs when you are overwhelmed by an event that you cannot process, says Julia Samuel, grief counsellor and bestselling author, whose latest book is titled Grief Works: Stories of Life, Death and Surviving. While the crisis is happening, you are in it and everything is uncertain and unpredictable. You dont have the emotional freedom to allow yourself to process the trauma, so it is held in the body. The most common reaction is to shut down and just exist somehow. It is only when the external world becomes more safe and predictable again that people may feel able to reach out for support.
Those most at risk of suffering post-traumatic stress are the frontline medical staff who, in the first chaotic weeks of the Covid-19 pandemic, may have felt overwhelmedby the dramatically increased levels of patient suffering and deaths, as well as at risk from infection from inadequate PPE and anxious about bringing the virus home with them.
Studies have also shown that, in ordinary times,patients who have spent time in intensive care are at a 20% increased risk of developing PTSD. Already with some of the support initiatives that have been put in place, we are seeing survivors of Covid-19 showing post-traumatic symptoms, says Stubley. She explains that there is an accepted timeline for thetreatment of post-traumatic stress. Time zero is the moment the trauma itself ends. In the first months or so afterwards, around 90% of those who experienced trauma will have PTS symptoms including feeling edgy or constantly on guard, sleeplessness, irritability and acute anxiousness. The Nice [National Institute forHealthand Care Excellence] guidelines state that we should not treat people in that first month as these symptoms can often pass.
The second stage is altogether more serious: flashbacks, nightmares, intrusive thoughts or images that are triggered by anything that reminds you of the trauma. The third stage, PTSD, which will affect around 10% of those who have experienced a traumatic event, is a kind of prolonged shutdown. Peopledissociate from their feelings, go numb, says Stubley. It can last for years and years.
Her main concern, though, is for those already in the mental health system, for whom lockdown has already had a major impact. It is an anxiety shared by many therapists, who have been unable to see their patients face to face throughout the lockdown period, instead hosting online sessions.
For those with a history of trauma, says Orbach, it has been a particularly difficult time, not just because of the loneliness and isolation, but because it may also have re-stimulated past traumas. There is so much about the pandemic that is disturbing and distressing on so many levels.
The Royal College of Surgeons recently carried out research into the effects of the coronavirus pandemic on healthcare workers, gathering personal testimonies from nurses and doctors on the frontline. Many reported experiencing increased levels of anxiety, stress, depression as well as panic attacks and bouts of guilt about the amount of people who have died. I cant see how I can keep doing this... said one. I really wish I wasnt a doctor, said another.
Writing in the Guardian, lead researcher and NHS doctor Ankur Khajuria noted that even before the pandemic around 50% of doctors and 40% of nurses were suffering from stress-related psychiatric illness. A perfect storm is gathering, he warned.
Lucy Warner is chief executive of NHS Practitioner Health, a confidential service that treats doctors with mental health issues. They expect to treat around 3,500 doctors a year. When I spoke to her a few weeks ago, she said they had already treated about a third of that annual number in the preceding few weeks mostly through online spaces where people can connect, talk to each other, share their feelings and reflect.
In the early stage of the pandemic, she says, there was a lot of anticipatory anxiety. It was new and people didnt really know what was happening or how long it would go on, but they knew it was frightening. As the weeks have passed in long shifts and rising numbers of the sick and the dead, that gave way to a lot of emotional fatigue, a kind of mental and physical exhaustion. It was becoming a toil, it was becoming difficult for doctors to go on while not knowing how the pandemic would play out.
Over the last months, that state of mental and physical fatigue has for many become the default mode. In a way, it no longer feels like a break with the norm, says Warner, it just feels normal.
Like Stubley, Warner thinks the psychological fallout of the pandemic will be a huge and protracted challenge for an overstretched and underfunded health system.
This is a long game. We are seeing the beginnings of a surge in mental health issues among frontline staff, but over the next year or more we are going to see a lot of people who thought they were OK suddenly realising that they are not. There will be some nurses and doctors suddenly thinking: My God! What did I go through? Thats when we may have to deal with a surge in PTSD symptoms, and those people will need individual support but also support on an organisational level.
While the government and some media were quick to apply the language of wartime to the pandemic heroic British frontline warriors battling an invisible enemy Jo Stubley told me of her and her colleagues discomfort at that kind of distracting rhetoric. The NHS is not the military, she said quietly, and nurses are not soldiers.
Like several others I spoke to, Warner was also uncomfortable with what she called the hero narrative that has taken hold of the public imagination during the long weeks of lockdown. It is unhelpful in some ways because you dont want doctors and nurses to feel they are superheroes, who have to pat themselves on the back when they are on the line and not sleeping or even having time for a pee. What can tend to get overlooked is that they are human beings who are entitled to a rest as much as we all are. They are ordinary people doing their very best, but we need them to be well to do their jobs well.
In response to the emergency of the last few months, several psychotherapists have set up online drop-in support groups for NHS staff, who may be feeling overwhelmed or emotionally exhausted. I spoke to one who, with a colleague, has created a support group for clinical staff in London. She asked for anonymity.
The first thing to stress is that it is drop-in support, not psychotherapy the midst of a crisis is not the time to start psychotherapy for clinical staff. What they need is a safe space to come together, share their thoughts and anxieties and listen to others experiencing similar challenges. To this end, everyone uses first names only and they do not have to say where they work. They can also choose to be seen on a screen or not.
Perhaps surprisingly, the take-up rate has been low and almost all those who have used the service are doctors rather than nurses. I think there are various reasons for that, she says. First, they are in it, and when they get home, they are utterly exhausted. Also, they are perhaps not aware of what help has been made available to NHS staff, even though there is actually a lot of help out there.
The other more positive reason is that they may already be receiving support from their fellow workers, from the strength of being part of a team that is responding well in extremely difficult circumstances. The way the nursing profession works is that you tend to get on with it, says Jo Stubley. You are to a degree encouraged to feel that way, so even when the normal rules dont apply there is the sense that this is what you have been trained for. Its amazing in many ways, but it means that everybody seems to be coping on the surface, while underneath they may well be struggling.
In the first chaotic weeks of the Covid pandemic, many nurses and doctors felt not just overwhelmed, but threatened and unsafe. There were serious issues over the lack of adequate PPE,leading to increased anxiety about contracting the virus and passing it on to family members. Both the workplace and the home thus became places that were unsafe and uncertain.
The nurse from Sierra Leone quoted at the beginning of this article recalled her feelings of being alone, at risk and anxious. Initially it was chaos we didnt have equipment, we didnt have senior support, we were short-staffed.
For two long weeks, she and her colleagues worked in an environment she compared to a war zone, tending to patients who were very unwell, very unstable, very sick... We didnt even have masks. We were tired, dehydrated, thirsty, she continued, still sounding traumatised. She recalled returning home each night to her daughters, thinking: What is happening? How far will this go?
That anonymous nurse belongs to the BAME community who make up 20% of the NHS workforce. On 25 May, the Guardian reported that 200 healthcare workers had died from Covid-19. More than six out of 10 victims were from BAME backgrounds. One of their number was urologist Abdul Mabud Chowdhury, whose 18-year-old son voiced what many inside the NHS were feeling. Its good to see NHS workers getting the recognition they deserve, he said, but they should not have to give their lives, they should not have to go as martyrs. They did not sign up to battle on the frontline and give up their lives.
In the coming second pandemic of mental health issues, it may well be those we heralded as heroes who will be among the most vulnerable, alongside key workers on low incomes who also toiled through this long emergency at considerable and often unnecessary risk to their health, their lives.
If we were prepared to clap for our health workers, we should also be insisting that they are looked after in the wake of this emergency, says Jo Stubley. I want to be optimistic about that, but the market economy has been a disaster for the health service and, within it, mental health has always been the poor sibling. I have spent years saying to my managers, we need more resources, too many people are waiting. If there was no room in the system before this began, what will happen when it ends and we are in the middle of another recession?
Julia Samuel concurs: The fear is that the system will be overwhelmed, not least because there is not the parity of resources in mental health that there is in physical health.
When this is over, how will we acknowledge the haunting presence of the dead, the thousands of lives lost unexpectedly and in often extremely upsetting circumstances for loved ones? In time to come, hard questions must surely be asked about the British death rate and the practical ways many thousands of those deaths might have been prevented. For now, it is the hardest aspect of the pandemic to grasp, much less make sense of. Only months ago, it would have seemed like the stuff of dark imaginings: gothic fiction or apocalyptic sci-fi. How swiftly it has become real; all too real.
On Sunday 24 May, The New York Times filled its entire front page with death notices from across America, a bold statement that nevertheless only hinted at the immensity of the human toll: 1,000 victims symbolising around 100,000. Outside of wartime or other historical pandemics like the Spanish flu in 1918, there is no precedent for the number of lives lost within a relatively short period.
The global virus has, in the most insidious and cruelly indiscriminate way, turned our world upside down, denting our faith in the infallibility of science and medicine, global capitalism and in progress itself. It has made us fretful for our lives and the lives of those around us, while simultaneously robbing us even of our traditional way of death. Relatives have not been allowed to visit their loved ones in their final days or to be present when they breathed their last. Some have been forced to keep a vigil on their computer screens via live feeds from a Covid ward. Funerals have been limited to small groups of people, all keeping the requisite two metres from one another.
If distance and isolation have become the new touchstones of daily life, they have also intruded even on peoples heartbreak and their grieving. The thing that makes grief tolerable for many people is the love and affection of others, says Samuel, We need to be held when we feel broken.
In her heartbreaking poem, My Sister Is Not a Statistic, Dorothy Duffy remembered her sister, Rose, who
died without the soft touch of a loved ones hand. Without a feathered kiss upon her forehead.
Without the muted murmur of familiar family voices gathered around her bed...
In composing that sad, defiant elegy, Duffy found a way to express her tumult of emotions in the face of the viruss assault on our collective sensibilities. In this, though, she was undoubtedly the exception. Countless others have not found a way to articulate their sorrow, their isolation and their disorientation. You dont expect to lose someone in this way, says Orbach, to not be able to say goodbye and then to be forced to grieve alone.
For Orbach, the pandemic has also brutally exposed our cultures collective denial of the final inevitable. The rituals are there to help us get through it, she elaborates, but also because death is such a problematic idea in our culture, an almost impossible idea. We dont live with death, as it were. Instead, we live to a great degree in denial of it, particularly our own death. And suddenly, we are witnessing death on a grand scale. It has in effect cut through our belief systems, our expectations of what life is.
As someone who specialises in grief, what does Julia Samuel think will be the lasting collective impact of so many deaths, but also of our prolonged proximity to the threat of death?
The impact will by no means be the same for everyone, she says. For an older person to lose a long-term partner so suddenly and unexpectedly is a different experience to a family who have lost someone young who was expected to survive. Both traumas will leave a deep and lasting imprint on their family members.
Samuel points out that guilt is often a component of grief, and may be exacerbated by the ways in which people have died during the pandemic. To be the only family member permitted to be present in an ICU is heartbreaking of itself, but then to have to be in full PPE, while your loved one is on a ventilator surrounded by medical staff who also look like astronauts. It is as good as it can be, but it is not the death that anyone would wish for.
I ask Julia Samuelif there is any way to accurately predict what the long-term fallout of the pandemic will be
As humans, we are born to adapt, she says. But while we are still in it and so much is still uncertain, I dont think we have a clue what the long-term consequences will be.
When pressed, she mentions one of the possible beneficialeffects of our time in lockdown.One thing I sense is that many people are questioning how they lived before. The badge of busyness, for instance, has to a degree lost its lustre. Being busy was somehow being important, but maybe people have realised that busyness is essentially an anaesthetic to feeling.
I ask Susie Orbach the same question. She, too, attests to the power of not being frantic.The lockdown certainly changed our relationship to time. In the beginning, there was a kind of panic about time running though our hands it was two oclock and suddenly its five oclock. How did that happen? I think not being frantic was a challenge for some people, but for others, the not-doing and simply being became almost mindful. To just be is actually quite liberating.
Will these small epiphanies be enough for the reorientation of our social and political values that some have suggested will be the necessary outcome of this global emergency?Writer and activist Arundhati Roy has described the pandemic as a portal, a gateway between one world and the next. We can, she suggested, choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.
Orbachcautiously agrees. Part of me thinks that this is somehow a moment of possibility. Many of us who believe we need to work together to democratise our institutions saw that actually happen when the doctors and nurses took control on the ground, while management did not have a clue.
She pauses for a moment, gathering her thoughts. In terms of our political culture, we entered the pandemic with a government born of fright. Brexit was essentially an act of fright, and the climate of fear that was created left so many people feeling marginalised in this swashbuckling, Darwinian, self, self, self culture. And yet, against all that, when the pandemic happened and real fear spread among us, people wanted to make a contribution, they wanted to be decent.
The experts agree that the psychological fallout of the Covid-19 pandemic will be felt for some time to come and that, as ever, the most vulnerable, no matter their recent sacrifices, will be most at risk. In the new normal, will we find ways to be fairer, kinder, more decent when this is all over, if it can ever be said to be truly over?Or will todays heroes become tomorrows overlooked victims like the traumatised veterans of so many wars we willed ourselves so quickly to forget?
Will we hold our political leaders to account when the coming economic crisis inevitably takes precedence over the psychological one and already limited resources are channeled away from a beleaguered NHS that nevertheless saved us from an even deeper, darker abyss?Or will we simply get on with it as before, finding ways to forget that, for a long, uncertain time, when time itself seemed out of joint, we lived amid the mounting dead in a world turned upside down. Ultimately, how we respond to this looming second pandemic may be the measure of how much the first one really taught us about ourselves and the kind of world we want to live in.
In the UK and Ireland,Samaritanscan be contacted on 116 123 or emailjo@samaritans.orgorjo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found atwww.befrienders.org
John Stubits in 2014(Photo: Eva Stubits)
This obituary is part of We Will Remember, a series about those weve lost to the coronavirus.
John Stubits, 96, of Farmington Hills was president of the Hungarian Freedom Fighters Federation of Detroit for more than 50 years and who fluently spoke Hungarian, English, Portuguese and Spanish passed away April 24 due to COVID-19 complications.
He was born in Hungary, where he earned two engineering degrees, worked as a mining engineer in Budapest and participated in the Hungarian Revolution of 1956. Stubits emigrated to the United States with his wife and two daughters as a political refugee and worked as a surveyor while obtaining a third engineering degree in civil engineering from Wayne State University and subsequently worked as a civil engineer for Ford Motor Company.
John and Emilia Stubits in the late 1950s.(Photo: submitted by Eva Stubits)
Stubits loved to play cards, go to the beach, recite Hungarian poetry and playing tennis and Ping-Pong with his wife, Emilia, who subsequently became a Michigan doubles table tennis champion. She passed away eight years ago.
Stubits was sent to Henry Ford Hospital in West Bloomfield on March 30, where he tested positive for the virus. After briefly improving, the hospital searched for somewhere to discharge him to, according to his daughter, Eva Stubits. His previous residence would not accept him back unless he tested negative for the infection, which was the case for manynursing homes in the state at the time. His health deterioratedand his daughter finally found a nursing home in Livingston County that would take him. He passed away two days later.
John Stubits with daughter Eva Stubits(Photo: submitted by Eva Stubits)
He was a man who loved life, according to his daughter and is survived by his daughters Dr. va (Clifton Gallagher) Stubits and Emmy (Ray) Peck; grandchildren Katalin Stubits-Gallagher, Ray Peck III, and Laura Eklov; great grandchildren Ray Peck IV, Adam Eklov, Julia Eklov, Esther Kim and Edwin Kim; sister Ilona Lukcs.
Memorial tributes are suggested to the Holy Cross Hungarian Catholic Church in Detroit.
If you have a family member or close friend who has died from COVID-19 and you would like to share their story, go to bit.ly/freep-will-remember.
Read or Share this story: https://www.freep.com/story/news/local/michigan/2020/06/07/john-stubits-true-his-hungarian-heritage-tested-positive-covid-19/5213237002/
Hamilton Countynow has 3 confirmed cases, Becky Barnes, Administrator of health services for the Chattanooga-Hamilton County Health Department shared in Wednesday's news conference. The second case may have had contact with Hamilton County priest Father Brad Whitaker, who was recently confirmed as positive for coronavirus.
RICHMOND, Va. (WRIC) Heres the latest on the coronavirus pandemic for June 7, 2020:
TheVirginia Department of Healthreported 50,681 cases of COVID-19 48,349 confirmed and 2,332 probable Sunday.
Virginia Hospitals and Healthcare Associationreported that more than 6,538 people with the virus have been released from the hospital. The VDH and VHHA do not report recoveries.
The Richmond Health District is holding three free coronavirus testing events this week.
The events are:
For more information or other COVID-19 testing sites or to register call 804- 205-3501 from 8 a.m. to 6 p.m. Monday through Friday.
Canterbury Rehabilitation and Healthcare Center hit a major COVID-19 milestone after over 100 residents and team members recovered from the virus.
Jeremiah Davis, an administrator at Canterbury, said the skilled nursing facility is grateful to the Henrico community for their support during this difficult past few months.
This comes after the nursing facility experienced one of theworst clusters of positive coronavirus cases in the United States.
Davis also added that three dozen Canterbury team members battled COVID-19 over the past two months.
Day in and day out, our medical and nursing professionals, dietary department, housekeepers, laundry personnel, supply coordinators, department heads and countless others have been working around the clock to provide our residents with the very best care, he said.
COMPLETE COVERAGE: Coronavirus pandemic
Doctors, nurses and disease experts have warned that dousing crowds with teargas and pepper spray will accelerate the spread of coronavirus as mass demonstrations against police brutality rage on, raising concerns that police tactics could worsen a pandemic that has already taken a disproportionate toll on black and brown Americans.
Nearly 1,300 medical providers and public health experts have signed a petition this week calling for police to stop using the chemical agents, amid scenes of law enforcement officers launching plumes of chemical irritants and smoke to subdue demonstrators in Minneapolis, Philadelphia, New York and many other American cities.
In addressing demonstrations against white supremacy, our first statement must be one of unwavering support for those who would dismantle, uproot, or reform racist institutions, the open letter reads. Therefore, we propose the following guidelines to support public health.
Public health experts and civil rights advocates have long advocated against the use of teargas, a chemical weapon that can be lethal, especially to the elderly and those with underlying conditions including asthma. Various international treaties and the Geneva Convention have banned its usein international warfare.
Officials in some cities have agreed to curb its use. On Friday, Seattles mayor announced a 30-day moratorium on the use of teargas during protests after an outcry. Californias governor, Gavin Newsom, called for new statewide standards for law enforcement crowd control. And late on Friday night, a federal judge in Denver issued an order limiting the police departments use of chemical weapons against peaceful protesters.
Because coronavirus spreads through droplets of mucus and spit that people launch into the air when they cough, sneeze, breathe and talk, teargas and other irritants that cause people to choke, hack and rip off their face masks will help the virus proliferate, according to Dr Peter Chin-Hong, an infectious disease physician who helped draft the petition.
Gas and pepper sprays also cause tears, saliva and mucus to stream from demonstrators eyes and noses, said Chin-Hong. And itll cause people to shout and scream, propelling droplets of these fluids which could be carrying coronavirus and giving them superpowers, to spread much farther than six feet.
Moreover, these chemical agents can irritate the nose, mouth and lungs, causing inflammation that could weaken the bodys ability to resist infection, he said.
Experts warn that the liberal use of chemical agents against protesters across the country is deeply concerning. The escalation of teargas use were seeing now really seems unprecedented, said Sven-Eric Jordt, a professor of anesthesiology at Duke University. It was used liberally during the Ferguson protests, and now its escalating and its really concerning.
In Washington DC, park police acknowledged firing pepper balls, projectiles that launch irritant powder into the air, at peaceful protesters to clear the path for Donald Trump to pose for photos in front of a church near the White House. Reporters uncovered a spent canister of oleoresin capsicum (OC) gas which harnesses oils from chili peppers to make the air sting and burn. In many other incidents across the country, police departments used the teargas compound CS short for 2-chlorobenzalmalononitrile. Most studies of these chemicals, according to Jordt, have looked at how they affect police and military personnel most of whom are young men in peak physical health. Little is known about how they affect most other people, including those with underlying health conditions.
Although CS, pepper balls and OC gas are all intended as non-lethal munitions, theyre designed to be used sparingly, in wide open spaces, and only if protesters have a way to escape, Jordt said. In Philadelphia, New York and Washington this week, officers boxed in, or kettled, demonstrators before spraying them with chemical agents. They are exposing people to much higherlevels of these chemicals than was ever intended, and its unclear what the health consequences are, Jordt said.
During the Arab Spring uprising of 2010, demonstrators reported lung injuries after being exposed to high concentrations of teargas. And small studies in Chile and Bahrain connected teargas exposure to miscarriages.
Although scientists have yet to study how teargas affects the bodys ability to resist Covid-19, its concerning, and plausible that exposure could make people more vulnerable to the new coronavirus, Chin-Hong told the Guardian.
A 2014 study found that military recruits exposed to CS teargas were at a higher risk of contracting respiratory illnesses such as the flu and pneumonia.Having teargas sprayed on to you is like someone smoking into your lungs, he said. Its like any other pollution and like pollution it can increase the risks of respiratory illnesses.
In the open letter, experts urged police to refrain from arresting and detaining demonstrators in confined spaces like jails and police vans, where the risk of coronavirus transmission is higher.
Antagonizing and brutalizing protestors could also further erode a communitys trust, posing challenges for health officials seeking to track and trace those who are infected with coronavirus, and warn those who may have been exposed. After these protests, people may be mistrustful of giving names and addresses of people they were with to health officials, if theyre worried about their friends getting arrested, Chin-Hong said.
Although medical experts worry about the spread of coronavirus during large demonstrations, the letter asks officials to not disband protests under the guise of maintaining public health.
As an infectious disease specialist, Chin-Hong and his colleagues are acutely aware that coronavirus disproportionately kills black and brown Americans, he said. The same communities that are at increased risk of dying from the virus are also most at risk from dying at the hands of police officers.
As much as coronavirus is a risk, racism is an infectious disease. Racism is a public health threat, he said. Its really important to affirm peoples right to be heard right now.
The failure to consider air pollution as a factor in the higher rates of coronavirus deaths among minority ethnic groups is astonishing and wholly irresponsible, according to critics of a Public Health England review.
The PHE report released on Tuesday confirmed the disproportionate impact of Covid-19 on people from ethnic minorities but did not mention air pollution. Minorities in the UK,US and elsewhere are known to generally experience higher levels of air pollution, and there is growing evidence around the world linking exposure to dirty air exposure to increased coronavirus infections and deaths.
Scientists said air pollution should absolutely be considered and that it could have a double effect, with long-term exposure weakening lungs and hearts and short-term exposure potentially making viral infection more likely. Before the pandemic, air pollution was estimated to cause 40,000 early deaths a year in the UK, about the same number as the official UK coronavirus death toll to date.
I find it astonishing that they didnt look at air pollution, said Rosamund Kissi-Debrah, a World Health Organization advocate for health and air quality. Her daughter Ella died in 2013 from a severe asthma attack that medical experts have now linked to spikes in air pollution.
Air pollution is linked to diabetes, strokes, heart attacks, asthma attacks, and those with underlying health conditions are dying more from Covid-19, she said. So I expected the black and minority ethnic community to come out worse, because health inequalities are worst in the BAME community, let alone adding a lethal respiratory virus.
Some people will say air pollution in itself is racism because, yet again, it disproportionately affects black people Covid-19 has just made it more obvious.
Geraint Davies, the chair of the all-party parliamentary group on air pollution, said: It is wholly irresponsible for PHE not to correct for air pollution and occupation. The review therefore wrongly projects the idea that [minority ethnic] communities may be more susceptible to coronavirus, when it should instead say they are put into harms way by living in more polluted areas and by being overrepresented amongst frontline workers.
Prof Jonathan Grigg, of Queen Mary University of London, a member of the Committee on the Medical Effects of Air Pollutants, which advises the government, said: Air pollution absolutely should be part of the consideration. Its entirely plausible [and] we should at least ask the question.
You might get a double hit from long- and short-term exposure to dirty air, he said. [Exposed groups] will have a vulnerability due to air pollution coming into Covid, so it will contribute to some extent, but it is difficult to say to what extent.
Prof Francesca Dominici, of Harvard University in the US, also said pollution was an important factor. We have a large body of evidence that health risks associated with air pollution exposure are higher among ethnic minorities. Her research has shown that even a small increase in previous pollution exposure is linked to an 8% rise in Covid-19 deaths.
The PHE report was heavily criticised for a lack of recommendations on how to reduce the disproportionate impact among people from ethnic minorities and for removing a section detailing responses from third parties, many of whom highlighted structural racism. On Thursday the equalities minister, Kemi Badenoch, rejected claims that systemic injustice was the reason for the disparities. Scientists say it is unlikely that any genetic factors play a major role.
Badenoch said it was clear that much more needs to be done to understand the key drivers of the disparities, and said PHE did not make recommendations because the data needed was not available. On Friday the Equality and Human Rights Commission said it would carry out an in-depth analysis and develop urgent recommendations to address the loss of lives of people from ethnic minorities.
A PHE spokeswoman said: The review looked at factors including age, sex, geography, ethnicity, occupation and deprivation. These were set out in the terms of reference for the work. To further understand the disparities, PHEs work will be complemented by studies to be undertaken in response to a research call.
Winston Morgan, a toxicologist and clinical biochemist at the University of East London, said: The fact that we can map death rates from Covid-19 on to almost all other negative societal outcomes is all the evidence we need to know the main problem is with structural racism.
A simple genetic cause linked to race does not make scientific sense. The data shows the affected groups transcend the classical definitions of both race and ethnicity. That is not to say when we examine all the data in the future we will not find a very tiny sub-population with a mutation which makes them more susceptible. But many find it easier to use race rather than racism as an explanation, partly because you can link it to something inherent in the victims.
Dominici said: I really doubt that genetic factors play a bigger role than environmental and societal factors and racism.
Issy Bray, a health statistics expert at the University of the West of England, said: We cannot rule it out, as other diseases do affect certain ethnic groups for genetic reasons, eg sickle cell anaemia. However, it is already clear that the relationship between ethnicity and risk of coronavirus is at least partially explained by a range of societal factors, and it is these inequalities that we should be tackling.
The scientists said the influence of air pollution could be singled out if carefully analysed alongside other important factors such as population density, deprivation, occupation and obesity, ideally using data on individuals. Bray said smartphone apps that monitor symptoms could be useful by providing large amounts of personal and location data.
Nearly 600 frontline healthcare workers have died of Covid-19, according to Lost on the Frontline, a project launched by the Guardian and Kaiser Health News (KHN) that aims to count, verify and memorialize and every healthcare worker who dies during the pandemic.
The tally includes doctors, nurses and paramedics, as well as crucial healthcare support staff such as hospital janitors, administrators and nursing home workers, who have put their own lives at risk during the pandemic to help care for others. Lost on the Frontline has now published the names and obituaries for more than 100 workers.
A majority of those documented were identified as people of color, mostly African American and Asian/Pacific Islander. Profiles of more victims, and an updated count, will be added to our news sites twice weekly going forward.
There is no other comprehensive accounting of US healthcare workers deaths. The Centers for Disease Control and Prevention (CDC) has counted 368 Covid deaths among healthcare workers, but acknowledges its tally is an undercount. The CDC does not identify individuals.
The Guardian and KHN are building an interactive, public-facing database that will also track factors such as race and ethnicity, age, profession, location and whether the workers had adequate access to protective gear. The database to be released this summer will offer insight into the workings and failings of the US healthcare system during the pandemic.
In addition to tracking deaths, Lost on the Frontline reports on the challenges healthcare workers are facing during the pandemic. Many were forced to reuse masks countless times amid widespread equipment shortages. Others had only trash bags for protection. Some deaths have been met with employers silence or denials that they were infected at work.
The number released today reflects the 586 names currently in the Lost on the Frontline internal database, which have been collected from family members, friends and colleagues of the deceased, media reports and unions, among other sources. Reporters at the Guardian and KHN are independently confirming each death by contacting family members, employers, medical examiners and others before publishing names and obituaries on our sites. More than a dozen journalists across two newsrooms as well as student journalists are involved in the project.
This project aims to capture the human stories of compassion and heroism behind the statistics. None of the healthcare workers honored started 2020 knowing that simply showing up to work might expose them to a virus that would kill them.
When the crisis hit, they met the challenge. They steeled themselves against the long hours. Emergency medical technicians raced to ambulances to help. Others did the cleanup, maintenance, security or transportation jobs needed to keep operations running smoothly.
They undertook their work with passion and dedication. They were also beloved spouses, parents, friends, military veterans and community activists.
Among those lost were Dr Priya Khanna, a nephrologist, who continued to review her patients charts until she was put on a ventilator. Her father, a retired surgeon, succumbed to the disease just days after his daughter.
Susana Pabatao, one of thousands of Philippine health providers in the US, became a nurse in her late 40s. Susana died just days after her husband, Alfredo, who was also infected with Covid-19.
Dr James Goodrich, a renowned pediatric neurosurgeon, acclaimed for separating conjoined twins, was also remembered as a renaissance man who collected antique medical books, loved fine wines and played the didgeridoo.
Some of the first to die faced troubling conditions at work. Rose Harrison, 60, a registered nurse, wore no mask while taking care of a Covid-19 patient at an Alabama nursing home, according to her daughter. She felt pressured to work until the day she was hospitalized. The nursing home did not respond to requests for comment.
Thomas Soto, 59, a Brooklyn radiology clerk faced delays in accessing protective gear, including a mask, even as his hospital was overwhelmed with Covid-19 patients, his son said. The hospital did not respond to requests for comment.
The Lost on the Frontline team is documenting other worrying trends. Healthcare workers across the US said failures in communication left them unaware they were working alongside people infected with the virus. And occupational safety experts raised alarms about CDC guidance permitting workers treating Covid-19 patients to wear surgical masks which are far less protective than N95 masks.
The Occupational Safety and Health Administration, the federal agency responsible for protecting workers, has launched dozens of fatality investigations into health workers deaths. But recent agency memos raise doubts that many employers will be held responsible for negligence.
As public health guidelines have largely prevented traditional gatherings of mourners, survivors have found new ways to honor the dead: in Manhattan, a medical resident played a violin tribute for a fallen co-worker; a nurses union placed 88 pairs of shoes outside the White House commemorating those who had died among their ranks; fire departments have lined up trucks for funeral processions and held last call ceremonies for EMTs.
The Lost on the Frontline death toll includes only healthcare workers who were potentially exposed while caring for or supporting Covid-19 patients. It does not, for example, include retired doctors who died from the virus but were not working during the pandemic.
The number of reported deaths is expected to grow. But as reporters work to confirm each case, individual deaths may not meet our criteria for inclusion and, therefore, may be removed from our count.
You can read our first 100 profiles here. And if you know of a healthcare worker who died of Covid-19, please share their story with us.
