Category: Corona Virus

COVID-19 hasre-emerged on the radar for WestAustralians.

The community is talking about the virus again, and for some it could be cause for concern.

Caseshave been increasing in WA since early September,driven by the Omicron XBB variant EG.5.

"We all know someone who's got COVID-19, or who has recently had it," Premier Roger Cook said this week after recovering from the virus himself.

People are noticing growing numbers of friends and co-workers falling ill, but for many it is a long time since they have given the pandemic much thought.

WA is about 10 weeks into its eighth COVIDwave, seeing a spike in hospitalisations and in cases amongst residents of aged care homes.

This week there were 201 patients in hospitalwith COVID, up from 134 at the start of the month.

Five COVID patients are in intensive care units and in the most recent reporting period there were two deaths.

For now, COVID hospitalisations remain lower than the levels reached during the two most recent COVID peaks in WA, which saw 268 COVID hospitalisations in December 2022, and 258 in May 2023.

But WA's Chief Health Officer Andy Robertsonsaid he expectedthis current wave to be larger.

"I expect it will track upwards a bit further," Dr Robertson said.

"It's really difficult to forecast at the moment, we may be getting up towards the peak but, as you know from previous experiences, often we can't really predict the peak until after we've crested.

"But obviously this is a good time to encourage people to do the right thing, particularly if you're unwell, don't go to work, don't go to events, that will help.

"Please don't go and visit your grandparents, or go to a nursing home orhospital."

Dr Robertson said at this stage the state's hospitals were "coping well"but he said illness picked up in the community was impacting the levels of health staff available.

WA's aged care sector is also being impacted, with 209 COVID-positive residents and 93 cases among aged care staffas of November 8.

Dr Robertson said at this stage there were no plans to introduce mandatory restrictions or mask wearing for the community.

COVID hospitalisations remain the key indicator for WA Health, but how it is monitored in the broader community has changed a lot recently.

The days of enormous queues for PCR testing and daily press conferences with the premierare a distant memory.

And last month WA Health shut down its website that allowed members of the public to self-report a positive RAT result.

The government still releases a 'COVID-19 Weekly Surveillance Report'every Friday withthe latest available data, but since October 9 that only includes PCR results.

In that most recent reporting period, there were 466 official cases.

But a recentanalysis of Perth's wastewater indicatedthe virus was being detected in the community at levels similar to November 2022, when there were up to 11,000confirmed weekly cases.

Wastewater samples are collected twice a week from treatment plants in Beenyup, Subiacoand Woodman Point, and are analysed by WA Health.

Between those three plants, about 79 per cent of Perth's population is covered by the analysis, which also confirms trends and which strains or variants of COVID-19 are prevalent at any given time.

However, WA Health said the wastewater testing results should be interpreted with caution because it does not detect individual cases, rather virus particles.

People who have had COVID-19 shed the virus when they go the toilet and can continue to shed viral particles for several weeks after they recover.

The Director of the Australian National Phenome Centre at Murdoch University, Professor Jeremy Nicholson, warned people against assuming changes to the COVID testing regime meant there was any less danger.

"Western Australia had one of the best testing programs in the world, and it kept the state safe," he said.

"People think because that was shut down then the virus has gotten safer. And it hasn't."

But Professor Nicholson pondered whether rapid antigen tests themselves were becoming less reliable as the chemical 'shape' of the virus changed with each new strain and each new variant.

"Eventually you get to the point that the test isn't particularly good for that particular virus, and it's possible that we might have reached that now," he said.

"There are people that have been tested, who havevery clearly got the infection, and yetit's still coming up as negative."

The chief health officer said RATs remained reliable, but Dr Robertson did encourage anyone unwell and testing negative to follow up with further testing the next day as the virusmay not yet be showing up.

"RATs have actually remained fairly good, and that's not to say, in future, there may not be mutations in some of those areas that may impact them, but generally, our pathologists are pretty happy that they remain pretty robust for detections," he said.

Dr Robertson did however warn that people should not wait for a positive result to begin isolating.

"We are obviously strongly encouraging people, as soon as they get symptoms don't come to work, don't go to an event, stay at home, and stay at home for at least five days.

"Even if you're feeling better towards the end of end of it, it takes generally four or five days before you've cleared the virus and become less of an infectious risk."

Professor Nicholson said work was being done on a new urine test that could help test for when a person was infectious with COVID-19.

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"We developed a test now that in the urine, you can tell whether you are aninfectious individual, because thereare certain metabolites in there that only present when the virus is actually replicating," he said.

"And that's something we're trying to develop as a sort of statewide initiative to create a new urine test that would allow you to know when you were safe to go out into society again."

The Health Department also continues to encourage handwashing and voluntary mask-wearing in certain settings.

And the number one piece of advice from the chief health officer, who recently had COVID himself, after almost four years of dodging the virus, is to stay up to date with COVID vaccinations.

There has been marked drop in the number of WestAustralians keeping up to date with COVID boosters.

According to Commonwealth data, just 197,000 WestAustralians over the age of 18 received a COVID jab in the past six-months.

That leaves the vast majority of the population, 1.9 million adults in WA, who have not had a COVID vaccine or booster in the past six months.

Then there is also a minority, just 44,000WestAustralians, who never got the COVID vaccine in the first place.

ATAGI recommends anyone over 65, or with significant health issues, gets a COVID booster every six months.

But Dr Robertson said anyone hoping to avoid long COVID or endangering vulnerable people in the community should consider doing the same.

"For those who are under 65 or who are otherwise healthy, they should consider it particularly if working in areas of high risk," he said.

Areas of high risk includehealth, aged, and disability care settings, but also anything involving lots of people, such as hospitality or events work.

"The vaccinations do protect people from severe illness. They are cheap or free. They are effective, and they're incredibly safe," Australian Medical Association WA president Dr Michael Page said.

"So we certainly recommend people keep up to date with boosters.

"People should also consider vaccinating their children, particularly those aged under 12."

Professor Nicholson warned there was increasing evidence emerging about the dangers of long COVIDand the susceptibility of children to the condition.

"There's now strong scientific evidence with every time you get infected with COVID that it makes your chance of getting longCOVID worse and the thing is that children can get affected by it," he said.

"Because there's this sort of assumption, which is not correct, that you have to have a severe disease in order to get long COVID.

"Thatsimply isn't true. Probably the majority of people with long COVID only have fairly mild disease when they actually had it."

Professor Nicholson has suffered from long COVID himself and said the condition left him diabetic and with a heart injury.

"COVID has some, what we call 'occult effects', they're silent, so you don't necessarily have to have direct symptoms in order to have a long-term health risk from this," he said.

"You don't get complacent about those other things such as diabetes, do you? So why should you be complacent about something that can cause some of the worst illnesses in our society?"

Editor's note: Thisstory initially said wastewaster testing had picked up 50,000 cases in the community. But wastewater testing detectslevels of virus particles in sewage rather than actual cases. As a comparison, the most recent wastewater tests detectedvirus particles at a level comparable to November 2022,when there were about11,000confirmed COVID-19 cases in the community.

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COVID cases are rising in WA, and experts warn the virus is still a force to be reckoned with - ABC News

The United States has been witnessing a spike in new highly contagious COVID-19 variant HV.1 cases. This variant is credited for over a quarter of all coronavirus cases since October end, Hindustan Times reported.

According to the US Centers for Disease Control and Prevention, the HV.1 variant which is also dominating EG.5 aka Eris accounted for an estimated 25.2% of all newly diagnosed cases during the two-week period till October 28.

In July, the HV.1 variant accounted for only 0.5% of the total coronavirus cases. However, it had increased to over 12% and now become the most dominant strain in the US, as per CDC data.

In an interview with TODAY.com, Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center said that people can consider the HV.1 COVID-19 variant as a grandchild of Omicron.

The COVID family of viruses likes to mutate. Weve all learned that by now. HV.1 is still very close to the existing omicron subvariants," he told TODAY.com.

Dr. William stated that some of the common symptoms for the HV.1 variants are congestion, runny nose, headache, fatigue, cough, sore throat, and muscle aches or chills.

The officials have now started examining the HV.1 variant to deal with a possible surge in winters. Following HV.1, EG.5, also known as Fornax, FL.1.5.1, and XBB.1.16, also known as Arcturus, were the most prevalent variants in the United States, the report said.

The World Health Organization (WHO) has earlier categorized the EG.5 strain of the Covid-19 virus as a variant of concern. The variant was reported on 17 February this year and later designated as a variant under monitoring (VUM) on July 19.

The international organization categorizes variants into three categories namely: a) variants of interest b) variants of concern and c) variants of high consequence. EG.5 is a sub-variant of omicron and is considered to be a descendant of the XBB lineage of the virus.

WHO has advised the countries to share information on the growth advantage of the EG.5 variant and also provide its sequence information.

The global health body along with its Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) assesses the impact of variants on the performance of COVID-19 vaccines in order to inform decisions about updates on vaccine composition.

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US witnesses spike in latest Covid variant cases, HV.1 accounts for over 25% of total infections | Mint - Mint

A fever and persistent cough are well recognised signs of COVID. However, there is one sign that can appear in an infected persons mouth. This symptom could be caused by new COVID variants, including HV.1 and JN.1, according to health experts.

COVID tongue refers to swelling or inflammation of the tongue after getting infected with COVID-19. Some patients may also notice that their tongue appears whiter and patchier than normal. Other symptoms include excessive redness, burning sensation, loss of taste, and some degree of numbness. This can sometimes also lead to the formation of bumps and ulcers on the tongue.

There are many reasons why COVID tongue may occur. One cause can be an immune response to the virus. When your immune system is fighting an infection, it can cause swelling throughout your body. This could include swelling of the tongue, associated with COVID tongue.

It can also develop due to a large amount of ACE receptors (the protein that provides the entry point for the Coronavirus to hook into and infect a wide range of human cells) in the mouth. COVID tongue could be caused by the virus attaching itself to the receptors and seeping into the cells, according to health experts.

According to health experts, COVID tongue symptom could be more prominent with the Pirola variant. Pirola is slightly more likely to cause inflammation in the mouth and skin. Other signs of Pirola include shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.

Read more: World Diabetes Day 2023: Follow this morning routine to help in diabetes management

It is important to consult your doctor if you experience COVID tongue. While for some people, the inflammation goes away on its own after a few days, some people may need prescription medication to reduce the swelling. According to health experts, you can take over-the-counter medicine like ibuprofen, notes Express UK.

Here are some tips to protect yourselves from COVID infection. Get vaccinated and stay up-to-date with booster shots. Wear masks, especially in crowded or enclosed spaces, and follow proper respiratory etiquette by covering your mouth and nose when coughing or sneezing. Wash hands frequently with soap and water for at least 20 seconds or use hand sanitizer containing at least 60% alcohol, particularly after touching surfaces or being in public areas. Take care of your overall health by eating a balanced diet, exercising regularly, managing stress, and getting enough sleep.

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Coronavirus: This symptom in your mouth indicates you have been infected by new COVID variants - IndiaTimes

Fall and winter months are generally when viruses that causes respiratory illnesses tend to spread among communities, according to The Centers for Disease Control and Prevention.

As of November 13, the CDC reported the amount of respiratory illness causing people to seek healthcare is low in most areas of the country. However, the number of jurisdictions experiencing high or moderate levels continues to slowly increase.

COVID-19 remains the cause of most new respiratory virus hospitalizations and deaths nationwide. Sustained RSV activity continues, with most parts of the country experiencing elevated activity. Influenza activity is increasing throughout much of the country. Hospital bed occupancy and capacity, including within intensive care units, remain stable nationally. Vaccines are available and canhelp protect people from the most serious health effectsof fall and winter viruses.

Vaccines are available and canhelp protect people from the most serious health effectsof fall and winter viruses.

News Channel 3 is checking in with some of our local doctors at Eisenhower Health and Desert Regional to see how the trends being reported across the country compare to whats happening in the Coachella Valley.

Tune in at 5:00 p.m. tonight for more on the story.

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Local doctors discuss trends in Flu, RSV, and Covid-19 this respiratory virus season - kuna noticias y kuna radio

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Teleconsultation for Children With Developmental Disabilities During the Coronavirus Pandemic: Caregivers' Experience - Cureus

A Coromandel rest home is locked down with visits restricted to compassionate grounds amid an outbreak of Covid-19 which has infected at least 22 residents and 13 staff.

It comes as experts point to a new Christmas wave with reported Covid-19 cases increasing by 50 per cent recently and wastewater testing showing the number of active cases has more than doubled.

The Tararu Care Home manager, Jade Monigatti, said the Thames rest home was closed, but we are considering visits on compassionate grounds.

Our team [is] doing the utmost to reduce the risk of further spread and our priority remains the health and safety of our residents and team members. We will be open for visits once this outbreak is over, she said.

A spokeswoman for the rest home said the decision to limit visits was based on advice from the centres clinical team and infection prevention control specialists.

So yes, families can still visit their loved ones but they just need to ring first, the spokeswoman said.

Ten residents are isolating with the virus, while 12 had already recovered, she said.

A further four staff members are isolating and nine had recovered, she said.

Weve been actively communicating with our [residents] family members so they are all up to date with whats going on.

There is Covid everywhere, Covid is actually quite widespread at the moment, she said.

Covid-19 cases are expected to peak just before Christmas, as a new wave sees a surge in infections across New Zealand.

Health officials are urging people to get their booster shots, as a notable increase of people fall ill with new Covid-19 variants.

In the latest data for November 6, the seven-day rolling for Covid cases was 896. The rolling average for the week prior was 601 cases.

University of Canterburys Professor Michael Plank said there had been a notable increase in cases over the past couple of weeks as new variants emerged and the populations immunity waned.

Its a steady increase that looks like more of a slow burn. We are still at a significantly lower level than we were last Christmas. Things are increasing but they are increasing from a relatively low base.

Plank said the increase in cases was not a cause for alarm and pointed to steps people could take: If you are feeling unwell, stay home, dont go to that office party. Check that you are up to date with your vaccines.

Raphael Franks is an Auckland-based reporter who covers breaking news. He joined the Herald as a Te Rito cadet in 2022.

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Covid-19 outbreak at Tararu Care Home, Thames: Visits restricted as virus infects residents and staff - New Zealand Herald

There are more Americans who say they have serious cognitive problems with remembering, concentrating or making decisions than at any time in the last 15 years, data from the Census Bureau shows.

The increase started with the pandemic: The number of working-age adults reporting serious difficulty thinking has climbed by an estimated one million people.

About as many adults ages 18 to 64 now report severe cognitive issues as report trouble walking or taking the stairs, for the first time since the bureau started asking the questions each month in the 2000s.

And younger adults are driving the trend.

The sharp increase captures the effects of long Covid for a small but significant portion of younger adults, researchers say, most likely in addition to other effects of the pandemic, including psychological distress. But they also say its not yet possible to fully dissect all the reasons behind the increase.

Richard Deitz, an economist at the Federal Reserve Bank of New York, analyzed the data and attributed much of the increase to long Covid. These numbers dont do this they dont just start suddenly increasing sharply like this, he said.

In its monthly Current Population Survey, the census asks a sample of Americans whether they have serious problems with their memory and concentration. It defines them as disabled if they answer yes to that question or one of five others about limitations on their daily activities. The questions are unrelated to disability applications, so respondents dont have a financial incentive to answer one way or another.

At the start of 2020, the survey estimated there were fewer than 15 million Americans ages 18 to 64 with any kind of disability. That rose to about 16.5 million by September 2023.

Nearly two-thirds of that increase was made up of people who had newly reported limitations on their thinking. There were also increases in census estimates of the number of adults with a vision disability or serious difficulty doing basic errands. For older working-age Americans, the pandemic ended a yearslong decline in reported rates of disability.

The rise in cognitive issues aligns with a common symptom that plagues many Covid long-haulers: brain fog.

Emmanuel Aguirre, a 30-year-old software engineer in the Bay Area, had Covid at the end of 2020. Within a month, he said, his life was transformed: I felt like I was permanently hung over, drunk, high and in a brain freeze all at once.

He stopped dating, playing video games and reading novels, though he managed to keep his job, working remotely. Some of his physical symptoms eventually abated, but the brain fog has lingered, disappearing at times only to steamroll him days later.

Cognitive impairment is a hallmark of long Covid, said Dr. Ziyad Al-Aly, chief of research and development at the V.A. St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis.

Studies estimate some 20 percent to 30 percent of people who get Covid have some cognitive impairment several months later, including people with symptoms ranging from mild to debilitating. Research has also shown clear biological changes from the virus related to cognition, including, in some long Covid patients, lower levels of serotonin.

Its not just fog, its a brain injury, basically, said Dr. Monica Verduzco-Gutierrez, chair of rehabilitation medicine at the University of Texas Health Science Center at San Antonio. There are neurovascular changes. Theres inflammation. There are changes on M.R.I.s.

Why the changes in reported cognitive impairment appear more common for younger adults is not clear. But older adults are more likely to have had some age-related cognitive decline pre-Covid, said Dr. James C. Jackson, a neuropsychologist at Vanderbilt Medical Center. Cognitive changes stand out far more for younger cohorts, he said.

And long Covid often presents differently in younger and older adults, said Dr. Gabriel de Erausquin, a professor of neurology at U.T. Health San Antonio. In his research, he has found that older adults with long-Covid-related cognition deficits have more issues linked to memory. But younger adults are more likely to experience difficulty with attention and concentration and, in some cases, fatigue or pain so severe their thinking is affected.

Heather Carr, 31, sold agricultural machine parts in Syracuse, N.Y., but two coronavirus infections left her largely bed-bound and barely able to string together a basic train of thought. She had trouble staying awake while driving, and eventually had to give up her job.

I cry when I try to think, now, she said. My brain short-circuits.

The number of working-age Americans with a disability who are unemployed or out of the labor force, like Ms. Carr, has roughly held steady during the pandemic.

But the number of working-age Americans with a disability who are employed has increased by an estimated 1.5 million people, census data show.

The tight labor market and flexibility of remote work during the pandemic have made it easier for people who had disabilities pre-Covid to get jobs. Its also likely that more workers became newly disabled, by the census definition, and held onto their jobs.

That could help explain what has been so far only a relatively subtle increase in Social Security disability applications.

Long Covid is probably not the only factor driving the increase in disability, experts say.

The reported rate of cognitive disability for younger adults in the census data had been increasing slowly for years prepandemic. Experts on disability data suggest that, among many factors likely responsible for the increase, rising A.D.H.D. and autism diagnoses in children could have led more people to recognize and report their cognitive difficulties.

Then, during the pandemic, Americans spent more time alone, reported higher rates of depression and were prescribed more psychiatric medications.

The pandemic changed the world, Dr. Jackson said. I do think the sum total of the mental health challenges people are having impacts cognitive function.

Younger adults appeared to experience significantly more psychological distress than older adults, and poor mental health has been linked to cognitive issues. Polling from Gallup found that depression rates for different age groups, which were relatively similar prepandemic, shot up for adults under 45 during the pandemic, while remaining flat for older adults.

Kristen Carbone, a 34-year-old actress in New York, said her anxiety and depression spiked when the pandemic hit, and her memory began to slip. Her issues fell short of the serious difficulty the census asks about, but they were worse than anything shed experienced prepandemic and she never tested positive for Covid, so she said it was unlikely an infection was at fault. At her second job as a server, she had to start writing down every customers order, even the ones she used to fill by memory.

If I dont deal with it immediately, it doesnt exist, she said.

Her mental health has since recovered, she says, but her memory and focus have not.

The stressors of the pandemic could have worsened existing conditions such as A.D.H.D., said Dr. Margaret Sibley, a professor of psychiatry and behavioral sciences at the University of Washington.

If that persons under extreme duress or strain, those symptoms might be temporarily exacerbated, she said.

Because the census relies entirely on self-reporting, experts say the data could also be capturing a shift in how people perceive their cognition, even absent changes to their health.

People with disabilities might have taken note of rising disability acceptance and become more likely to answer the census questions honestly, researchers say. Some young people may have been influenced by what disability researchers describe as increased awareness and acceptance of neurodiversity during the pandemic, as videos about mental illness and developmental disorders proliferated online, often encouraging people to self-diagnose. There was also an increase in advertisements for A.D.H.D. medication, Dr. Sibley said.

Everyone was saying, Im getting this messaging online, she said. The subjective experience of people receiving them was they could make anyone believe they had A.D.H.D.

But those changes in perception are likely to have a relatively small influence on the numbers, said Monika Mitra, who directs the Lurie Institute for Disability Policy at Brandeis University. Most of the increase is probably capturing real changes in peoples health, she said.

We need to take this very seriously as a society, she said. We need to understand who these people are, how theyre being impacted and what we can do about it.

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Can't Think, Can't Remember: More Americans Say They're in a Cognitive Fog - The New York Times

Big families cramming into cramped kitchens. Worn-out revelers with weakened immune systems. Stressed travelers spreading germs as they fly to see their loved ones.

Its the perfect combo for catching pesky viruses amid the Thanksgiving holiday.

Since the pandemic arrived in the U.S., the coronavirus has rudely crashed countless seasonal gatherings. But, as Dallas Countys health department recently pointed out, there is a highly effective way to prevent such sickness: vaccines.

Dr. Philip Huang, director of the countys health department, told the Observer that an uptick in COVID-19 cases could potentially occur this holiday season.

Definitely everyone should get caught up on their vaccinations; that's the easiest thing and some of the most effective, he said. The vaccines work.

People who sign up for the COVID jab can still get a $25 Walmart gift card, he added.

The countys COVID-19 dashboard, updated on Nov. 10, shows a daily average count of 20 cases, down from the prior weeks daily average of 24. Texas health department noted in a report last week that 613,165 confirmed and probable COVID cases had been logged in the state thus far this year.

The vaccines work. Dr. Philip Huang

Gov. Greg Abbott signed Senate Bill 7 on Friday after two years of pushing by state GOP lawmakers. The legislation bans private businesses from imposing COVID vaccine requirements. Employers who discipline workers for rejecting the jab could be slapped with a $50,000 fine.

Healthcare facilities, including clinics and doctors offices, are not immune to the legislation, according to The Texas Tribune. But despite Republican lawmakers efforts, many public health experts continue to promote signing up for the shot as a means to protect oneself and the broader community.

Dr. Lucky Tran, a public health communicator and scientist who works at Columbia University, noted on social media that the sooner people get the updated COVID shot, the better.

Tran offered additional tips to reduce the risk of catching the virus over the holidays. Aside from getting the new vaccine, masks are advisable in public and while traveling. Its also a good idea to test for COVID ahead of get-togethers, and to congregate outside, use air purifiers or open the windows when you can, he posted.

Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention, is urging Americans to get vaccinated now against COVID-19, the flu and RSV. In a video posted to X on Thursday, she said that the latest COVID shot is updated to match the current version of the virus and its free.

Everyone 6 months of age and older is encouraged to get one, she said, emphasizing that the vaccine is safe and has been vetted by qualified experts.

"I know folks want to leave COVID in the rear-view mirror, but unfortunately it is still here, and is still causing folks to get very sick and even die," Cohen told CBS News.

This years Thanksgiving travel period is expected to be the liveliest that the U.S. has seen since before the pandemic, according to the American Automobile Association. In fact, AAA predicts that itll be the third-busiest Thanksgiving on the books since the organization started keeping track in 2000.

In addition to signing up for shots, Huang offered some advice for people looking to stay healthy this holiday:

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Dallas Thanksgiving Marked by COVID-19, Doctors Advise Vaccine - Dallas Observer

Flaws in decision making and governance resulted in a chaotic response

The covid-19 inquiry is currently focusing on core UK decision making and governance. Recent witnesses have described how decision making was centred on Boris Johnson as prime minister who was slow to understand the significance of covid-19, dismissive of its likely impact, and largely absent from discussion of its implications in the first weeks of 2020. Johnsons vacillating stance on how best to respond to covid-19 was a source of immense frustration for the advisers and civil servants working with him and had measurable consequences for the publics health.1 The civil service through the Cabinet Office and Department of Health and Social Care was also ill-prepared for the biggest crisis facing the British state in decades.

So far so familiar in validating the findings of inquiries by parliamentary committees and accounts by scientists and journalists who have reported on these issues.234 The picture of highly centralised decision making, weak institutions in Whitehall, and ineffective checks and balances on the prime minister raise serious questions about what needs to be done to prepare for the next crisis on this scale. Public reporting may have emphasised toxic relationships and a macho and misogynistic culture at the heart of government, but the most important task for the inquiry is to draw out lessons to ensure this can never happen again.

A good place to start is Whitehall. The Cabinet Office and its Civil Contingencies Secretariat (CSC) have a key role in planning for and responding to crises. In the event, they lacked the people and capabilities needed to deal with covid-19 resulting in the absence of a plan on issues like shielding vulnerable people and managing the disruption of schools. As the National Audit Office reported in 2021, this meant that a playbook of responses had to be developed rapidly resulting in delays and missteps at a critical juncture.5 At a minimum, the Cabinet Office and CSC need the resources to undertake assurance of departmental plans and the authority to challenge plans that are inadequate.

The civil service must draw on people with experience of leading key public services at a local level to ensure that national plans reflect a deep understanding of how these services work. The governments abysmal management of social care in the first stages of covid-19 demonstrated what happened when this understanding was lacking. It was only when the Social Care Sector Covid-19 Support Taskforce was established, under the leadership of an experienced social care leader, that matters improved. The work of the taskforce enabled finance and support to be targeted where it was most needed based on a well informed appreciation of how social care was organised and delivered.6

The linked and more profound point is that central government should be more willing to trust and support local government in responding to crises. Examples during covid-19, such as shielding vulnerable people, test and trace, and schools policy, illustrate the folly of trying to run everything from Whitehall. In the case of test and trace, folly was compounded by the government favouring private sector companies over the public sector and weaknesses in procurement from the private sector.

Partnerships of public sector bodies, including local resilience forums and integrated care systems, played a valuable role in the pandemic response when the government was willing to recognise their contribution. The same was evident in the vaccination programme where collaboration between the NHS, local authorities, the army, and others delivered one of the most important and successful aspects of the response. Emily Lawson, programme director, has described how its success was based on assembling a team of teams with the range of talents needed to deliver vaccinations at speed and scale.7

A combination of collective leadership, partnership working, team working, and experience from the front line are more likely to succeed than heroic leadership by a prime minister widely acknowledged to have lacked the skills required during covid-19. Greater diversity among those working with the prime minister, as advocated in the evidence of deputy cabinet secretary, Helen McNamara, is also required. Very senior civil servants must also reflect on how they might have brought more stability and direction to a febrile working environment.

What then of the contribution of the chief scientific adviser and the chief medical officer? Notes released from Patrick Vallances personal diaries to the inquiry show that he shared the frustrations of others who were in the room with Boris Johnson when decisions were made. There is also an argument that Vallance and Chris Whitty were a shield behind which the prime minister sheltered when claiming that he was following the science. This has led to the contention that scientists may be better advised to work from the outside to avoid being compromised.8

Against this, it is important to recognise that both Vallance and Whitty may have moderated the more libertarian instincts of Johnson, even if their views were not always acted on. Vallance was also instrumental in setting up the Vaccine Task Force and helping to appoint Kate Bingham to lead its workanother successful part of the pandemic response. A plausible case can be made that he and Whitty were able to exert more influence by being inside the tent, exasperating as that may have been at times. Their future evidence to the inquiry will be particularly important in shedding light on this issue.

Boris Johnsons power in 2020 resulted from his hold over his party and the government after leading Britain out of the EU at the beginning of the pandemic and winning a majority at the 2019 general election. As well as appointing his supporters to the Cabinet, he preferred to inform the Cabinet of decisions rather than seek their views, and he was mindful of the libertarian views of Conservative MPs on the Covid Recovery Group.6 These considerations underline the need for effective checks and balances to avoid power being used recklessly. The inquiry will have performed a useful service if it can formulate recommendations on how to do so.

Competing interests: Chris Ham is co-chair of the NHS Assembly and emeritus professor of health and management at the University of Birmingham. He writes here in a personal capacity.

Provenance and peer review: not commissioned, not peer reviewed.

Health and Social Care and Science and Technology Committees (2021), Coronavirus: lessons learned to date

Farrar J. with Ahuja, A. (2021) Spike. London: Profile Books.

NAO (2021a) The governments preparedness for the COVID-19 pandemic: lessons for government on risk management.

Lawson, E. (2021) Coronavirus: How to vaccinate a nation - Science Museum Group

Sridhar D. (2023) Where should scientists have been: inside or outside No 10? The Guardian, 4 November.

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What have we learnt from the covid-19 inquiry so far? - The BMJ

The first person I met with long COVID was Kenton Kaplan, a student I was mentoring at Georgetown University. Without much warning, he had called me in January 2022 to drop out of our departmental honors program. As we talked over the next year and a half, he told me about debilitating fatigue, dizziness and intense memory inconsistencies. He and his doctors believed that these symptoms were related to a COVID infection he likely caught at a New Years Eve party.

Kaplan recovered and graduated with honors from Georgetown, but since meeting him, Ive encountered many other people with long COVIDa syndrome of neurological, psychological and physical issues that lasts long after the disease-causing virus, SARS-CoV-2, is gone. As a medical anthropologist, Ive been fascinated by this postviral illness as both a sociocultural and a biological phenomenon. Millions of people seem to have it, even as some health care professionals still believe postviral syndromes are all in your head. I believe that even I have had some form of itfor several months after my first COVID infection, I was struck with anxiety, depression and fatigue that eventually passed. I have spent hundreds of hours thinking about long COVID and interviewing peoplepatients, caregivers, physicians, nurses, academics and policymakersabout their firsthand experiences.

One of the physicians I interviewed was Anthony Fauci, former head of the National Institute of Allergy and Infectious Diseases (NIAID). He is currently a faculty member at Georgetown. As part of the book I am now writing on contested chronic illnesses, we talked about postviral illnesses such as long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and the challenge of understanding our body after an infection has ravaged it. I was surprised to learn that postviral illnesses have been on the embattled doctors radar for about 50 years and that early research on these illnesses fell by the wayside as we struggled to understand their causes.

Fauci and I met over Zoom. I was right on time, albeit a bit disheveled. He, however, was put together and already waiting for me, ready to talk about the question of whether postviral illnesses such as long COVID are real.

Fauci told me how, when he arrived at the National Institutes of Health in 1968 he would see patients who had interesting symptomatology, as he called it: messed-up bodily systems from brain to gut, including the kidneys, heart, blood and nerves. This, he thinks, was perhaps his first concentrated look at what we would initially call chronic fatigue syndrome and eventually refer to as ME/CFS. Half of the people who experience chronic fatigue for several months or years have also had one or more of the following diagnoses: infections, anemia, thyroid dysfunction, diabetes mellitus or cancer. And neuroscientists think that symptoms such as fatigue likely reflect a combination of many factors triggered by one event (such as SARS-CoV-2 infection) in people with chronic stressors, traumas that irreversibly affect the body or previous infections that linger through viral reservoirs (infected cells that do not actively produce viral particles).

Fauci told me, This was before chronic fatigue syndrome ... even had a name.... [People were very sick] following a variety of what they perceived as viral infections. He said that back then we didnt have the diagnostics that we do now and that there would be things about their demeanor and their ability to function, which were markedly compromised for variable periods of time.

I found this off-the-cuff comment to be striking because it meant that ME/CFS activists have been struggling for at least five decades to get recognition for their disabilities despite having what medical anthropologist Emily Lim Rogers described in a 2022 paper as the dual-pronged challenge of people with ME/CFS confronting stigma caused by its lack of biological verification and societal acceptance and doing so in bodies that are exhausted.

Fauci said, however, that he and other infectious disease physician-scientists were soon swooped up into the still-ongoing global emergency of HIV/AIDS, leaving relatively less time and resources to devote to chronic, debilitating but non-fatal conditions. These illnesses frequently dont get the attention they deserve and it leaves many people suffering without the possibility of a diagnosis, let alone a cure.

We talked about more recent COVID cohort studies showing that more women are affected by long COVID than men. Perhaps they are more susceptible to the dysregulation of whatever immune response is triggering ... long COVID, Fauci told me.

These gendered trends should not be surprising. In addition to long COVID and ME/CFS, chronic Lyme disease, multiple sclerosis and autoimmune diseases such as lupus affect women more often. For centuries women have been dismissed, ignored and punished for thinking differently about our body than the dominant culture does. This is more intense for women whose race, class, gender, sexuality, nationality, documentation status, and so on differs from their doctors. But this evidence simply cant be set aside.

Because long COVID is often described as a neurological disease, an idea that is intriguing to me is related to the vagal nerves. These are responsible for many of the automatic functions in our body, such as breathing, standing and calming ourselves. Mike VanElzakker, a neuroscientist at Harvard Medical School, has argued that perhaps SARS-CoV-2 tricks the immune response by linking to this nerve bundle, making the body think its under attack when in fact it is relatively healthy. This would mean that the vagal nerves calming action is getting delayedso the panic, heart palpitations and constant anxiety many people have described to me make sense. Certainly more research on womens nervous systems and the interplay of immunology, neurology and anthropology is imperative.

A lingering question is whether long COVID and ME/CFS are the same thing. Fauci emphasized what makes long COVID distinct from ME/CFS, even when the symptoms are the same, is the presence of a specific virus and the knowledge of when the infection occurred. He told me that historically, we didnt have the ability to pinpoint what infectious agent had caused a persons ME/CFS. We could maybe see what antibodies a person had against different viruses, but we never knew exactly when the infectious event happened, so we couldnt say with any certainty what caused someones disease.

Finally, Fauci emphasized to me how important it is to do more research on postviral syndromes and, specifically, on how long COVID affects people differently. He told me, There is going to be a group of people that, somehow or another..., have a genetic predisposition, just the way you have a genetic predisposition to diabetes or to rheumatoid arthritis or to lupus.... When [these people] get a viral infection, [it] somehow dysregulates [multiple functions and organ systems].

But the key, he said, would be the kind of long-range, multiple-year funding that isnt necessarily dependent on a result for renewalthe type of funding that has existed in the past where so long as the work was good, he said, the researchers job would be safe. We talked about how current funding structures dont really support this kind of open-ended research.

I was struck throughout the interview by Faucis candor. During the pandemic, seemingly every word he uttered was interpreted with a political edge. I almost laughed when he breezily said near the end, I am just giving you my scientific opinion in my experience as an immunology, virology, infectious disease guy. Having served NIAID for five decades, advised seven presidents, led the nation through several pandemics and set a high bar for what a scientific leader can do, I think that with his words, we can now put to rest the question of whether long COVID is real.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.

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What Tony Fauci Told Me About Long COVID and Other Postviral Illnesses - Scientific American