Category: Corona Virus

Two and a half years and billions of estimated infections into this pandemic, SARS-CoV-2s visit has clearly turned into a permanent stay. Experts knew from early on that, for almost everyone, infection with this coronavirus would be inevitable. As James Hamblin memorably put it back in February 2020, Youre Likely to Get the Coronavirus. By this point, in fact, most Americans have. But now, as wave after wave continues to pummel the globe, a grimmer reality is playing out. Youre not just likely to get the coronavirus. Youre likely to get it again and again and again.

I personally know several individuals who have had COVID in almost every wave, says Salim Abdool Karim, a clinical infectious-diseases epidemiologist and the director of the Center for the AIDS Program of Research in South Africa, which has experienced five meticulously tracked surges, and where just one-third of the population is vaccinated. Experts doubt that clip of reinfectionseveral times a yearwill continue over the long term, given the continued ratcheting up of immunity and potential slowdown of variant emergence. But a more sluggish rate would still lead to lots of comeback cases. Aubree Gordon, an epidemiologist at the University of Michigan, told me that her best guess for the future has the virus infiltrating each of us, on average, every three years or so. Barring some intervention that really changes the landscape, she said, we will all get SARS-CoV-2 multiple times in our life.

If Gordon is right about this thrice(ish)-per-decade pace, that would be on par with what we experience with flu viruses, which scientists estimate hit us about every two to five years, less often in adulthood. It also matches up well with the documented cadence of the four other coronaviruses that seasonally trouble humans, and cause common colds. Should SARS-CoV-2 joins this mix of microbes that irk us on an intermittent schedule, we might not have to worry much. The fact that colds, flus, and stomach bugs routinely reinfect hasnt shredded the social fabric. For large portions of the population, this is an inconvenience, Paul Thomas, an immunologist at St. Jude Childrens Research Hospital, in Tennessee, told me. Perhaps, as several experts have posited since the pandemics early days, SARS-CoV-2 will just become the fifth cold-causing coronavirus.

Or maybe not. This virus seems capable of tangling into just about every tissue in the body, affecting organs such as the heart, brain, liver, kidneys, and gut; it has already claimed the lives of millions, while saddling countless others with symptoms that can linger for months or years. Experts think the typical SARS-CoV-2 infection is likely to get less dangerous, as population immunity builds and broadens. But considering our current baseline, less dangerous could still be terribleand its not clear exactly where were headed. When it comes to reinfection, we just dont know enough, says Emily Landon, an infectious-disease physician at the University of Chicago.

Read: Coronavirus reinfection will soon become our reality

For now, every infection, and every subsequent reinfection, remains a toss of the dice. Really, its a gamble, says Ziyad Al-Aly, a clinical epidemiologist and long-COVID researcher at Washington University in St. Louis. Vaccination and infection-induced immunity may load the dice against landing on severe disease, but that danger will never go away completely, and scientists dont yet know what happens to people who contract mild COVID over and over again. Bouts of illness may well be tempered over time, but multiple exposures could still re-up some of the same risks as beforeor even synergize to exact a cumulative toll.

Will reinfection be really bad, or not a big deal? I think you could fall down on either side, says Vineet Menachery, a coronavirologist at the University of Texas Medical Branch. Theres still a lot of gray.

The majority of infections we witnessed in the pandemics early chapters were, of course, first ones. The virus was hitting a brand-new species, which had few defenses to block it. But people have been racking up vaccine doses and infections for years now; immunity is growing on a population scale. Most of us are no longer starting from scratch, says Talia Swartz, an infectious-disease physician, virologist, and immunologist at Mount Sinais Icahn School of Medicine. Bodies, wised up to the viruss quirks, can now react more quickly, clobbering it with sharper and speedier strikes.

Future versions of SARS-CoV-2 could continue to shape-shift out of existing antibodies reach, as coronaviruses often do. But the body is flush with other fighters that are much tougher to bamboozleamong them, B cells and T cells that can quash a growing infection before it spirals out of control. Those protections tend to build iteratively, as people see pathogens or vaccines more often. People vaccinated three times over, for instance, seem especially well equipped to duke it out with all sorts of SARS-CoV-2 variants, including Omicron and its offshoots.

Gordon, who is tracking large groups of people to study the risk of reinfection, is already starting to document promising patterns: Second infections and post-vaccination infections are significantly less severe, she told me, sometimes to the point where people dont notice them at all. A third or fourth bout might be more muted still; the burden of individual diseases may be headed toward an asymptote of mildness that holds for many years. Gordon and Swartz are both hopeful that the slow accumulation of immunity will also slash peoples chances of developing long COVID. An initial round of vaccine doses seems to at least modestly trim the likelihood of coming down with the condition, and the risk may dwindle further as defenses continue to amass. (We do need more data on that, Gordon said.)

Read: The pandemic after the pandemic

Immunity, though, is neither binary nor permanent. Even if SARS-CoV-2s assaults are blunted over time, there are no guarantees about the degree to which that happens, or how long it lasts. Maybe most future tussles with COVID will feel like nothing more than a shrimpy common cold. Or maybe theyll end up like brutal flus. Wherever the average COVID case of the future lands, no two peoples experience of reinfection will be the same. Some may end up never getting sick again, at least not noticeably; others might find themselves falling ill much more frequently. A slew of factors could end up weighting the dice toward severe diseaseamong them, a persons genetics, age, underlying medical conditions, health-care access, and frequency or magnitude of exposure to the virus. COVID redux could pose an especially big threat to people who are immunocompromised. And for everyone else, no amount of viral dampening can totally eliminate the chance, however small it may be, of getting very sick.

Long COVID, too, might remain a possibility with every discrete bout of illness. Or maybe the effects of a slow-but-steady trickle of minor, fast-resolving infections would sum together, and bring about the condition. Every time the bodys defenses are engaged, it takes a lot of energy, and causes tissue damage, Thomas told me. Should that become a near-constant barrage, thats probably not great for you. But Swartz said she worries far more about that happening with viruses that chronically infect people, such as HIV. Bodies are resilient, especially when theyre offered time to rest, and she doubts that reinfection with a typically ephemeral virus such as SARS-CoV-2 would cause mounting damage. The cumulative effect is more likely to be protective than detrimental, she said, because of the immunity thats laid down each time.

Al-Aly sees cause for worry either way. He is now running studies to track the long-term consequences of repeat encounters with the virus, and although the data are still emerging, he thinks that people who have caught the virus twice or thrice may be more likely to become long-haulers than those who have had it just once.

Theres still a lot about SARS-CoV-2, and the bodys response to it, that researchers dont fully understand. Some other microbes, when they reinvade us, can fire up the immune system in unhelpful ways, driving bad bouts of inflammation that burn through the body, or duping certain defensive molecules into aiding, rather than blocking, the viruss siege. Researchers dont think SARS-CoV-2 will do the same. But this pathogen is much more formidable than even someone working on coronaviruses would have expected, Menachery told me. It could still reveal some new, insidious qualities down the line.

Studying reinfection isnt easy: To home in on the phenomenon and its consequences, scientists have to monitor large groups of people over long periods of time, trying to catch as many viral invasions as possible, including asymptomatic ones that might not be picked up without very frequent testing. Seasonal encounters with pathogens other than SARS-CoV-2 dont often worry usbut perhaps thats because were still working to understand their toll. Have we been underestimating long-term consequences from other repeat infections? Thomas said. The answer is probably, almost certainly, yes.

Of the experts I spoke with for this story, several told me they hadnt yet been knowingly infected by SARS-CoV-2; of those who had, none were eager for the sequel. Menachery is in the latter group. He was one of the first people in his community to catch the virus, back in March of 2020, when his entire family fell ill. That November, he discovered that he had lost most of his kidney function, a rapid deterioration that he and his doctors suspect, but cannot prove, was exacerbated by COVID. Menachery received a transplant three months ago, and has been taking immunosuppressive medications sincea major shift to his risk status, and his outlook on reinfection writ large. So I wear my mask everywhere, he told me, as do his wife and their three young kids. Should the virus return for him, its not totally clear what might happen next. Im nervous about reinfection, he said. I have reason to be.

Almost no one can expect to avoid the virus altogether, but that doesnt mean we cant limit our exposures. Its true that the bodys bulwarks against infection tend to erode rather rapidly; its true that this virus is very good at splintering into variants and subvariants that can hop over many of the antibodies we make. But the rhythm of reinfection isnt just about the durability of immunity or the pace of viral evolution. Its also about our actions and policies, and whether they allow the pathogen to transmit and evolve. Strategies to avoid infectionto make it as infrequent as possible, for as many people as possibleremain options, in the form of vaccination, masking, ventilation, paid sick leave, and more. There are still very good reasons to keep exposures few and far between, Landon, of the University of Chicago, told me. Putting off reinfection creates fewer opportunities for harm: The dice are less likely to land on severe disease (or chronic illness) when theyre rolled less often overall. It also buys us time to enhance our understanding of the virus, and improve our tools to fight it. The more we know about COVID when we get COVID, the better off well be, she said.

Read: The coronaviruss next move

SARS-CoV-2 may yet become another common-cold coronavirus, no more likely to screw with its hosts the fifth time it infects them than the first. But thats no guarantee. The outlooks of the experts I spoke with spanned the range from optimism to pessimism, though all agreed that uncertainty loomed. Until we know more, none were keen to gamble with the virusor with their own health. Any reinfection will likely still pose a threat, even if its not the worst-case scenario, Abdool Karim told me. I wouldnt want to put myself in that position.

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You Are Going to Get COVID Again And Again And Again - The Atlantic

SEOUL, May 27 (Reuters) - North Korean health officials are testing rivers, lakes, the air and household wastewater and garbage for the coronavirus as the country intensifies its fight against its first outbreak, state media said on Friday.

The isolated country has been in a heated battle against an unprecedented COVID wave since declaring a state of emergency and imposing a nationwide lockdown this month, fuelling concerns about a lack of vaccines, medical supplies and food shortages.

State media said authorities are stepping up testing and disinfection across the country, after reporting this week a "stabilising" trend in the outbreak, including signs that the a wave of fevers was abating and a relatively low death toll. read more

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Some 100,460 more people showed fever symptoms as of Thursday evening, compared with nearly 400,000 about 10 days ago, the official KCNA news agency said, citing data from the state emergency epidemic prevention headquarters.

The total number of fever patients since April rose to 3,270,850 among the 25 million population, and a death toll to 69, up by one from a day earlier.

In another dispatch, KCNA said anti-virus offices gathered samples from many sources to check whether areas had been infected with COVID-19.

"Emergency anti-epidemic sectors at all levels give precedence to the test of specimens collected in rivers and lakes, while disinfecting hundreds of thousands of cubic meters of sewage and thousands of tons of garbage every day and examining and analysing samples," KCNA said.

It did not elaborate on testing methods. North Korea said last year it had developed its own polymerase chain reaction (PCR) test equipment, but has never confirmed how many people have tested positive, instead reporting the number with fever symptoms.

Experts have said those figures could be underreported, and make it difficult to assess the scale of the situation. read more

A video provided by KCNA showed a group of officials wearing protective clothing and medical masks conveying boxes with signs saying "specimen carrier" or "bacteria, virus tester."

Reuters was unable to independently verify information contained in the video.

"Officials are collecting samples from people showing fever ... and testing drinks produced at water factories in Pyongyang to ensure they are clean and safe," Jo Chol Ung, vice chief of the Pyongyang Municipal Hygienic and Anti-epidemic Centre, said in the footage.

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Reporting by Hyonhee Shin; Additional reporting by Minwoo Park and Joori Roh; Editing by Leslie Adler and Gerry Doyle

Our Standards: The Thomson Reuters Trust Principles.

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North Korea tests rivers, air, garbage as anti-COVID efforts gather steam - Reuters.com

Spallanzani infectious disease hospital Director Francesco Vaia talks to reporters at the end of a news conference Friday in Rome. Andrew Medichini/AP hide caption

Spallanzani infectious disease hospital Director Francesco Vaia talks to reporters at the end of a news conference Friday in Rome.

The recent headlines about a sudden emergence of an unusual disease, spreading case by case across countries and continents may, for some, evoke memories of early 2020.

But monkeypox is no COVID-19 in a good way.

Health officials worldwide have turned their attention to a new outbreak of monkeypox, a virus normally found in central and west Africa that has appeared across Europe and the U.S. in recent weeks even in people who have not traveled to Africa at all.

But experts say that, while it's important for public health officials to be on the lookout for monkeypox, the virus is extremely unlikely to spin out into an uncontrolled worldwide pandemic in the same way that COVID-19 did.

"Let's just say right off the top that monkeypox and COVID are not the same disease," said Dr. Rosamund Lewis, head of Smallpox Secretariat at the World Health Organization, at a public Q&A session on Monday.

For starters, monkeypox spreads much less easily than COVID-19. Scientists have been studying monkeypox since it was first discovered in humans more than 50 years ago. And its similarities to smallpox mean it can be combated in many of the same ways.

As a result, scientists are already familiar with how monkeypox spreads, how it presents, and how to treat and contain it giving health authorities a much bigger head start on containing it.

Here are some of the other ways the public health approach to monkeypox is different from COVID-19:

Monkeypox typically requires very close contact to spread most often skin-to-skin contact, or prolonged physical contact with clothes or bedding that was used by an infected person.

By contrast, COVID-19 spreads quickly and easily. Coronavirus can spread simply by talking with another person, or sharing a room, or in rare cases, being inside a room that an infected person had previously been in.

"Transmission is really happening from close physical contact, skin-to-skin contact. It's quite different from COVID in that sense," said Dr. Maria Van Kerkhove, an infectious disease epidemiologist with the WHO.

The classic symptom of monkeypox is a rash that often begins on the face, then spreads to a person's limbs or other parts of the body.

"The incubation from time of exposure to appearance of lesions is anywhere between five days to about 21 days, so can be quite long," said Dr. Boghuma Kabisen Titanji, an infectious disease physician and virologist at Emory University in Atlanta.

The current outbreak has seen some different patterns, experts say particularly, that the rash begins in the genital area first, and may not spread across the body.

Either way, experts say, it is typically through physical contact of that rash that the virus spreads.

"It's not a situation where if you're passing someone in the grocery store, they're going to be at risk for monkeypox," said Dr. Jennifer McQuiston of the Centers for Disease Control and Prevention, in a briefing Monday.

The people most likely to be at risk are close personal contacts of an infected person, such as household members or health care workers who may have treated them, she said.

"We've seen over the years that often the best way to deal with cases is to keep those who are sick isolated so that they can't spread the virus to close family members and loved ones, and to follow up proactively with those that a patient has contact with so they can watch for symptoms," McQuiston said.

With this version of virus, people generally recover in two to four weeks, scientists find, and the death rate is less than 1%.

One factor that helped COVID-19 spread rapidly across the globe was the fact that it is very contagious. That's even more true of the variants that have emerged in the past year.

Epidemiologists point to a disease's R0 value the average number of people you'd expect an infected person to pass the disease along to.

For a disease outbreak to grow, the R0 must be higher than 1. For the original version of COVID-19, the number was somewhere between 2 and 3. For the omicron variant, that number is about 8, a recent study found.

Although the recent spread of monkeypox cases is alarming, the virus is far less contagious than COVID-19, according to Jo Walker, an epidemiologist at Yale School of Public Health.

"Most estimates from earlier outbreaks have had an R0 of less than one. With that, you can have clusters of cases, even outbreaks, but they will eventually die out on their own," they said. "It could spread between humans, but not very efficiently in a way that could sustain itself onward without constantly being reintroduced from animal populations."

That's a big reason that public health authorities, including the WHO, are expressing confidence that cases of monkeypox will not suddenly skyrocket. "This is a containable situation," Van Kerkhove said Monday at the public session.

Monkeypox and smallpox are both members of the Orthopox family of viruses. Smallpox, which once killed millions of people every year, was eradicated in 1980 by a successful worldwide campaign of vaccines.

The smallpox vaccine is about 85% effective against monkeypox, the WHO says, although that effectiveness wanes over time.

"These viruses are closely related to each other, and now we have the benefit of all those years of research and diagnostics and treatments and in vaccines that will be brought to bear upon the situation now," said Lewis of the WHO.

Some countries, including the U.S., have held smallpox vaccines in strategic reserve in case the virus ever reemerged. Now, those can be used to contain a monkeypox outbreak.

The FDA has two vaccines already approved for use against smallpox.

One, a two-dose vaccine called Jynneos, is also approved for use against monkeypox. About a thousand doses are available in the Strategic National Stockpile, the CDC says, and the company will provide more in the coming months.

"We have already worked to secure sufficient supply of effective treatments and vaccines to prevent those exposed from contracting monkeypox and treating people who've been affected," said Dr. Raj Panjabi of the White House pandemic office, in an interview with NPR.

Link:

Monkeypox and COVID-19 are different in a good way - NPR

How can we tell how high cases are when people have stopped testing?

For almost two years weve been glued to a set of numbers: the grim trio of cases, hospitalisations and deaths that defined coronavirus in the UK.

The daily figures led news reports for more than a year: people watched in horror as the height of the Omicron wave brought the highest ever daily caseload on Tuesday 4 January 2022 when 275,618 people tested positive. And they saw how many people died: a number that peaked on Tuesday 19 January 2021, when 1,366 people died, making it the the worst day of the pandemic*.

Since March 2022 case numbers from the daily government dashboard have tumbled. A fall that has coincided with the governments Living with Covid plan: as restrictions fell away in England, so did cases. The government ended restrictions including the legal requirement to self-isolate on 24 February and cut the provision of free tests on 1 April.

After two long years of disease, restrictions and fear its the news everyone has been hoping for.

But have cases really gone down that fast?

Like all statistics the UKs coronavirus statistics are a way of measuring something but not the thing itself.

Its not hard to see that as the government cut free NHS tests and people werent able to report private tests, the total number of tests fell, and so did the number of positive tests. Then, by the governments measurements at least, cases fell.

And falling cases made it look like the government was justified to cut tests.

The good news? Cases are on a downward trend. But it hasnt been as fast or as rosy as the government charts have made out.

Looking at the weekly coronavirus infection survey from the Office for National Statistics (ONS) puts the recent fall in perspective.

What the government (coronavirus.gov.uk) case numbers actually measure is not the number of of new people in the UK infected with coronavirus every day. But, the number of people who take a test, get a positive test result, and then report that test.

Throughout most of the pandemic, government numbers were recording about a third of the cases that the ONS was picking up.

Instead of relying on people choosing to take a test, the ONS numbers are estimates based on a sample of around 200,000 people across the UK who take a test every month regardless of whether they have symptoms. This makes the ONS system better at catching asymptomatic infections, and better at picking up milder variants like Omicron.

However the ending of free tests sees that relationship break down with the gov.uk figures almost entirely missing the March 2022 spike and recording less than a twelfth of the cases that the ONS picked up at the start of April

But the overall picture is positive. On all measures cases are down. Vaccination levels are high, antibody levels are high, and the spread of infectious disease tends to reduce in the summer. But that wont last for ever.

In all four scenarios considered by the Scientific Advisory Group for Emergencies of how the pandemic will unfold, there is a resurgence in the autumn/winter of 2022. In the best case, it is a small one.

Given that this will happen, it is vital to maintain virus surveillance system and the ability to ramp up protection measures again, as Sir Patrick Vallance, the UK governments chief scientific adviser, argued at the launch of the Living With Covid plan.

But the warning system doesnt have to come from the daily numbers we have got used to on the government dashboard. Prof Kevin McConway argues that daily cases numbers from the gov.uk dashboard were always more about news cycles than actual health surveillance.

The data from tests did help, but the numbers and rates were always subject to biases of unknown size, because they depended on who was turning up to be tested, he says. That varied some people had jobs that required frequent testing, and those requirements changed over time; some people might not choose to be tested even if they knew, or suspected, they had symptoms because they would lose their income; at a few times tests were difficult to get.

Even before people had to turn to private tests on 1 April, we see a big dip in testing showing a change in attitude to the virus, as much as people reacting to the price change.

UK testing peaked in January 2022

Registered coronavirus test results and number that are positive, by date of publication. 5 April 2020 had the highest percentage of positive test results. 4 January 2022 had the highest number of registered tests. *From 26th Feb 2022: no case data is published on Saturdays or Sundays and figures published on Monday include three days' data, so case data is removed from this label on these days to allow for accurate comparisions over time. Test data continues to be reported as normal over the weekend. Data: data.gov.uk. updated

Even if free tests were still available now, peoples propensity to ask for them would have changed a lot because of the perception that the disease isnt as important or dangerous as it was, says McConway. That partly stems from government policies and announcements but by no means all of it it would have happened anyway.

The UK Health Surveillance Agency (UKSHA), which has taken over from Public Health England, is continuing to publish Flu and Covid-19 Surveillance reports that draw together data sources including the ONS infection survey but also information from GPs and hospitals, places outside the health system such as care homes and schools, and even sources such as Google searches for symptoms and reports of disease outbreaks at workplaces like restaurants.

More creative data sources such as sewage have even been used to gauge coronavirus levels in the population. Though are not currently referenced in the surveillance report.

The emergence of a more transmissible or more deadly variant is one of the key areas of concern for next winter so continued genomic sequencing of samples is required to keep track of how the virus is mutating. And blood samples will continue to be needed as antibody levels give an indication of immunity.

McConway says the UK has decent measures in place to keep track of diseases that get less media attention than coronavirus.

Whats unique about Sars-CoV-2 is the scale of the pandemic, and the public and government and media interest, and some of that led to different and more elaborate and expensive surveillance approaches, but lots of things go on all the time without most people noticing.

So as with flu it is likely authorities will see the warning signs before a new surge hits in the winter. The question is then as Vallance notes whether the government will act on it.

The Guardians UK coronavirus tracker will switch over shortly to use ONS infection survey numbers for cases, instead of the gov.uk numbers

Notes:

* Gov.uk counted 275,618 new cases by specimen date on 4 January 2022 in the UK the highest daily caseload for the pandemic. The date with the highest number of cases by date reported was also the 4 January 2022 with 218,724 new cases (for the period when the government was publishing figures daily).

Gov.uk counted 1,366 deaths within 28 days of a positive test by date of death on 19 January 2021, in the UK. The worst day for deaths by date reported within 28 days of a positive test in the UK is 20 Jan 2021, when 1,820 deaths were reported.

Continued here:

Are UK coronavirus cases actually going down or are they just harder to count? - The Guardian

Twenty-seven months into the COVID-19 pandemic, our defenses against the coronavirus seem at once stronger and more penetrable than ever. A growing majority of the U.S. population now has some immunity to SARS-CoV-2, the virus that causes COVID-19, whether from vaccination, past infection, or both. However, staggeringly infectious members of the Omicron family have demonstrated an ability to evade some of those protections. Since April, they have led to a quadrupling of daily coronavirus cases; the U.S. has been reporting more than a hundred thousand a day, but, because widely used at-home tests dont show up in official tallies, the true number could be five or even ten times higher.

When the original Omicron, BA.1, swept the country this winter, it was by far the most contagious variant to date. But a subvariant that emerged more recently, BA.2, appears to be thirty per cent more transmissible, and one of its descendants, BA.2.12.1, is more contagious still. Unfortunately, people who have recovered from BA.1 infections can be reinfected by Omicron subvariants. According to some estimates, the U.S. could see a hundred million coronavirus infections this fall and winter. This is approaching one of the most transmissible pathogens in history, Eric Topol, the director of the Scripps Research Translational Institute, told me.

Yet the countrys response has been one of indifference. No state currently requires masks in public places, even though the director of the Centers for Disease Control and Prevention has said that a third of Americans should consider wearing them, and New York City recently recommended them indoors. When a judge struck down a federal mask requirement for trains and airplanes, the Biden Administration appealed, but did not seek to immediately reinstate the mandate. In April, less than a third of Americans said that they were even somewhat worried about getting COVID-19, the lowest proportion since July, 2021, and fewer people were socially distancing than at any time during the pandemic. A third of the population believes that the pandemic is over, including more than half of unvaccinated Americans and nearly six in ten Republicans.

This attitude is attributable, in part, to an indisputable reduction in the most serious consequences of COVID-19. Although new variants are causing more breakthrough infections, vaccines remain protective against severe illness. During the current surge, COVID deaths have been steady at around three hundred a daystill too many, but near pandemic lowsand hospitalizations have risen modestly. But our apathy also seems related to a pandemic malaisean inability or unwillingness to devote more cognitive and material resources to a problem that refuses to leave us alone. Congress has so far failed to fund an adequate supply of vaccines, tests, and treatments this winter, suggesting that the country has retreated not only from controversial mandates but from the most basic tools of public health.

As a physician, I have struggled to know what to make of this moment in the pandemic, and I fear that it will last a long time. We may be in this phase forever, Robert Wachter, the chair of the department of medicine at the University of California, San Francisco, told me. Lately, Ive been seeking out people who have shaped the COVID discourseexperts who have not only shared and interpreted information but helped to construct a pandemic narrative and, in doing so, influenced policymakers and the public. I wanted to understand how their thinking has changed on key questions now facing the country: How should we live? Who should decide? How long will this last? As the coronavirus has become less deadly yet more difficult to contain, they told me, strategies that defined the early pandemic have fallen away, and responsibility for our everyday behavior has shifted away from public-health officials and toward individuals. In the coming months, well learn the consequences of this approach.

Doctors often categorize medical conditions as acute, subacute, or chronic. A patient with crushing chest pain and an alarming EKG is experiencing an acute emergency, meaning that, within minutes, they need a specific series of drugs and a team of medical professionals to unclog the culprit blood vessel. Another patient may feel his chest tighten when he walks up stairs, but the discomfort fades when he rests, and its been this way for years. His angina is said to be chronic: its serious and needs medical attention, but can usually be managed with medications and checkups. The subacute condition is somewhere in between. Last month, a man could climb three flights; last week, only two; and today, his torso feels heavy when he walks to the bathroom. Subacute illnesses are hazardous in their own way. They can often be mitigated if treated appropriately, but they may be difficult to diagnose, and, if you ignore or mismanage them, they can spiral out of control.

I sometimes think of this period as a subacute phase of the pandemic. COVID-19 is no longer an acute emergency, but its not yet clear how it will become an endemic disease that we are ready to live with. Public weariness, highly transmissible variants that evade some of our immunitythese factors may condemn us to intermittent surges long into the future. Within the realm of my imagination, I can no longer see a true game changer that alters the fundamental dynamics from where we are today, Wachter told me. For me to say otherwise would be some combination of wishful thinking and reacting to my own internal pressure, and pressure from those around me, not to be a bummer. This is, of course, a bummer. Still, it might not be as bad as it sounds. Were not going to see another million COVID deaths in the United States, Wachter said. The vast majority of severe illness will be fully preventable. Well probably wear masks in some places, maybe get regular boosters. Its not the end of the world. It doesnt diminish my life significantly.

The experts I spoke to seemed to accept that, as a society, our options for containing such a transmissible virus are limited. If cases were falling and there were not new variants that are so highly contagious, then suppressing infection would actually be a viable path, Leana Wen, the former health commissioner of Baltimore, told me. We have to recognize that the price of prioritizing low infection rates would be astronomical. In her view, the U.S. cant afford to close schools, restrict travel, or shutter businesses for long periods, and those stringent measures might not work anyway. Even China, with the strictest lockdown in the world, is struggling to contain these hyper-contagious variants, Devi Sridhar, a professor of public health at the University of Edinburgh and the author of Preventable: How a Pandemic Changed the World and How to Stop the Next One, told me. We have to pivot away from the idea that we can avoid getting infected.

Wen once advocated for strict measures to suppress the virus, but now argues for a return to something like normal life. She told me that she changed her mind in part because infections have grown less punishing with time, as more people acquire immunity and gain access to effective drugs. In two years, the infection fatality rate of SARS-CoV-2 has fallen dramatically. For people whove received a booster shot, it now really is on par with the flu. (Of course, the coronavirus is still infecting a lot more people.) As the risk of severe COVID-19 falls, Wen said, the threshold for policymakers to impose restrictions should rise. She argued that mandates would become appropriate only if a new and deadlier variant emerges. Reintroducing them now would erode trust in public health and weaken our ability to respond to future emergencies, she said. As soon as the emergency fades, individual choice is again the key decider.

Wen frequently hears the criticism, sometimes in the form of online vitriol, that her position does not fully account for the roughly seven million Americans who remain at higher risk for serious COVID-19, even after vaccination, because of compromised immune systems. Although she thinks that more should be done to protect the immunocompromised, she also believes that most Americans should be allowed to return to their pre-pandemic routines. In my clinical practice, I often care for immunocompromised patients who express fear and frustration that the country seems determined to move on from the pandemicand, in their minds, to leave them behind. Having treated the devastating consequences of infections in these patients, I find it hard not to empathize with them, and I dont have easy answers. Wachter told me that he is sympathetic to the idea that were not doing enough to protect vulnerable peoplebut in a country where many people dont even have access to medical care, he said, the idea that, all of a sudden, everyone in society is going to do everything possible... that strikes me as seeking a perfect world that were awfully far from. In his view, most immunocompromised people now have the tools to keep themselves relatively safe. He pointed to vaccines, boosters, antivirals, N95 masks, and Evusheld, a preventive monoclonal antibody authorized for people who are moderately or severely immunocompromised. And, of course, we should all be encouraged to get tested and mask up before we spend time with someone whos at high risk of a serious infection.

If were all likely to get COVID at some point, should everyone still try to avoid it? Wachter thinks so, and called for individuals to take precautionsmasks, tests, steering clear of large indoor gatheringsin places where the coronavirus is highly prevalent. For me at least, the long-COVID risk makes the benefits of reasonable amounts of caution outweigh the downsides, but I could see others making different choices, he told me. In the future, antivirals are likely to get better. Vaccines may be better. Well understand more about long COVID and how to manage it. At some point in my life, I know Im going to get some terrible disease, whether COVID or something else. Id like it to be as far down the road as possible. He pointed to a recent estimate from the C.D.C. that nearly sixty per cent of Americans have been infected by the coronavirus, which suggests that more than a hundred million Americans have not.

The virus will continue to evolve, but so will our tools for fighting it. Its going to be innovation, not behavior change, that gets us out of this mess, Topol, the Scripps director, told me. You cant keep people in a cave forever. Topol fears that a future variant will be more virulent. It pains me to say it, because Im an optimist, he said. But he argued that the U.S. still has the power to change the course of the pandemic, by continuing to invest in scientific research.

So far, new variants have tended to become more transmissible and better at getting around our immune defenses, but not more lethal. This makes sense from an evolutionary perspectivethe virus faces selective pressure to find new ways to spread, not killand SARS-CoV-2 could go the way of other coronaviruses that cause the common cold. Then again, it might not. People have this delusional idea that somehow the variants are just going to get milder over timewrong! Topol said. They could easily become more pathogenic. He pointed out that, compared with prior variants, Omicron has spawned more subvariants, which are chipping away at the immunity wall of vaccination.

In addition to advances such as better antiviral drugs, several types of vaccine innovations would be especially valuable. The first is a universal coronavirus vaccine. Such a vaccine could potentially give us some immunity against all SARS-CoV-2 variants, as well as other coronaviruses. (A research group at the California Institute of Technology, for example, has used a vaccine platform called a mosaic nanoparticle, which incorporates proteins from up to eight types of coronaviruses and has shown promising results in mice.) A second transformative innovation would be a vaccine that produces sterilizing immunitythat is, in its ideal form, an antibody response so potent that it prevents the pathogen from infecting and reproducing within us at all. This would dramatically slow the spread of the virus, but, for COVID-19 and many other pathogens, sterilizing vaccines have remained elusive. A vaccine thats sprayed into the nose might be one path toward something closer to it. Because nasal vaccines produce high levels of antibodies inside the nose, where the virus often enters the body, they could be more effective at preventing infection altogether. There are now three such vaccine candidates in late-stage clinical trials; they present the body with many viral proteins, not just the spike, and could therefore produce broad, variant-resistant immunity. Many people have needle-phobia and would probably say, I dont want any more booster shots, but I wouldnt mind taking a nasal spray every four-to-six months, Topol told me. We should be getting the nose and mouth Teflon-coated. Hes troubled by a profound lack of investment in these kinds of advances.

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Will the Coronavirus Pandemic Ever End? - The New Yorker

BOISE - New coronavirus cases continued to climb statewide last week, but cases slowed among school-age children.

The state reported more than 1,300 new cases last week still a relatively low number compared to last falls delta variant surge and the winters record-setting omicron variant surge. Still, new cases increased by 27% last week.

Meanwhile, the state reported 86 new cases involving 5- to 17-year-olds, a 17% decrease.

Numbers from the states largest school districts were mixed:

Other metrics worsened slightly.

On Wednesday, 55 Idahoans were hospitalized with COVID-19, up from 44 the previous week. Seven patients were in ICUs, down from seven the previous week. One COVID-19 pediatric patient was hospitalized.

For the week ending May 14, 5.5% of test results came back positive, up from 4.9%. A positive test rate exceeding 5% suggests a virus is spreading.

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Idaho's New Coronavirus Cases on the Rise - But Not Among School-Age Children - bigcountrynewsconnection.com

Mike Stucka USA TODAY NETWORK| St. George Spectrum & Daily News

New coronavirus cases leaped in Utah in the week ending Sunday, rising 33.1% as 4,504 cases were reported. The previous week had 3,385 new cases of the virus that causes COVID-19.

Utah ranked 31st among the states where coronavirus was spreading the fastest on a per-person basis, a USA TODAY Network analysis of Johns Hopkins University data shows. In the latest week coronavirus cases in the United States increased 31.8% from the week before, with 796,108 cases reported. With 0.96% of the country's population, Utah had 0.57% of the country's cases in the last week. Across the country, 42 states had more cases in the latest week than they did in the week before.

More: COVID-19 case rates are rising again in Utah. Here is what healthcare leaders think that means

Within Utah, the worst weekly outbreaks on a per-person basis were in Summit County with 301 cases per 100,000 per week; Salt Lake County with 205; and Wasatch County with 153. The Centers for Disease Control says high levels of community transmission begin at 100 cases per 100,000 per week.

Adding the most new cases overall were Salt Lake County, with 2,374 cases; Utah County, with 655 cases; and Davis County, with 473. Weekly case counts rose in six counties from the previous week. The worst increases from the prior week's pace were in Salt Lake, Davis and Utah counties.

>> See how your community has fared with recent coronavirus cases

Utah ranked 28th among states in share of people receiving at least one shot, with 72.1% of its residents at least partially vaccinated. The national rate is 77.7%, a USA TODAY analysis of CDC data shows. The Pfizer and Moderna vaccines, which are the most used in the United States, require two doses administered a few weeks apart.

In the week ending Wednesday, Utah reported administering another 26,848 vaccine doses, including 3,326 first doses. In the previous week, the state administered 10,967 vaccine doses, including 1,555 first doses. In all, Utah reported it has administered 5,212,257 total doses.

In Utah, four people were reported dead of COVID-19 in the week ending Sunday. In the week before that, one person was reported dead.

A total of 943,368 people in Utah have tested positive for the coronavirus since the pandemic began, and 4,765 people have died from the disease, Johns Hopkins University data shows. In the United States 83,281,329 people have tested positive and 1,002,173 people have died.

>> Track coronavirus cases across the United States

USA TODAY analyzed federal hospital data as of Sunday, May 22.

Likely COVID patients admitted in the state:

Likely COVID patients admitted in the nation:

Hospitals in 31 states reported more COVID-19 patients than a week earlier, while hospitals in 29 states had more COVID-19 patients in intensive-care beds. Hospitals in 37 states admitted more COVID-19 patients in the latest week than a week prior, the USA TODAY analysis of U.S. Health and Human Services data shows.

The USA TODAY Network is publishing localized versions of this story on its news sites across the country, generated with data from Johns Hopkins University and the Centers for Disease Control. If you have questions about the data or the story, contact Mike Stucka at mstucka@gannett.com.

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Hospitalizations on the rise as Utah COVID-19 case counts jump more than 33% in past week - The Spectrum

For the past year and a half, since the COVID-19 vaccines first became availableeven as last summers reprieve gave way to Deltas surge, then Omicrons; even as the coronavirus continued to rack up mutations that lifted its speed and its stealth; even as millions of vaccinated Americans caught the pathogen and passed it ontheres been one huge slice of solace to cling to: The shots we have are still doing an excellent job of staving off severe disease and death.

Billions of people around the world have now been dosed at least once, twice, or thrice; the shots have saved hundreds of thousands, if not millions, of lives, in the United States aloneand they probably could have saved hundreds of thousands more, had more people rolled up their sleeves. Were so much better off than where we were in 2020, when nobody had any immunity, says Donna Farber, an immunologist at Columbia University. It feels, in some ways, like gazing down the side of a mountain weve been trekking up for a good 30 months: A nice, stubborn buffer of elevation now lies between us and the bottom, the sea-level status of no protection at all. The bodys defenses against severe disease are immunological bedrockonce cemented, theyre quite difficult to erode. Even as the fast-mutating virus pushes down from above, our footing has, for more than a year now, felt solid, and the ground beneath us unlikely to give.

Read: America is starting to see what COVID immunity really looks like

The shots arent perfect: They cant completely block infections or keep the debilitating symptoms of long COVID at bay. Still, against the severest outcomes, I think vaccination is holding up, Ali Ellebedy, an immunologist at Washington University in St. Louis, told me. It provides a lot of comfort, just knowing that layer is there, says Natalie Dean, a biostatistician at Emory University.

As SARS-CoV-2s shape-shifting shenanigans continue, though, widening the evolutionary chasm between its current iteration and the version that inspired 2020s vaccines, our position is starting to feel more precarious. Say our immune defenses weaken, and cause us to slip; say the virus ups the ante again, and delivers a particularly powerful blow. A rapid tumble down to the trailheada total immunological resetstill seems very, very unlikely. The further away we stay from that juncture, though, the better off well be. If minimizing severe disease is a summit of sorts, its one we have to keep striving for, likely by revaccinating, and hopefully with updated shots. Knowing when to dose up again, and with what, will require keeping close watch on local conditions, trying to anticipate how the virus might shove us, and maintaining our gear in tip-top shape. Its a long way to the bottom, but backslides are possible.

Stopping severe disease and death is the first goal of any vaccine. But its not necessarily the first protective pinnacle the world set its sights on. Back when the vaccines were new and a near-perfect match for the circulating strain, many people felt hopeful that wed quickly clamber up to some Symptom-Free Vistamaybe even dart up to No-Infection Point.

As the vaccines got further out from their debut, however, it became clear that we werent going to be camping at those outcrops long-term. Which is pretty expected: For any immunization to sustainably and reliably keep people safe from all infections is rare. In the months after people get their shots, levels of infection-blocking antibodies naturally drop off, making it easier for pathogens to infiltrate the body and reproduce. At the same time, the virus is only getting better at knocking us downit strikes a new blow each time it tacks on another mutation that distances it from the version of itself that inspired our shots. That wild card worries experts far more than any immunological stumble. Virus evolution is always my biggest concern, Ellebedy told me. Members of the Omicron clanthe most formidable branch of the SARS-CoV-2 family to datehave proved themselves deft at infecting even the multiply vaccinated, slipping around shot-raised antibodies with ease.

Immunity is too multifaceted, too broad, and too flexible for SARS-CoV-2 to shove us all the way down to the mountains base; although speedy defenders such as antibodies decline in the short term, other soldiers such as B cells and T cells can stick around for years, even decades, stowing intel on the virus so they can rise up again. These veteran fighters arent fast enough to stop a virus from breaching the bodys barriers. But when it does, they can trounce it before the infection gets too severe. Theyre also far harder to stump than fickle, fragile antibodies; even weird morphs like Omicron are familiar-looking enough to evoke the ire of most vaccine-trained T cells and an appreciably large fraction of B cells. That protects us, even if antibodies are lost, says Hana El Sahly, an infectious-disease physician at Baylor College of Medicine.

Still, the viruss assaults on our position on the flanks of Protection Peak are getting stronger. Weve had to dig our heels in far deeper to stay the course. Two doses of mRNA vaccine, for instance, were enough to hold the line against SARS-CoV-2 in the Delta era and before. Omicrons mutations, though, upped the ante and made the mountain more formidable. The latest estimates provided by the CDC, which run through the first part of winter, suggest that adults who have received a duo of mRNA doses can cut their risk of serious sickness from Delta by at least 80 to 95 percent; the numbers drop into the 50ish to 70ish range with the original iteration of Omicron, or BA.1, subbed in. So experts recommended an equipment upgrade to keep the summit in sight: another dose, which can restore the bodys ability to stave off severe disease from BA.1 at rates of about 75 to 90 percent.

Whats not certain, though, is how long SARS-CoV-2 will continue to rest on its laurels. Faced with growing population immunity, the virus is being forced to repeatedly switch up its appearance. In the span of just a few months, Omicron has already sprouted several new alphanumeric offshootsBA.2.12.1, BA.4, and BA.5that can dodge the defenses that even a tussle with their sibling BA.1 leaves behind. And its not entirely clear how wild SARS-CoV-2s costume changes could get. Parts of the virus that scientists once thought were unlikely to change much have since transformed. This coronavirus, like others that have come before it, has shown a remarkable capacity to shape-shift when faced with immunity blockades, says David Martinez, a viral immunologist at the University of North Carolina at Chapel Hill. Theres a lot of real estate left in spike, he told me, for the virus to continually evolve. Our vaccines, meanwhile, remain modeled on a version of the virus that first infiltrated the population more than two years ago, and that has since disappeared. Yes, vaccine effectiveness remains really high against severe disease, even months out, even against Omicron, says Saad Omer, an epidemiologist at Yale University. But that doesnt mean there isnt room to relace our boots and attempt to ascend again.

Just how well protected we are right nowhow close to the bottom or the top of the peakisnt totally clear. Our ability to capture this is clouded, Dean told me. So much of the landscape weve been meandering upon has shifted in recent months; we, the travelers, have also changed.

To really get a good grip on vaccine performance, Dean said, researchers need to carefully track large groups of people who have gotten different numbers of shotsanywhere from zero to three or moreover long periods of time, carefully tabulating whos getting infected, sick, hospitalized, or killed. Metrics like these were relatively easy to monitor during the shots clinical trials. But the real world is far messier, and gathering data is much more difficult now. Thats especially true in the U.S., which lacks a nationalized health-care system, and has no single, uniform way to record-keep. Americans immunization options also keep splintering. Shots are being administered to different people at different intervals, in different combinations, against different variants; successes and failures against the virus are now much harder to tie directly to the potency of the injections themselves. Vaccinated and unvaccinated people have also gotten way more challenging to compare: They belong to very different demographic groups, split apart by when (or if) they became eligible and how vulnerable to the virus they are, as well as the allegiances that might have swayed some of them toward opting into or out of shots.

Its also getting rougher and rougher to statistically account for how the pandemic, and the response to it, has evolved. Vaccines work better against all outcomes when the bodies theyre protecting arent constantly being taxed by heavy, frequent exposures to a pathogen; in recent months, mask mandates have lifted, and crowded indoor gatherings have gone back into full swing. On the flip side, treatments such as Paxlovid have become more available, muddying patterns that could help clue researchers in to what interventions are saving the most lives. Effectiveness estimates can also be obscured by how severity is defined. Even tracking who gets hospitalized can be a pretty coarse metric. Different hospitals use different criteria to admit patients, especially during surges, when capacity gets stretched. And parsing out the severity of an infection isnt easy in someone whos battling another ailment, says Westyn Branch-Elliman, an infectious-disease physician at VA Boston Healthcare System and Harvard Medical School. Nor are all serious COVID cases the same: Some people might be discharged after just a couple of days, while others end up on ventilatorsnuances that get lost when all cases that meet the bare minimum criteria for severity are lumped together. Add to that the complexities of actual infectionswhich happen more commonly in the unvaccinated and layer on their own patinas of protectionand its that much tougher to figure out how well the shots are performing on their own.

Read: What COVID hospitalization numbers are missing

Our estimates are also always a few steps behind. The most up-to-date effectiveness numbers in the books still largely reflect how the shots are faring against BA.1, which, thanks to its speedier siblings, has now almost entirely blipped off the American map. If were having trouble figuring out where we stand on this mountainous trail, forking paths exacerbate the confusion, along with a compass that gets more challenging to calibrate by the day.

Practically, that all makes assessing when, or whether, to intervene very difficult. A catastrophic, cliff-like plunge in effectivenessespecially one tied to the emergence of a new variant of concernmight prompt a scramble to revamp our vaccine recipes, stat. That doesnt seem to be what were seeing, though, and experts are still working on timing our next steps just right. Scientists are used to strategizing against other viruses, such as the ones that cause seasonal flus: Scientists reformulate and readminister those shots every year, in an attempt to counteract both waning immunity and viral mutations before most people hit a winter surge. By comparison, this coronaviruss spread is still too haphazard, too unpredictable. If we can barely gauge which mile marker were at, its hard to know how often well need to update our approach.

It has, at least, become clear that protection can fall off far faster in some vulnerable populations, who may need immune refurbishings more often: older people, immunocompromised people, people with certain chronic health conditions. In the rest of the population, though, the extent of the decline feels far murkier. Branch-Elliman told me that some studies are likely overestimating drops in effectiveness against severe disease: Some arent accounting for the immunity building up in the unvaccinated; others are failing to disentangle the true severity of infection in each case. Adjust for them, she said, and the evidence for waning becomes much weaker. Still, as the virus continues to change, and peoples most recent doses recede further into the past, I think we are seeing a little bit of a performance drop, says Huong McLean, an epidemiologist and a vaccine researcher at the Marshfield Clinic Research Institute. The dip isnt massivemaybe a few percentage points over several months, in those who are up-to-date on their shots. But, Omer told me, it is there.

The experts I spoke with couldnt point to a single threshold at which theyd really start to worrywhen the dreaded bottom of Protection Peak might feel just too close. One tentatively offered a dip below 50 percent effectiveness against severe disease as an obvious bad-news-bears benchmark. A couple said theyd start to worry at about 70 percent, while another told me that anything below the range of the 80s would be clearly problematic (which, maybe, means now). Martinez, of UNC Chapel Hill, framed it by outcomes: If rates of hospitalization or death among people up to date on their vaccines were to approach an uncomfortably high ratemaybe half what experts are seeing among the unvaccinated, he told methats when you want to patch this.

The clearest and most immediate intervention available would be administering an additional vaccine dose. And ideally, it would be tailored to better match the circulating strains du jour, which, for now, requires at least some nod to Omicron and its offshoots. Ellebedy suspects that the U.S. may be on track to revaccinate against this virus with a new vaccine recipe as often as each autumn, as we do for the fluan annual adjustment that may become as necessary as redrawing trail maps to account for shifting mountain terrain. But it will be a behavioral hurdle as much as a technological one. Just a third of Americans are boosted, and uptake on future doses might not fare much better.

Read: The U.S. is about to make a big gamble on our next COVID winter

None of this means our vaccines have been a bust. Protection against severe disease and death is what you want out of a vaccine in a public emergencythats the most important thing, and thats what the vaccines have done, Farber, the Columbia immunologist, told me. And the shots continue to trim down symptoms, transmission, and infection, even if they do not completely stave off those outcomes; the illnesses that do occur among the vaccinated also tend, on average, to be notedly less severe, Branch-Elliman points out. But our current crop of immunizations has its limits; shots wont be enough to end the pandemic on their own, especially not with uptake lagging, and global vaccine equity still in a disastrous state. I feel worried, just looking ahead, Farber told me. As long as the virus can infect, its going to change and adapt. The virus could get more chances to transform into something more troubling; it may become even tougher to hold our ground against it, should we grow complacent now.

Longer-term solutions, better at tackling infections, transmission, and less-severe disease, may be in the pipeline. Martinez is one of several researchers hoping to cook up a universal vaccine that will teach the body to arm itself against a panoply of coronaviruses at once; others are working on up-the-nose vaccines that could post up defenses in the airway, to head off future infections at the pass. There may even someday be an immunization recipe that better cements the durability of defense, so future generations wouldnt need so many shots. Those innovations might be years away, if they appear at all. For now, well likely need more than vaccines to stay on top of protectionto reach for the zeniths where not just severe disease is minimized, but infections and transmission can stay low, too. Fortunately, its a path weve charted before, with tools and footfalls that are by now familiar: masks, ventilation, antivirals, tests. The way back up to a peak isnt always the way we came down. Sometimes, we just need to blaze a better trail.

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Are COVID Vaccines Still Blocking Severe Disease? - The Atlantic

Total vaccine doses distributed: 741,676,155

Patients whove received the first dose: 258,149,591

Patients whove received the second dose: 220,914,142

% of population fully vaccinated: 66.5%

% tied to Omicron variant: 99.8%

% tied to Other: 0.2%

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Coronavirus Omicron variant, vaccine, and case numbers in the United States: May 23, 2022 - Medical Economics

In this photo provided by the North Korean government, North Korean leader Kim Jong Un covers the coffin of Hyon Chol Hae, marshal of the Korean People's Army, with earth at a cemetery in Pyongyang, North Korea Sunday, May 22, 2022. The content of this image cannot be independently verified. AP hide caption

In this photo provided by the North Korean government, North Korean leader Kim Jong Un covers the coffin of Hyon Chol Hae, marshal of the Korean People's Army, with earth at a cemetery in Pyongyang, North Korea Sunday, May 22, 2022. The content of this image cannot be independently verified.

SEOUL, South Korea A large number of North Koreans including leader Kim Jong Un attended a funeral for a top official, state media reported Monday, as the country maintained the much-disputed claim that its suspected coronavirus outbreak is subsiding.

Since admitting earlier this month to an outbreak of the omicron variant, North Korea has only stated how many people have fevers daily, and has only identified a few of the cases as COVID-19. Its state media said Monday that 2.8 million people have fallen ill due to an unidentified fever but only 68 of them died since late April, an extremely low fatality rate if the illness is COVID-19 as suspected.

North Korea has limited testing capability for that many sick people, but some experts say it is also likely underreporting mortalities to protect Kim from political damage.

The official Korean Central News Agency said Kim attended the funeral Sunday of Hyon Chol Hae, a Korean People's Army marshal who reportedly played a key role in grooming him as the country's next leader before Kim's father died in late 2011.

State media photos showed a bare-faced Kim carrying Hyon's coffin with other men wearing masks before he threw earth to his grave at the national cemetery. They showed many soldiers clad in olive-green uniforms saluting while other officials dressed in dark suits stood at attention. KCNA said "a great many" soldiers and citizens earlier turned out along streets to express their condolences when Hyon's coffin was moved to the cemetery.

North Korea maintains a nationwide lockdown and other stringent rules to curb the virus outbreak. Region-to-region movement is banned, but key agricultural, economic and other industrial activities were continuing in an apparent effort to minimize harm to the country's already moribund economy.

KCNA said Monday that 167,650 new fever cases had been detected in the past 24-hour period, a notable drop from the peak of about 390,000 reported about one week ago. It said one more person died and that the fever's fatality rate was 0.002%.

In this photo provided by the North Korean government, a funeral for Marshal of the Korean People's Army Hyon Chol Hae is held at the April 25 House of Culture in Pyongyang, North Korea Sunday, May 22, 2022. AP hide caption

In this photo provided by the North Korean government, a funeral for Marshal of the Korean People's Army Hyon Chol Hae is held at the April 25 House of Culture in Pyongyang, North Korea Sunday, May 22, 2022.

"All the people of (North Korea) maintain the current favorable turn in the anti-epidemic campaign with maximum awareness, in response to the call of the party central committee for defending their precious life and future with confidence in sure victory and redoubled great efforts," KCNA said.

Experts question the the true toll, given North Korea's 26 million people are mostly unvaccinated and about 40% are reportedly undernourished. The public health care system is almost broken and chronically short of medicine and supplies. In South Korea, where most of its 52 million people are fully vaccinated, the fatality rate of COVID-19 was 0.13% as of Monday.

South Korea's spy agency told lawmakers last week that some of the fever cases tallied by North Korea include people suffering from other illnesses like measles, typhoid and pertussis. But some civilian experts believe most of the cases were COVID-19.

Before admitting to the omicron outbreak on May 12, North Korea had insisted it was virus-free throughout the pandemic. It snubbed millions of vaccines offered by the U.N.-backed COVAX distribution program and has not responded to offers of medicine and other aid from South Korea and the United States.

The World Health Organization has also pleaded for more information on the outbreak but not gotten a response.

Some observers say North Korea would only receive assistance from China, its last major ally, because Western aid shipments could hurt Kim's leadership as he's repeatedly called for "a self-reliance" to fight against U.S.-led pressure campaigns.

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Kim and other N. Koreans attend large funeral amid COVID worry - NPR