Category: Corona Virus

We regularly answer frequently asked questions about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions." See an archive of our FAQs here.

Many of us are returning from spring break travel and holiday celebrations with loved ones just as cases in parts of the United States and in some other countries are starting to tick back up.

Testing for COVID is as critical now as it was in earlier stages of the pandemic in order to understand where cases are rising and so that you can seek treatment.

So you may be wondering: When do I need to test now? And can I trust a first test result?

First off: If you develop COVID-like symptoms, test as soon as possible.

And let's assume you're going to self-test because you don't have easy access to a facility that offers PCR tests and/or your insurance doesn't cover it and/or you don't want to wait extra time for results rather than an instant read off a do-it-yourself antigen test.

So you take that home test... and it's negative. Are you in the clear? Maybe, but not definitively. Our experts suggest testing again after a couple of days.

Your body's response to SARS-CoV-2 infection depends on your level of immunity from previous encounters with the virus and from vaccines and boosters.

So it's possible that the negative result is correct and you simply didn't get infected.

Or you might not have enough "viral load" in the early stages of being infected to test positive. That can happen if you have some degree of immunity from a prior case or a vaccination but you get infected anyway (see: Nancy Pelosi).

That's why experts recommend testing at least twice. Test number one would come when you first have concerns that you are infected based on symptoms.

And if you've been exposed to someone with COVID or were in a higher-risk situation (traveling, karaoke party, Gridiron dinner) and then plan to be around an older relative or a child too young to be vaccinated or someone who's immune-compromised?

"If you are going to be around the vulnerable population that can't be protected from the disease and, unfortunately, we have a lot of people that fall into that category then you should do everything in your power to try and make sure you don't have the virus," said Omai Garner, director of clinical microbiology in the UCLA Health System.

You might be tempted to test right away to ease your anxiety. But the recommendation from the U.S. Centers for Disease Control and Prevention is to wait five days after a possible exposure.

It takes a little while for the virus to build up in your body. Testing too soon might give you a false negative.

"You can't take a pregnancy test the day after intercourse to see if you're pregnant, right?" Bergstrom said. The rapid test for COVID is "an excellent test it just has to be used properly and at the right time."

And there's a reason tests come in pairs of two, Garner said. "You need to use them in the pair that they come in, and have multiple days in between, in order to be sure."

And for that second test, waiting a few hours doesn't count because your viral load still might not be high enough to detect. Testing experts suggest an interval of 48 hours before a second test.

Now if you do go for a PCR test, you won't have quite the same concerns. That's because for rapid home tests to turn positive, you need a higher viral load: Those antigen tests don't amplify the sample as PCR tests do.

For those with prior immunity to the virus, "most people feel that a PCR is positive 24 hours sooner than the rapid," says Ida Bergstrom, an internal medicine physician at a medical and travel clinic that conducts testing in Washington, D.C.t.

If you've developed symptoms after close, significant contact, you might consider getting a PCR even after negative rapid tests.

"If your husband is positive, and you develop symptoms, and you have a negative rapid and then the subsequent day you have a negative rapid I would still personally do a PCR before I called myself in the clear," Bergstrom says.

And should I contact my doctor if I have a positive test?

YES. There are a few reasons why.

If you are at risk of severe outcomes because of your age or preexisting conditions, you should try to get highly effective antivirals or monoclonal antibodies as soon as you test positive. The faster you can get the treatments, the better they work but they can only be prescribed after a positive test.

Even if you're not at high risk, you should let your doctor know of your positive test so that they can help you monitor your symptoms and have a more complete record of your health history.

This is a really important step, because you could go on to develop long COVID even after a mild illness, even if you were previously healthy. Between 10 to 50% of people who recover from COVID have long-term symptoms.

"If your symptoms linger or if there's any question with disability or anything in the future, it's nice that there's a trail," Bergstrom said.

Insurance companies may not cover treatments for long COVID if you don't have documented evidence of a positive test, and you may not be able to apply for disability without it.

It's also a great idea to report your home test results to your local health department, if that's an option, so that they can track local cases. Some states and cities also offer services like deferred rent or mortgage assistance for those who test positive.

Melody Schreiber (@m_scribe) is a journalist and the editor of What We Didn't Expect: Personal Stories About Premature Birth.

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COVID home tests are still critical but there's confusion about test protocols : Goats and Soda - NPR

At the height of the Omicron wave in early January, the United States was administering an average of 2.5 million tests per day. That number has dropped to an average of about 540,000 at the start of this week.Credit... Spencer Platt/Getty Images

About 30,000 marathoners from 122 countries and all 50 U.S. states will hit the streets on Monday in and around Boston, where the citys Public Health Commission reports that the Covid positivity rate has risen to 6.6 percent, passing its threshold of concern of 5 percent.

The agency urged residents to mask, to test before joining indoor gatherings, to gather outdoors if possible, and to get booster shots to protect themselves and others in the coming days as Easter, Passover, Ramadan and public school vacations converge. The citys positivity rate has risen by 4 percentage points since early March, it noted.

This month the Omicron BA.2 subvariant has flattened the steep downward glide in official case counts that Boston and the rest of the country had been on after the BA.1 surge in the winter. The turn is not unexpected, but it comes as in-person gatherings have resumed, vaccinations have flatlined, officially reported tests are falling and politicians and many Americans want an end to most restrictions.

And while hospitalizations and deaths remain on the decline nationally, concerns are rising for unvaccinated and unboosted people, who remain more vulnerable to serious illness and death.

BA.2, which is more transmissible and has spread even faster than BA.1, has quickly risen to account for what the Centers for Disease Control and Prevention estimates to be 86 percent of all U.S. cases. Twenty states, including the entire Northeast, have seen their daily cases rise by at least 30 percent in the past two weeks. Experts believe that two new subvariants may be contributing to this growth.

The rise of at-home testing obscures the data, and suggests that the true case increase may be far higher. Some newly available treatments are most effective when administered early in an infection, making testing more urgent.

Were right to be worried about our publicly available test results, said Dr. Cassandra Pierre, the associate hospital epidemiologist and director of public health programs at Boston Medical Center, who emphasized that nationally, testing capacity has diminished. Im absolutely concerned because I see transmission in family and work groups, and to vulnerable people.

At the height of the Omicron wave in early January, the United States was administering an average of 2.5 million tests per day. That number has dropped to an average of about 540,000 at the start of this week, according to the C.D.C.

Notable efforts to brake cases popped up this week, including the C.D.C.s two-week extension of the federal transportation mask requirement; the White Houses renewal of the Covid public health emergency for at least three more months; Philadelphias announcement that its indoor mask mandate will return; and several universities reinstatement of their mask policies.

Philadelphia is really the way its supposed to work, said Samuel Scarpino, the vice president of pathogen surveillance at the Rockefeller Foundations Pandemic Prevention Institute. The thing they do well is that they have public, published measures that say: If we hit this, the masks go on. People are ready, and its not a surprise.

The C.D.C., as of Thursday, does not recommend mandated masking for Philadelphia, nor for almost the entire rest of the country. Using data on new Covid-related hospital admissions and the percentage of hospital beds occupied by Covid patients, it says that only 0.4 percent of counties in the United States have high community levels of the virus.

When you use hospital-based metrics, you may be losing the story of whats happening in a vulnerable community, Dr. Pierre cautioned. She said that state and county data has become even more obscured because many states are phasing out testing, and because community testing centers have closed after the federal government ended a program that reimbursed providers for virus-related care for the uninsured.

BA.2 set off case surges earlier this year in Europe, where pandemic trends have acted as a harbinger for the United States. Americans have lower booster coverage than Europeans, Dr. Scarpino noted, and less immunity because more time has elapsed since most people got their second or third doses. The risk is higher here than in the U.K. and in Europe, he concluded.

Massachusetts, where new infections and positivity rates are rising, is offering family-friendly vaccination clinics at zoos, bowling alleys and Six Flags New England during next weeks school vacation period. The state is offering gift cards and free admission to some of the attractions, reminiscent of last years incentives when vaccines became widely available.

It makes sense that we want to move forward because we cant constantly stay on red alert, Dr. Pierre said. But this is not the time to do that.

Theres this assumption that future variants will be kinder and gentler, but theres no evidence of that. What we experience now is something different from what we might experience in the fall or winter.

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Covid News: BA.2 Rise Across U.S. Evident Even With Diminishing Test Data - The New York Times

An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has found that vastly more people died than previously believed a total of about 15 million by the end of 2021, more than double the official total of six million reported by countries individually.

But the release of the staggering estimate the result of more than a year of research and analysis by experts around the world and the most comprehensive look at the lethality of the pandemic to date has been delayed for months because of objections from India, which disputes the calculation of how many of its citizens died and has tried to keep it from becoming public.

More than a third of the additional nine million deaths are estimated to have occurred in India, where the government of Prime Minister Narendra Modi has stood by its own count of about 520,000. The W.H.O. will show the countrys toll is at least four million, according to people familiar with the numbers who were not authorized to disclose them, which would give India the highest tally in the world, they said. The Times was unable to learn the estimates for other countries.

The W.H.O. calculation combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aim to account for deaths that were missed. Most of the difference in the new global estimate represents previously uncounted deaths, the bulk of which were directly from Covid; the new number also includes indirect deaths, like those of people unable to access care for other ailments because of the pandemic.

The delay in releasing the figures is significant because the global data is essential for understanding how the pandemic has played out and what steps could mitigate a similar crisis in the future. It has created turmoil in the normally staid world of health statistics a feud cloaked in anodyne language is playing out at the United Nations Statistical Commission, the world body that gathers health data, spurred by Indias refusal to cooperate.

Its important for global accounting and the moral obligation to those who have died, but also important very practically. If there are subsequent waves, then really understanding the death total is key to knowing if vaccination campaigns are working, said Dr. Prabhat Jha, director of the Centre for Global Health Research in Toronto and a member of the expert working group supporting the W.H.O.s excess death calculation. And its important for accountability.

To try to take the true measure of the pandemics impact, the W.H.O. assembled a collection of specialists including demographers, public health experts, statisticians and data scientists. The Technical Advisory Group, as it is known, has been collaborating across countries to try to piece together the most complete accounting of the pandemic dead.

The Times spoke with more than 10 people familiar with the data. The W.H.O. had planned to make the numbers public in January but the release has continually been pushed back.

Recently, a few members of the group warned the W.H.O. that if the organization did not release the figures, the experts would do so themselves, three people familiar with the matter said.

A W.H.O. spokeswoman, Amna Smailbegovic, told The Times, We aim to publish in April.

Dr. Samira Asma, the W.H.O.s assistant director general for data, analytics and delivery for impact, who is helping to lead the calculation, said the release of the data has been slightly delayed but said it was because we wanted to make sure everyone is consulted.

India insists that the W.H.O.s methodology is flawed. India feels that the process was neither collaborative nor adequately representative, the government said in a statement to the United Nations Statistical Commission in February. It also argued that the process did not hold scientific rigor and rational scrutiny as expected from an organization of the stature of the World Health Organization.

The Ministry of Health in New Delhi did not respond to requests for comment.

India is not alone in undercounting pandemic deaths: The new W.H.O. numbers also reflect undercounting in other populous countries such as Indonesia and Egypt.

Dr. Asma noted that many countries have struggled to accurately calculate the pandemics impact. Even in the most advanced countries, she said, I think when you look under the hood, it is challenging. At the start of the pandemic there were significant disparities in how quickly different U.S. states were reporting deaths, she said, and some were still collecting the data via fax.

India brought a large team to review the W.H.O. data analysis, she said, and the agency was glad to have them do it, because it wanted the model to be as transparent as possible.

Indias work on vaccination has won praise from experts globally, but its public health response to Covid has been criticized for overconfidence. Mr. Modi boasted in January 2021 that India had saved humanity from a big disaster. A couple of months later, his health minister declared that the country was in the endgame of Covid-19. Complacency set in, leading to missteps and attempts by officials to silence critical voices within elite institutions.

Science in India has been increasingly politicized over the course of the pandemic. In February, Indias junior health minister criticized a study published in the journal Science that estimated the countrys Covid death toll to be six to seven times greater than the official number. In March, the government questioned the methodology of a study published in The Lancet that estimated Indias deaths at four million.

Personally, I have always felt that science has to be responded with science, said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who has been working with the W.H.O. to review the data. If you have an alternative estimate, which is through rigorous science, you should just produce it. You cannot just say, I am not going to accept it.

India has not submitted its total mortality data to the W.H.O. for the past two years, but the organizations researchers have used numbers gathered from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least four to five times more deaths as a result of Covid-19.

Jon Wakefield, a professor of statistics and biostatistics at the University of Washington who played a key role in building the model used for the estimates, said an initial presentation of the W.H.O. global data was ready in December.

But then India was unhappy with the estimates. So then weve subsequently done all sorts of sensitivity analyses, the papers actually a lot better because of this wait, because weve gone overboard in terms of model checks and doing as much as we possibly can given the data thats available, Dr. Wakefield said. And were ready to go.

The numbers represent what statisticians and researchers call excess mortality the difference between all deaths that occurred and those that would have been expected to occur under normal circumstances. The W.H.O.s calculations include those deaths directly from Covid, deaths of people because of conditions complicated by Covid, and deaths of those who did not have Covid but needed treatment they could not get because of the pandemic. The calculations also take into account expected deaths that did not occur because of Covid restrictions, such as those from traffic accidents.

Calculating excess deaths globally is a complex task. Some countries have closely tracked mortality data and supplied it promptly to the W.H.O. Others have supplied only partial data, and the agency has had to use modeling to round out the picture. And then there is a large number of countries, including nearly all of those in sub-Saharan Africa, that do not collect death data and for which the statisticians have had to rely entirely on modeling.

Dr. Asma of the W.H.O. noted that nine out of 10 deaths in Africa, and six out of 10 globally, are not registered, and more than half the countries in the world do not collect accurate causes of death. That means that even the starting point for this kind of analysis is a guesstimate, she said. We have to be humble about it, and say we dont know what we dont know.

To produce mortality estimates for countries with partial or no death data, the experts in the advisory group used statistical models and made predictions based on country-specific information such as containment measures, historical rates of disease, temperature and demographics to assemble national figures and, from there, regional and global estimates.

Besides India, there are other large countries where the data is also uncertain.

Russias ministry of health had reported 300,000 Covid deaths by the end of 2021, and that was the number the government gave the W.H.O. But the Russian national statistics agency that is fairly independent of the government found excess mortality of more than one million people a figure that is reportedly close to the one in the W.H.O. draft. Russia has objected to that number, but it has made no effort to stall the release of the data, members of the group said.

China, where the pandemic began, does not publicly release mortality data, and some experts have raised questions about underreporting of deaths, especially at the beginning of the outbreak. China has officially reported fewer than 5,000 deaths from the virus.

While China has indeed kept caseloads at much lower levels than most countries, it has done so in part through some of the worlds strictest lockdowns which have had their own impact on public health. One of the few studies to examine Chinas excess mortality using internal data, conducted by a group of government researchers, showed that deaths from heart disease and diabetes spiked in Wuhan during that citys two-month lockdown. The researchers said the increase was most likely owing to inability or reluctance to seek help at hospitals. They concluded that the overall death rate in Wuhan was about 50 percent higher than expected in the first quarter of 2020.

Indias effort to stall the reports release makes clear that pandemic data is a sensitive issue for the Modi government. It is an unusual step, said Anand Krishnan, a professor of community medicine at the All India Institute of Medical Sciences in New Delhi who has also been working with the W.H.O. to review the data. I dont remember a time when it has done so in the past.

Ariel Karlinsky, an Israeli economist who built and maintains the World Mortality Dataset and who has been working with the W.H.O. on the figures, said they are challenging for governments when they show high excess deaths. I think its very sensible for the people in power to fear these consequences.

Vivian Wang contributed reporting.

Originally posted here:

India Is Stalling the W.H.O.s Efforts to Make Global Covid Death Toll Public - The New York Times

When the highly transmissible Omicron variant of the coronavirus arrived in the United States last fall, it pushed new case numbers to previously unseen peaks.

Even then, the record wave of recorded infections was a significant undercount of reality.

In New York City, for example, officials logged more than 538,000 new cases between January and mid-March, representing roughly 6 percent of the citys population. But a recent survey of New York adults suggests that there could have been more than 1.3 million additional cases that were either never detected or never reported and that 27 percent of the citys adults may have been infected during those months.

The official tally of coronavirus infections in the United States has always been an underestimate. But as Americans increasingly turn to at-home tests, states shutter mass testing sites and institutions cut back on surveillance testing, case counts are becoming an increasingly unreliable measure of the viruss true toll, scientists say.

It seems like the blind spots are getting worse with time, said Denis Nash, an epidemiologist at the CUNY Graduate School of Public Health & Health Policy who led the New York City analysis, which is preliminary and has not yet been published.

That could leave officials increasingly in the dark about the spread of the highly contagious new subvariant of Omicron known as BA.2, he said, adding, We are going to be more likely to be surprised. On Wednesday, New York officials announced that two new Omicron subvariants, both descended from BA.2, have been circulating in the state for weeks and are spreading even faster than the original version of BA.2.

The official case count can still pick up major trends, and it has begun to tick up again as BA.2 spreads. But undercounts are likely to be a bigger problem in the weeks ahead, experts said, and mass testing sites and widespread surveillance testing may never return.

Thats the reality we find ourselves in, said Kristian Andersen, a virologist at the Scripps Research Institute in San Diego. We dont really have eyes on the pandemic like we used to.

To track BA.2, as well as future variants, officials will need to pull whatever insights they can from an array of existing indicators, including hospitalization rates and wastewater data. But truly keeping tabs on the virus will require more creative thinking and investment, scientists said.

For now, some scientists said, people can gauge their risk by deploying a lower-tech tool: paying attention to whether people they know are catching the virus.

If youre hearing your friends and your co-workers get sick, that means your risk is up and that means you probably need to be testing and masking, said Samuel Scarpino, the vice president of pathogen surveillance at the Rockefeller Foundations Pandemic Prevention Institute.

Tracking the virus has been a challenge since the earliest days of the pandemic, when testing was severely constrained. Even when testing improved, many people did not have the time or resources to seek it out or had asymptomatic infections that never made themselves known.

By the time Omicron hit, a new challenge was presenting itself: At-home tests had finally become more widely available, and many Americans relied on them to get through the winter holidays. Many of those results were never reported.

We havent done the groundwork to systematically capture those cases on a national level, said Katelyn Jetelina, an epidemiologist at the University of Texas Health Science Center at Houston.

Some jurisdictions and test manufacturers have developed digital tools that allow people to report their test results. But one recent study suggests that it may take work to get people to use them. Residents of six communities across the country were invited to use an app or an online platform to order free tests, log their results and then, if they chose, send that data to their state health departments.

Nearly 180,000 households used the digital assistant to order the tests, but just 8 percent of them logged any results on the platform, researchers found, and only three-quarters of those reports were sent on to health officials.

General Covid fatigue, as well as the protection that vaccination provides against severe symptoms, may also prompt fewer people to seek testing, experts said. And citing a lack of funds, the federal government recently announced that it would stop reimbursing health care providers for the cost of testing uninsured patients, prompting some providers to stop offering those tests for free. That could make uninsured Americans especially reluctant to test, Dr. Jetelina said.

The poorest neighborhoods will have even more depressed case numbers than high-income neighborhoods, she noted.

Monitoring case trends remains important, experts said. If we see an increase in cases, its an indicator that something is changing and quite possibly that something is changing because of a larger shock to the system, like a new variant, said Alyssa Bilinski, a public health policy expert at the Brown University School of Public Health.

But more modest increases in transmission may not be reflected in the case tally, which means that it could take officials longer to detect new surges, experts said. The problem could be exacerbated by the fact that some jurisdictions have begun updating their case data less frequently.

Dr. Nash and his colleagues have been exploring ways to overcome some of these challenges. To estimate how many New Yorkers may have been infected during the winter Omicron surge, they surveyed a diverse sample of 1,030 adults about their testing behaviors and results, as well as potential Covid-19 exposures and symptoms.

People who reported testing positive for the virus on tests administered by health care or testing providers were counted as cases that would have been caught by standard surveillance systems. Those who tested positive only on at-home tests were counted as hidden cases, as were those who had probable unreported infections a group that included people who had both Covid-19-like symptoms and known exposures to the virus.

The researchers used the responses to calculate how many infections might have escaped detection, weighting the data to match the demographics of the citys adult population.

The study has limitations. It relies on self-reported data and excludes children, as well as adults living in institutional settings, including nursing homes. But health departments could use the same approach to try to fill in some of their surveillance blind spots, especially during surges, Dr. Nash said.

You could do these surveys on a daily or weekly basis and quickly correct prevalence estimates in real time, he said.

Another approach would be to replicate what Britain has done, regularly testing a random selection of hundreds of thousands of residents. Thats really the Cadillac of surveillance methods, said Natalie Dean, a biostatistician at Emory University.

The method is expensive, however, and Britain has recently started scaling back its efforts. Its something that should be part of our arsenal in the future, Dr. Dean said. Its sort of unclear what people have the appetite for.

The spread of Omicron, which easily infects even vaccinated people and generally causes milder disease than the earlier Delta variant, has prompted some officials to put more emphasis on hospitalization rates.

If our goal is to track serious illness from the virus, I think thats a good way to do it, said Jason Salemi, an epidemiologist at the University of South Florida.

But hospitalization rates are lagging indicators and may not capture the true toll of the virus, which can cause serious disruptions and long Covid without sending people to the hospital, Dr. Salemi said.

Indeed, different metrics can create very different portraits of risk. In February, the Centers for Disease Control and Prevention began using local hospitalization rates and measures of hospital capacity, in addition to case counts, to calculate its new Covid-19 community levels, which are designed to help people decide whether to wear masks or take other precautions. More than 95 percent of U.S. counties currently have low community Covid-19 levels, according to this measure.

But the C.D.C.s community transmission map, which is based solely on local case and test positivity rates, suggests that just 29 percent of U.S. counties currently have low levels of viral transmission.

Hospitalization data may be reported differently from one place to another. Because Omicron is so transmissible, some localities are trying to distinguish between patients who were hospitalized specifically for Covid-19 and those who picked up the virus incidentally.

We felt like, because of the intrinsic factors of the virus itself that were seeing circulating in our region now, that we needed to update our metrics, said Dr. Jonathan Ballard, the chief medical officer at the New Hampshire Department of Health and Human Services.

Until late last month, New Hampshires Covid-19 online dashboard displayed all inpatients with active coronavirus infections. Now, it instead displays the number of hospitalized Covid-19 patients taking remdesivir or dexamethasone, two frontline treatments. (Data on all confirmed infections in hospitalized patients remains available through the New Hampshire Hospital Association, Dr. Ballard noted.)

Another solution is to use approaches, such as wastewater surveillance, that dont rely on testing or health care access at all. People with coronavirus infections shed the virus in their stool; monitoring the levels of the virus in wastewater provides an indicator of how widespread it is in a community.

And then you combine that with sequencing, so you get a sense of what variants are circulating, said Dr. Andersen, who is working with colleagues to track the virus in San Diegos wastewater.

The C.D.C. recently added wastewater data from hundreds of sampling sites to its Covid-19 dashboard, but coverage is highly uneven, with some states reporting no current data at all. If wastewater surveillance is going to fill in the testing gaps, it needs to be expanded, and the data needs to be released in near real time, scientists said.

Wastewater is a no-brainer to me, Dr. Andersen said. It gives us a really good, important passive surveillance system that can be scaled. But only if we realize that thats what we have to do.

Dr. Scarpino, of the Pandemic Prevention Institute, said that there were other data sources that officials could leverage, including information on school closings, flight cancellations and geographic mobility.

One of the things were not doing a good enough job of doing is pulling those together in a thoughtful, coordinated way, Dr. Scarpino said.

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Are There Better Ways to Track Covid Cases? - The New York Times

Almost exactly 12 months ago, Americas pandemic curve hit a pivot point. Case counts peakedand then dipped, and dipped, and dipped, on a slow but sure grade, until, somewhere around the end of May, the numbers flattened and settled, for several brief, wonderful weeks, into their lowest nadir so far.

I refuse to use the term hot vax summer (oops, just did), but its sentiment isnt exactly wrong. A year ago, the shots were shiny and new, and a great match for the variants du jour; by the start of June, roughly half of the American population had received their first injections, all within the span of a few monthsa remarkable single buildup of immunity, says Virginia Pitzer, an epidemiologist at Yale. The winter surges had run their course; schools were letting out for the season; the warm weather was begging for outdoor gatherings, especially in the countrys northern parts. A confluence of factors came together in a stretch that, for a time, really was great, Katelyn Jetelina, an epidemiologist at the University of Texas Health Science Center at Houston, told me.

Its now the spring of 2022, and at a glance, the stop-SARS-CoV-2 stars would seem to be aligning once more. Like last time, cases have dropped from a horrific winter peak; like last time, people have built up a decent bit of immunity; like last time, rising temperatures are nudging people outside. Already, one of the pandemics best-publicized models is projecting that this summer could look about as stellar as the start of last.

These trends dont guarantee good times. If anything, national case countscurrently a woeful underestimate of realityhave started to creep upward in the past couple of weeks, as an Omicron subvariant called BA.2 continues its hostile takeover. And no one knows when or where this version of the virus will spit us out of its hypothetical surge. I have learned to not predict where this is going, says Theresa Chapple, a Chicago-area epidemiologist.

Read: America is staring down its first so what? wave

In crisis, its easy to focus our attention on wavesthe worst a pandemic can bring. And yet, understanding the troughswhether high, low, or kind of undecidedis just as essential. The past two years have been full of spastic surges; if the virus eventually settles down into something more subdued, more seasonal, and more sustained, these between-bump stretches may portend what COVID looks like at baseline: its true off-season.

At these times of year, when we can reliably expect there to be far less virus bopping around, our relationship to COVID can be different. But lulls are not automatic. They cannot be vacations. Theyre intermissions that we can use to prepare for what the virus serves up next.

Lulls, like waves, are the products of three variableshow fast a virus moves, how hospitable its hosts are to infection, and how often the two parties are forced to collide. Last years respite managed to hit a trifecta: a not-too-speedy virus met fresh vaccines while plenty of people were still on high alert. It was enough to stave off COVIDs worst, and tamp transmission down.

This time around, some of the variables are a bit different. The virus, for one, has changed. In the past year, SARS-CoV-2 has only gotten better at its prime operative of infecting us. High transmissibility nudges the natural set point of the pandemic higher: When the virus moves this fast among us, its simply harder to keep case levels ultralow. We have a lot less breathing room than we used to, says Alyssa Bilinski, a health-policy researcher at Brown University.

The situation arguably looks a bit better on the host side. By some estimates, population immunity in the U.S. could be near its all-time high. At least 140 million Americansperhaps many morehave been infected with SARS-CoV-2 since the pandemics start; some 250 million have dosed up at least once with a vaccine. Swirl those stats together, and its reasonable to estimate that more than 90 to 95 percent of the country has now glimpsed the coronaviruss spike protein in some form or another, many of them quite recently. On top of that, America has added a few tools to its defensive arsenal, including a heftier supply of at-home tests to identify infection early and super-effective oral antivirals to treat it.

But any discussion of immunity has to be tempered with a question: immunity against what? Although defenses against serious illness stick around pretty stubbornly, peoples safeguards against infection and transmission erode in the months after theyve been infected or vaccinatedwhich means that 90 to 95 percent exposed doesnt translate to 90 to 95 percent immune. Compared with last spring, the map of protection is also much patchier, and the range of immunity much wider. Some people have now banked several infections and vaccinations; others are many months out from their most recent exposure, or havent logged any at all. Add to that the trickiness of sustaining immunity in people who are older or immunocompromised, and the mediocrity of Americas booster campaign, and its easy to see how the country still has plenty of vulnerable pockets for the virus to exploit.

Read: Will Omicron leave all of us immune?

Then theres the mess of usour policies and our individual choices. The patterns of viral spread depend a lot on what we as a society do, and how we interact, Yonatan Grad, who studies infectious-disease dynamics at Harvard, told me. A concerted effort to mitigate transmission through masking, for instance, could help counteract the viruss increased contagiousness, and squish case curves back down nice and low. But the zeal for such measures is all but gone. Even amid the rise of actual waves, the willingness to take on interventions has gotten smaller, Yales Pitzer told me. During declines and lulls, people have even less motivation to act.

The more the virus is allowed to mosey about, the more chances it will have to mutate and adapt. Variants are always the wild card, says Ajay Sethi, an epidemiologist at the University of Wisconsin at Madison. Already, America is watching BA.2the speedier sister to the viral morph that clobbered the country this winter (now retconned as BA.1)overtake its sibling and spark outbreaks, especially across the northeast. Perhaps BA.2 will drive only a benign case bump. Maybe a sharp surge will happen, but contract quickly, ushering the country out of spring with even more immunity on its side. Or BA.2s rise will turn dramatic and prolonged, and sour summers start all on its own. Nor is BA.2 the worst-case scenario we could imagine, Sethi told me. Though its faster than BA.1, it doesnt appear to better sidestep the immune shields left behind by infection or vaccines. SARS-CoV-2s relentless mutational churn could still slingshot something far more problematic our way; already, a slew of recombinant variants and other Omicron subvariants are brewing.

I asked Deshira Wallace, a public-health researcher at the University of North Carolina at Chapel Hill, what would make this summer less than rosyor possibly, close to cataclysmic. Continuing as is right now, she told me. The pandemic is indeed still going, and the U.S. is at a point where excessive mingling could prolong the crisis. Tracking rises in cases, and responding to them early, is crucial for keeping a soft upslope from erupting into a full-on surge. And yet, across the nation, weve been seeing every single form of protection revoked, Wallace said. Indoor mask mandates have disappeared. Case-tracking surveillance systems have pulled back or gone dark. Community test and vaccination sites have vanished. Even data out of hospitals have begun to falter and fizz. Federal funds to combat the pandemic have dried up too, imperiling stocks of treatments and care for the uninsured, as the nations leaders continue to play chicken with what it means for coronavirus cases to stay low. And though many of the tools necessary to squelch SARS-CoV-2 exist, their distribution is still not being prioritized to the vulnerable populations who most need them. Spread is now definitively increasing, yet going unmeasured and unchecked.

Americans would have less to worry about if they reversed some of these behavioral trends, Wallace told me. But shes not counting on it. Which puts the onus on immunity, or sheer luck on the variant side, to countervail, which are gambles as well. Say no new variant appears, but immunity inevitably erodes, and no one maskswhat then? Behavior is the variable we hold most sway over, but Americas grip has loosened. Last year, around this time, there were more protections in place, Wallace said. Now it just feels like were in chaos.

Even last summers purported reprieve was a bit of an illusion. That lull felt great because it was the pandemics kindest so far in the United States. But even at its scarcest, the virus was still causing about 200 deaths per day, which translates to about 73,000 deaths per year, Bilinski told me. Thats worse than even what experts tend to consider a very bad flu season, when annual mortality levels hit about 50,000 or 60,000, Harvards Grad told me. (Stats closer to 10,000 or 20,000 deaths in a season are on the low end.) To chart a clearer future with COVID, even during lulls, the United States will have to grapple with a crucial question, says Shruti Mehta, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health: Whats the acceptable level of mortality per day?

Theres a bit of a bind to work through here. With SARS-CoV-2s dominant variants now as fast-spreading as they are, infections will remain tough to stave off, at least in the near term. The U.S. is growing only less equipped to track cases accurately, given the shift to home tests, which are rarely reported; community-level data collection is also in disastrous flux. So in some respects, the success of future COVID off-seasons might be better defined by hospitalizations or deaths, UT Healths Jetelina noted, as many other infectious diseases are. Its the exact shift that the Biden administration and the CDC have been pushing the population toward, and there is at least some logic to it. Thanks in large part to the potency of vaccines, infections have continued to untether from serious illnesses; speedy diagnostics and treatments have made a big dent as well. (Consider, for instance, that COVID hospital admissions have now dipped below last summers lows, even though documented cases have not.)

But merely tracking hospitalizations and deaths as a benchmark of progress doesnt prevent those outcomes; theyve already come to pass. By the time serious illness is on the rise, its too late to halt a surge in transmission that imperils high-risk groups or triggers a rash of long-COVID cases. That makes proactiveness during case lulls key: The virus doesnt have to be actively battering a countrys shields for them to get a shoring up. Its tempting to chill during low-case stretchesignore the virus for a little while, stick our heads in the sand, says Andrea Ciaranello, an infectious-disease physician at Massachusetts General Hospital. But its wiser, she said, to realize that efforts to build capacity at community, state, and federal levels cant rest during off-seasons. Lulls do tend to end. Its best if they dont catch people off guard when they do.

I asked nearly a dozen experts where theyd focus their resources now, to ameliorate the countrys COVID burden in the months and years ahead. Almost all of them pointed to two measures that would require intense investments now, but pay long-term dividendsall without requiring individuals, Chapple told me, to take repeated, daily actions to stay safe: vaccines, to blunt COVIDs severity; and ventilation, to clean indoor air. Other investments could similarly pay off when cases rise again. More widespread wastewater-surveillance efforts, Ciaranello says, could give public-health officials an early glimpse of the virus. Paid-sick-leave policies could offer workers the flexibility to isolate and seek care. If masking requirements stay in place on buses, trains, subways, and planes, they could more seamlessly move into other indoor public places when needed. The more were willing to do thats happening in the background, the more headroom we have, Bilinski told me.

Read: Were entering the control phase of the pandemic

Most essential of all, vaccines, tests, masks, and treatments will need to become and remain available, accessible, and free to all Americans, regardless of location, regardless of insurance. Supply alone is not enough: Leaders would need to identify the communities most in need, and concentrate resources therean approach, experts told me, that the U.S. would ideally apply both domestically and abroad. A truly good summer would be one in which we felt like the risk level was more comparable across populations, across individuals, Mehta told me. America, much less the globe, is nowhere near that benchmark yet.

As grand as last summer might have felt, it was also a time when the U.S. dawdled. Inequities went unaddressed. International aid fell short. Delta gained steam in parts of the American South where vaccination rates were low, and where people were cloistering indoors to beat the heat, then trickled into the east, west, and north. The pandemic simmered; Americans looked away, and let the crisis boil over again. Instead of holding last summer up as our paragon, we would do better to look ahead to the next one, and the nextmoving past wanting things as they were, and instead imagining what they could be.

Link:

What It'll Take to Have Actually Good COVID Summers - The Atlantic

STATEN ISLAND, N.Y. By now, weve all heard about the most common symptoms of coronavirus (COVID-19), but there are several unusual signs of the illness that no one seems to talk about.

While fatigue, sore throat, fever, body aches and cough are the most common symptoms of COVID and its subsequent variants, Dr. Thomas Gut, associate chair of medicine at Staten Island University Hospital, recently revealed to ETNT Health that there are four unusual symptoms that often signal the illness.

Other rare symptoms, such as loss of speech movement, conjunctivitis, discoloration of fingers or toes and rash, have been reported by the Centers for Disease Control and Prevention (CDC).

People experiencing difficulty breathing or chest pain or pressure should seek immediate medical attention, the CDC advises.

COVID symptoms vary from person to person, based on where the virus attacks first, or causes the most inflammation, Gut told ETNT Health, a science and health-related news website headquartered in Brooklyn. This has a large role in why some symptoms are present for some individuals, yet are absent in other cases. Also, the variants of COVID have caused some interesting and relatively unique symptoms to each wave.

People experiencing flu-like symptoms that feel worse than a cold or flu should also seek medical attention, experts advise.

Those who are fully vaccinated and still get COVID should only feel minor symptoms, doctors say. Anything new or alarming should be evaluated by a doctor, Gut told ETNT Health.

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Have you heard of these 4 unusual coronavirus symptoms? - SILive.com

First detected on January 19 2022, the Omicron XE variant, which some have called the "Frankenstein" ... [+] variant has been spreading in the United Kingdom. (Photo by TOLGA AKMEN/AFP via Getty Images)

The name Frankenstein may conjure up some frightening images. For example, telling your significant other, hey, your face has that Frankenstein look today could end up being quite scary for you. So now that some have dubbed the relatively new Omicron XE Covid-19 coronavirus variant the Frankenstein variant, should you be particularly worried?

Well, first of all, the XE is not going to turn you into Frankensteins monster. You wont suddenly wake up one day with bolts in your neck and a head thats flat enough to carry a plate of hot dog franks. Something like that will not occur, assuming that you arent using ecstasy. XE may sound like a new version of Microsoft Windows. But before you download in your pants, dont let the monstrous moniker mislead you. While Frankensteins monster may have been created by Dr. Victor Frankenstein, theres no evidence that the XE variant was produced in a laboratory.

Instead, the XE is something that was totally expected to arise naturally, especially with so many people abandoning Covid-19 precautions as if they were leaving a theater showing the movie Morbius. With the BA.1 and BA.2 Omicron variants circulating so widely, it was only a matter of time before they found themselves in the same human and started knocking spikes together, so to speak. When two different versions of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infect the same cell, they can swap their genetic material so that their progeny end up with a new combination. Scientists call the XE a recombinant because it is the result of the BA.1 and BA.2 swapping right with each other and recombining their genetic material. The XE contains BA.1 mutations for NSP1-6 and BA.2 mutations for the rest of its genome. Also present are three mutations that neither the BA.1 nor the BA.2 have: NSP3 V1069I (non-synonymous) and C3241T (synonymous), and NSP12 C14599T (synonymous).

This certainly wasnt the first time that such a thing has occurred. For example, just last month, I described for Forbes another recombination between the Delta GK/AY.4 and Omicron GRA/BA.1 lineages mixed to form the then-dubbed Deltacron recombinant. In fact, theres been a Wheel of Misfortune of Delta and BA.1 recombinants ranging from XD to XF to XS.

The relaxation of Covid-19 precautions such as face mask wearing and social distancing could be ... [+] making it easier for Covid-19 coronavirus variants to emerge and spread. Pictured here is a line into a nightclub in Cardiff, Wales. (Photo by Matthew Horwood/Getty Images)

First detected in England January 19 2022, the XE variant has been spreading in the U.K., primarily in East of England, London, and the South East. According to the U.K. Health Security Agency, from January 15 through the end of March, the amount of XE compared to BA.2 in tested samples in the U.K. grew by an average of 12.6% per week with a 20.9% increase per week over the last three weeks of March. As of April 5, the U.K. had 1,179 documented cases of XE, and England had 1,125 documented XE cases.

The spread of the XE does suggest that it may be more transmissible than the BA.2. A World Health Organization (WHO) report from March 29 stated that early-day estimates indicate a community growth rate advantage of ~10% as compared to BA.2, however this finding requires further confirmation. At this time, the WHO hasnt listed the XE as a separate variant of interest or variant of concern. There just isnt enough information yet, and its not clear how widely the XE has spread so far. The WHO report did add that XE belongs to the Omicron variant until significant differences in transmission and disease characteristics, including severity, may be reported. So more studies are needed to determine whether the XE is indeed more contagious, whether it is more likely to cause more severe Covid-19 outcomes, and how effective immune protection from vaccination or prior infection may be against XE.

One things for sure, new recombinants and new variants in general of the SARS-CoV-2 will continue to emerge like bad reality TV shows. The SARS-CoV-2 has a high mutation rate. Similar to a drunk person trying to make photocopies of his or her butt, the virus can make mistakes whenever it tries to reproduce. The resulting copies of the virus then may have somewhat different genetic material. And new genetic material can give these new copies different properties. Thats why scientists had warned years before 2020 about the possibility of some type of coronavirus jumping from other animals to humans to cause a pandemic.

Now, just because new variants will keep emerging indefinitely doesnt mean that the pandemic and Covid-19 precautions will last forever. The road to the end of the pandemic is maintaining Covid-19 precautions until enough of our immune systems go from virginal to been there, done that when it comes to the SARS-CoV02. This could occur something this year through a combination of people having gotten vaccinated or repeatedly infected with the virus. Of course, the problem with the get infected route right now is the whole potentially dying thing or the months and months of brain fog, fatigue, palpitations, shortness of breath, and other long Covid symptom thing. So encouraging each other to get vaccinated against Covid-19 remains the best way to shorten the duration of the pandemic and the length of time Covid-19 precautions like face mask wearing will be needed or recommended.

At this point, the Frankenstein name is probably not that appropriate for the XE variant. Its not as if theres going to be a Dracula variant, a werewolf variant, a mummy variant, a Tinder swindler variant, a Ponzi scheme variant, a douchebag variant, or any other type of monster variant. The emergence of the XE is a frank reminder that the pandemic is not over yet. And that you should do what you should have been doing all along, maintaining appropriate Covid-19 precautions.

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Omicron XE: How Concerning Is The So-Called Frankenstein Covid-19 Variant? - Forbes

INDIANAPOLIS (WISH) A decline in coronavirus cases and the easing of many restrictions means more people are getting together or going out. Thats a big change from life over the last two years, and it could cause some people to feel anxious or uneasy.

Dr. Danielle Henderson, a clinical psychologist with IU Health, says some COVID anxiety is possible as things open back up and people start making more plans.

More events and activities are being planned, and maybe, since we didnt get to do them last year or the year before, were feeling like weve got to do it now or we might miss out, Henderson said. That can be anxiety-provoking and overwhelming for people, particularly since were still in COVID.

Its okay to feel nervous or anxious, Henderson says, and its okay to take things slowly.

There are now probably a lot of events on peoples social calendars. Maybe think about, Ive been invited to a lot of things, but do I need to go to all of these things? Maybe I want to prioritize and then slowly build up to more activities.

Feeling worn out after a lot of socializing or after attending an event like dinner with a large group is normal, according to Henderson.

Were kind of trying to relearn those skills, and it can be tiring and hard, Henderson said.

Read more:

Dealing with anxiety during the decline of COVID-19 restrictions - WISH TV Indianapolis, IN

Omicron XE, which was first detected in the United Kingdom, has been found in the U.S. and, most recently, in Japan. While much is still unknown about the subvariant and what effect it will have on COVID-19s spread, heres what we know so far.

The XE variant is what experts call a recombinant of the BA.1 and BA.2 variants. Its name derives from the X prefix assigned for recombinants, said Stacia Wyman, senior genomics scientist at the Innovative Genomics Institute at UC Berkeley.

The coronavirus group of viruses make recombinants pretty readily, according to Shannon Bennett, chief of science at the California Academy of Sciences. However, whether the recombinant can be detected depends on whether the two parent strains are sufficiently different, she said.

Wyman said the XE subvariant likely arose from a person infected with both the BA.1 and BA.2 versions of the virus. When the virus was replicating, there was an error and the two viruses combined, she explained. Then the combined virus replicates and is spread to other people.

The first part of XEs genome sequence is BA.1, and then changes into BA.2 for the rest of the genome, she said. The S gene, or spike protein which latches onto healthy cells and causes infection comes from BA.2. However, Wyman said its not known yet if someone with a previous BA.2 infection would have some resulting protection from XE.

Since XE is a combination of both BA.1 and BA.2, it shares similarities and differences with both, Bennett said but from a public health standpoint, the variants infectiousness, the ability to evade prior immunity, and transmissibility are still being investigated.

According to a March 25 report from the U.K. Health Security Agency, XE has a growth rate 9.8% above that of BA.2, which Wyman said means it is 9.8% more transmissible. The World Health Organization has previously reported that figure may be 10%, though its still too early for a definitive conclusion.

The XE subvariant was first discovered in the U.K. in mid-January. As of April 5, 1,125 cases had been sequenced there.

In the U.S. so far, according to Wyman, two XE cases have been sequenced in Wisconsin and one in New York. She said Tuesday that she had learned about two unconfirmed cases in California. They had not yet been classified as XE on the international sequencing database GISAID, but have been on genome analysis tools UShER, out of UC Santa Cruz, and NextClade from Switzerlands University of Basel.

The subvariant has also been reported in Thailand, India and Israel, according to news reports. On Monday, Japan announced a traveler arriving from the U.S. was infected with the XE strain and was asymptomatic.

The BA.2 subvariant accounted for 86% of COVID cases in the U.S. for the week ending in April 9, according to the Centers for Disease Control and Prevention. It has quickly outstripped the original omicron variant, BA.1, which was last dominant during the week ending March 12 with 59% of sequenced cases, and led to the pandemics biggest surge so far.

The BA.2 subvariant is causing a spike in cases in the U.S., primarily on the East Coast, which prompted Philadelphia officials this week to reinstate the citys indoor mask mandate. U.S. officials on Wednesday extended the nationwide mask requirement for air travel and public transit, which was set to expire Monday, for another 15 days to allow more time to study and monitor BA.2.

Experts say any new variant that is more transmissible than others has a shot at eventually gaining dominance. Bennett said XE certainly could overtake BA.2, as every variant that takes over is likely to be a better spreader.

But Wyman said she is not too concerned yet about XE.

There is some early evidence that it may be more transmissible than BA.2, but the numbers are too small to draw any definitive conclusions at this time, she said. Its something to keep an eye on, but not for the general population to worry about.

She added that XE may die out completely regionally and never spread, which has occurred with other variants in different regions without clear explanations.

Wyman pointed to another variant, BA.2.12.1, that is being closely monitored in the U.S. According to data from CoV-Spectrum, a COVID variant monitoring platform using data from GISAID, there are 1,119 sequences in the U.S. so far, including 19 in California.

BA.2.12.1 been found in more than half of U.S. states, Wyman said.

We are seeing it spread quite rapidly in the U.S., particularly in New York, she said. The notable difference in this with respect to BA.2 is the addition of the S:L452Q mutation, which has been implicated in immune evasion.

The New York State Department of Health on Wednesday issued an announcement about BA.2.12.1 and another strain, BA.2.12 both sublineages of BA.2 saying they were contributing to a rise in infection rates in the central part of the state.

The Department's findings are the first reported instances of significant community spread due to the new subvariants in the United States, officials said.

The two subvariants are an estimated 23%-27% more transmissible than BA.2, officials said. While at this time, there is no evidence of increased disease severity by these subvariants, officials said, they are watching closely for any changes.

They urged New Yorkers to get fully vaccinated and boosted; mask up in public indoor spaces; get tested after exposure, symptoms or travel; stay home after a positive test and consult their health provider; and improve indoor ventilation or gather outdoors to reduce transmission risk during the Easter and Passover holidays.

Kellie Hwang is a San Francisco Chronicle staff writer. Email: kellie.hwang@sfchronicle.com Twitter: @KellieHwang

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Has omicron XE arrived in California? Here's what we know about the new coronavirus subvariant - San Francisco Chronicle

A Covid-19 vaccine developed by the French pharmaceutical company Valneva has been given regulatory approval by the Medicines and Healthcare products Regulatory Agency, bringing the total number of jabs approved for use in the UK to six.

As the Covid pandemic swept the world, scientists began developing vaccines against it, with the Pfizer/BioNTech jab being the first in the UK to be authorised for emergency use by the MHRA in 2020. Since then the MHRA has approved the Moderna, Oxford/AstraZeneca, Janssen and Novavax vaccines, although, according to NHS England, Janssen and Novavax are not currently available.

The UKs independent medicines regulator was the first in the world to approve the Valneva product, the MHRA said. Unlike the other approved Covid jabs, the Valneva vaccine is an inactivated whole-virus vaccine, which means the live virus was grown in a laboratory, rendered unable to infect cells, then administered to people to trigger an immune response.

The MHRA said this approach was already being used for flu and polio vaccines and experts have previously suggested that Covid jabs based on the whole virus may result in a broader immune response than those that involve only the spike protein, and may work better against new variants.

Results released by Valneva in October suggested the vaccine could be as effective as the Oxford jab. In addition, it is stable when stored in a standard refrigerator, which could make it easier to distribute than some other Covid jabs.

Prof Sir Munir Pirmohamed, the chair of the independent Commission on Human Medicines, said the commission and its Covid-19 expert working group had carefully considered the evidence and advised that the benefit-risk balance was positive. The vaccine is approved for use in people aged 18 to 50 years, with the first and second doses to be taken at least 28 days apart.

Prof Adam Finn, a member of the Joint Committee on Vaccination and Immunisation and the chief investigator on the Valneva clinical development programme, said that while the jab had been approved it was unlikely to be available in the UK soon, as the government had cancelled its contract to buy the vaccine in September.

However, he said the jab could prove more acceptable than others to some people. The people who could theoretically benefit from it now are unvaccinated 18- to 50-year-olds who want immunisation but are hesitant about currently available vaccines, he said, adding that the Novavax jab could also appeal to this group.

However, there was another hurdle. In the UK, no one has yet been offered any choice as to which vaccine they receive, said Finn, a professor of paediatrics at Bristol University.

The number of deaths involving coronavirus registered each week in England and Wales have continued to increase, although levels remain well below those reached during previous Covid waves.

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Valneva approved to be UKs sixth Covid vaccine - The Guardian