Category: Corona Virus

In a 1988 essay on pandemics Joshua Lederberg, Nobel laureate and president of The Rockefeller University, reminded the medical community that when it comes to infectious disease, the laws of Darwin are as important as the vaccines of Pasteur.

As medicine battles bacteria and viruses, those organisms continue to undergo mutations and evolve new characteristics.

Lederberg advised vigilance: We have no guarantee that the natural evolutionary competition of viruses with the human species will always find ourselves the winner.

With the emergence of what seem so far to be safe and effective vaccine candidates, it appears that humanity may be the winner again this time around, albeit with a dreadful loss of life.

But vaccines wont put an end to the evolution of this coronavirus, as David A. Kennedy and Andrew F. Read of The Pennsylvania State University, specialists in viral resistance to vaccines, wrote in PLoS Biology recently. Instead, they could even drive new evolutionary change.

There is always the chance, though small, the authors write, that the virus could evolve resistance to a vaccine, what researchers call viral escape. They urge monitoring of vaccine effects and viral response, just in case.

Nothing that were saying is suggesting that we slow down development of vaccines, Dr. Kennedy said. An effective vaccine is of utmost importance, he said, But lets make sure that it stays efficacious.

Vaccine makers could use the results of nasal swabs taken from volunteers during trials to look for any genetic changes in the virus. Test results need not stop or slow down vaccine rollout, but if recipients of the vaccine had changes in the virus that those who received the placebo did not, that would indicate the potential for resistance to evolve, something researchers ought to keep monitoring.

There are some reasons to be optimistic that the coronavirus will not become resistant to vaccines. Several years ago, Dr. Kennedy and Dr. Read presented an analysis of the difference between resistance to drugs and vaccines. Neither bacteria nor viruses evolve resistance to vaccines as easily as they do to drugs, they wrote. Smallpox vaccine never lost its effectiveness, nor did the vaccines for measles or polio, despite years of use.

Antibiotics, on the other hand, can quickly become useless as bacteria and other pathogens like viruses and fungi evolve defenses. And resistance builds to other drugs as well.

The reasons have to do with the very basic principles of evolution and immunity. The two key differences are that vaccines generally act earlier than drugs, and that the natural immune response they promote is usually more varied, with more lines of attack. A drug may be narrowly targeted, sometimes attacking one metabolic pathway or biochemical process.

With most drugs, the virus or bacteria has already been reproducing in the patients body and if one variant is better at surviving the drugs attack, it will continue to grow and perhaps be transmitted to another person. A combination of drugs, as with H.I.V. treatment, can be more effective because it unleashes a multipronged attack.

Vaccines, on the other hand, act early, before the virus begins to proliferate and perhaps change within a patients body. So there are no new variants, like those forged in the heat of a drug attack to grow and spread from the infected person.

Vaccines offer the bodys immune system a glimpse of the virus, and then the immune system builds a broad attack. For example, after a tetanus shot, a persons immune system may produce 100 different antibodies.

Some vaccines, however, do drive viruses to evolve resistance, Drs. Kennedy and Read noted in their 2015 article. A vaccine stopped Mareks disease, an illness in chickens that is important commercially. But the virus could still infect the chickens. It replicated and spread without causing disease and quickly became resistant.

In humans, a type of bacteria that causes pneumonia bacteria evolved resistance to a vaccine when the bacteria recombined in nature with existing strains that were naturally resistant. A vaccine for hepatitis B created antibodies targeting only one small part of one protein a loop made by nine amino acids, which is tiny in protein terms. It did not create a broad attack. A pertussis vaccine also appeared to drive resistance. It worked to fend off the disease, but targeted only a few proteins and was not effective at stopping infection and transmission of the virus.

The coronavirus vaccines now in development use different ways to get the immune system to respond. Some coronavirus vaccines under development or in use in Russia and China, use whole virus particles, inactivated or attenuated, to spark an immune system response.

Many other vaccine candidates, like the ones from Pfizer and Moderna, now nearing review by the Food and Drug Administration for first use as early as December, are meant to get the immune system to react to only a portion of the coronavirus, the so-called spike protein, which would seem to offer fewer targets.

But Dr. Kennedy said that was not necessarily a problem. A vaccine based on just the spike protein has the potential to generate a broad immune response, he said, because there are multiple sites on the spike protein where potent neutralizing antibodies can bind.

Although these are the first vaccines that use RNA particles to instruct the cells to make a viral protein, other vaccines use parts of the virus, rather than the whole. So far, Dr. Kennedy said, there was no evidence to show one type of vaccine would be more likely to drive resistance. We have seen vaccine resistance evolve against many different kinds of vaccines, he said, but there are also plenty of examples for each of these where resistance has never emerged.

Resistance can also evolve in ways that arent driven by how a vaccine acts. There may already be variants of the coronavirus that are less susceptible to the actions of vaccines. This concern prompted Denmark to announce that it would cull all of its mink because a variant of the virus had appeared in mink which showed in very preliminary lab tests that some antibodies were less effective against it.

The worry has lessened since the Danes announced the problem, with scientists and the World Health Organization saying they saw no evidence yet that the variant would interfere with any vaccines in development.

But Denmark, after the resignation of a minister, who announced the cull too soon, and a legislative debate that appears to be leading to approval of the cull, still plans to kill all the mink in the country.

Confused by the all technical terms used to describe how vaccines work and are investigated?Let us help:

And scientists say that caution in this kind of situation makes sense. As a virus jumps from people to animals and back again, as it has with mink, there are more opportunities for changes in the virus RNA, changes that could lead to resistance.

Researchers at the University of Pittsburgh have discovered a kind of mutation that hadnt been seen in coronaviruses before and raises fresh concerns about the evolution of vaccine resistance.

In their search for mutations, researchers have mostly focused on flips of one genetic letter to another a kind of mutation known as a substitution. But Paul Duprex and his colleagues discovered that the viruses mutating in a chronically infected patient were changing differently: They were losing sets of genetic letters.

Typically, a mutation that deletes a genetic letter is catastrophic to a virus. Our cells read genetic letters three at a time to choose a new building block to add to a growing protein. A deletion of one genetic letter can entirely scramble the instructions for a viral protein, so that it cannot form a functional shape.

But Dr. Duprex and his colleagues found that the coronaviruses in the patient could lose genetic letters and yet stay viable. The secret: The viruses lost genetic letters in sets of three. Instead of destroying the genetic recipe for a viral protein, the mutations snipped out one or more amino acids.

As much as Dr. Duprex despises the pandemic, he finds it hard not to admire the elegance of these mutations. Its so cool, its brilliant, he said.

Having found these deletion mutations in viruses from one person, Dr. Duprex and his colleagues wondered how common they were.

Searching public databases of coronavirus genomes, they discovered that deletions were surprisingly widespread. Its happening independently in different parts of the world, Dr. Duprex said.

All the deletions, it turns out, only arise in one region, the spike protein. Dr. Duprex and his colleagues found that deletions in the spike gene didnt prevent the coronavirus from infecting cells.

Dr. Duprex and his colleagues posted their study online Nov. 19. It has not yet been published in a peer-reviewed journal. The researchers are now infecting animals with deletion-mutant viruses to better understand the risk they may pose to vaccines.

Well, this paper does nothing to reduce the anxiety! Dr. Read said in an email. This is early data strongly suggesting the virus has the potential to escape human immunity.

But Drs. Read and Kennedy argue that viral evolution wont necessarily doom vaccines. Vaccine makers just need to stay aware of it, and devise new vaccines if necessary.

And there are numerous varieties of vaccines in development. The first two approaching approval in the United States both use a significant chunk of viral RNA to train the immune system. Other vaccines that are in development use the whole virus. And different vaccines deliver the virus or part of it in different ways, all of which could prompt a different immune response.

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The Coronavirus Won't Stop Evolving When the Vaccine Arrives - The New York Times

Having recently lost her job, she was hoping to make some money to tide her over until she was working again. She charged $15 an hour, but when I caught up with her on Tuesday morning, she had received only that single request for service.

Confused by the terms about coronavirus testing? Let us help:

In the past few years, CityMD has colonized Brooklyn and Manhattan, often displacing beloved businesses that fell prey to rising rents. Now, suddenly, the whole enterprise seemed less like space filler. At another branch on Atlantic Avenue in Boerum Hill, the crowds were nearly as gargantuan. One couple had set themselves up in folding seats. By 10 on Tuesday morning, those toward the front of the line had been incrementally making their way forward since 6:45. In Manhattan, near Gramercy Park, the line for a CityMD on East 23rd Street was so long it nearly converged with a different one unfurling in front of Prohealth Urgent Care, on Third Avenue.

The problem with all this diligence, of taking space on a testing line for the prospect of enjoying pie and families-of-origin in Connecticut, is that anyone with an immediate and pressing need for a test result is left to wait that much longer. One man I met on the Atlantic Avenue line had been there for hours, hoping for the best after his son came home from school after being exposed to the virus.

No one from CityMD seemed to be outside prioritizing who should be let in sooner rather than later. A spokeswoman for the company told me that patients are triaged whenever possible, but that the demand for Covid-related visits and testing had never been higher.

It is hard to imagine a 25-year-old in, say, 1977, bearing all this sacrifice and discomfort for the purpose of sharing a meal with his family in November. As a child, I had an older cousin who consistently approached the holidays in the spirit of absenteeism. No matter what his job was in any given year, he always managed to work on Thanksgiving, something I regarded then as a sign of commitment but would later understand as a means of avoiding predictable disappointment and pain.

In this particular habit he was joined by many co-conspirators, especially and perhaps historically so in the 1970s, when the divide between parents and their grown children seemed vast and unconquerable. A generation of mothers and fathers lost to their vices and distractions had left their young feeding at an empty trough. So there was something distinctly hollow about gathering for an occasion grounded in a holy reverence for nourishment and gratitude.

But things are different now, obviously. The modern parent spends years clearing the path for children, who cling to them unremittingly. A pandemic was no longer a welcome excuse for retreating from obligation because obligation itself had been recast as longing. What once might have been viewed as opportunity a free pass to skip familial duties was now a reason for defiance. Against the advice of Dr. Fauci and the entire medical establishment, the kids were on their way home, and there was nothing to be done over the river and through the obstacle course, assuming they hadnt moved in already.

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The Unexpected Message Revealed by Long Lines for Coronavirus Testing - The New York Times

Few things on the planet are being watched more closely than the development of vaccines for the coronavirus, which has killed 1.4 million people and infected 60 million worldwide.

In November, three drug companies developing experimental vaccines announced promising efficacy data that excited medical experts and health officials. But the good news came with a caveat: It will be months before vaccines are widely available to the public.

With a host of developments and cautions breaking over the past few weeks, The Chronicle researched the situation to obtain more clarity. Here is what we know, and dont know, about coronavirus vaccines:

Q: Are the vaccines effective?

A: Yes they are, based on the limited data released so far on three major vaccine clinical trials conducted by Pfizer and BioNTech, Moderna, and AstraZeneca and Oxford University, according to data released by the companies this month. The Pfizer and Moderna vaccines are about 95% effective, and the AstraZeneca vaccine is on average 70% effective. (The AstraZeneca vaccine is 62% effective under one dosing regimen, and 90% effective under another dosing regimen. But these results have come under some scrutiny after the company acknowledged an error in vaccine dosing given to some trial participants.) The data has not been peer reviewed. Pfizers data is final, but the other two companies data is preliminary. Pfizer is the only company to apply for FDA authorization for its vaccine.

Q: Are the vaccines safe?

A: They appear safe, based on the data thats been released. The three drug companies that have shared early results said there were no serious safety concerns among the tens of thousands of people who volunteered to participate in the trials. The Phase 3 trials enrolled 44,000 people (Pfizer), 30,000 people (Moderna) and 23,000 people (AstraZeneca).

Q: Are there any side effects?

A: Yes. A relatively small number of clinical trial participants experienced fatigue, headaches and some soreness around the injection site, though most side effects were mild or moderate and short-lived. In Pfizers trial, 3.8% of participants reported fatigue and 2% reported headaches after the second dose. Moderna said 9.7% of trial participants had fatigue, 8.9% had muscle pain, 5.2% had joint pain, 4.5% had headaches, 4.1% had pain and 2% had redness at the injection site. AstraZeneca said its vaccine did not cause any serious side effects, but unlike the two other companies, did not share details about potential mild or moderate side effects.

AstraZeneca and Johnson & Johnson both paused and later restarted their trials after a few participants reported serious illnesses a neurological illness in the AstraZeneca trial, and an unspecified serious medical condition in the Johnson & Johnson trial, but its unclear whether the problems were directly related to the vaccines.

Q: Who will get vaccinated first?

A: The highest-risk segments of the U.S. population will get vaccinated first. That will almost certainly be health care workers, first responders, and employees and residents of nursing homes. California is expected to start vaccinating 2.4 million of the states highest-priority health care workers in December, according to Gov. Gavin Newsom, most likely using the Pfizer vaccine.

Q: When will I be able to get vaccinated?

A: The vast majority of Americans will probably have access to a vaccine in the summer and fall of 2021, according to estimates from federal health officials. This wont happen all at once. The most likely scenario is that a limited number of doses will be available to health care workers in December. Then, as more doses and vaccines are manufactured, distributed and authorized, availability will gradually increase and go to other groups of people, in order of priority.

Q: How many doses will I need?

A: It depends on the vaccine. The Pfizer, Moderna and AstraZeneca vaccines are each administered in two doses. Pfizers is given 21 days apart, Modernas 28 days apart, and AstraZenecas at least one month apart. Its unclear whether partial immunity would be gained after receiving the first of the two doses, because the trials are focused on how well the vaccines work after two doses. Other vaccines, such as one being developed by Johnson & Johnson, could be administered in one dose.

Q: How many vaccines are in the pipeline?

A: There are 13 vaccine candidates in large-scale Phase 3 trials, and an additional 55 in Phase 1 or Phase 2 trials, according to the New York Times Coronavirus Vaccine Tracker. While six vaccines have been approved for early or limited use in China, Russia and the United Arab Emirates, none has received authorization in the United States. Phase 1 trials are done in a small number of people to test for safety and dosing. Phase 2 trials are done in hundreds of people to further test for safety. Phase 3 trials typically include tens of thousands of people and are the final stage of testing before a vaccine can be submitted for review by the Food and Drug Administration.

Q: Do the vaccines work well in older adults?

A: The early data suggests yes. The two vaccines that have reported more details about the demographics of their clinical trial participants, Pfizer and Moderna, indicate the vaccines work well in those 65 years and older. Pfizer said its vaccine is 94% effective in adults 65 and older. Moderna did not break out its efficacy data by age group, but about a quarter of the trial participants are 65 or older. AstraZeneca did not include details about how well the vaccine works in different age groups.

Q: Do the vaccines work well in children?

A: Its not yet known. Major clinical trials have tested the vaccines only in adults, and only recently began to expand enrollment to include teenagers and adolescents, from ages 12 to 17.

Q: How will vaccines be distributed?

A: The federal government will allocate vaccine doses to states. California will then allocate doses to local health departments, which will distribute them to health care providers. In some cases, vaccine manufacturers may send doses directly to health care providers.

Q: Where will I be able to get one?

A: Eventually, vaccines should be available at pharmacies, doctors offices and clinics. The federal government has reached agreements with CVS and Walgreens, for instance, to administer vaccines to nursing home residents. State and local officials may set up public vaccination sites, similar to the sites set up by cities and counties to do coronavirus testing and flu vaccinations.

Q: Which vaccine should I get?

A: Its too early to say. It will become more clear over time, as vaccines gain authorization and the drug companies share more details about how well each vaccine works in different age groups, ethnicities and among people who have certain health conditions. Some vaccines might work better for people 65 years and older, for instance, and others might work better for adolescents and teenagers.

The timeline of availability, and what the priority groups will look like once federal and state officials identify those groups will also factor in. The Pfizer vaccine, for example, will probably be the only one available at first, and initially those doses will go only to health care workers, first responders, and nursing home workers and residents.

Q: What are some of the hurdles to storing and transporting vaccines?

A: The Pfizer vaccine must be stored at minus-70 degrees Celsius, equivalent to minus-94 degrees Fahrenheit. Some research labs and hospitals affiliated with research institutions have ultra-cold freezers that can do this, but many rural hospitals and clinics do not. Pfizer plans to ship its vaccines in containers equipped with dry ice, and California plans to buy dozens of ultra-cold freezers to help supplement the storage and transporting of the Pfizer vaccine. Some health systems and local health departments have been buying ultra-cold freezers in anticipation of the Pfizer vaccine. The Moderna vaccine should be less difficult to manage, since it is kept at minus-20 degrees Celsius, which a standard medical freezer can accommodate. The AstraZeneca vaccine, and potentially others in the pipeline, can be kept in normal refrigerators (2 to 8 degrees Celsius) and will be easier to store and transport.

Q: Who is reviewing vaccine safety and efficacy data?

A: Each drug company has an independent data and safety monitoring board that reviews the Phase 3 clinical trial data. Once companies complete trials, they will submit the data to the FDA. The agencys Vaccines and Related Biological Products Advisory Committee will meet publicly to discuss the data. The FDAs career scientists will review the data and decide whether to grant the vaccine emergency use authorization.

In addition to the federal review, California is one of several states that has set up its own vaccine review board. Once the FDA has authorized a vaccine or vaccines, the state board made up of 11 vaccine experts, researchers and health officials will analyze the safety and efficacy of the vaccines.

Catherine Ho is a San Francisco Chronicle staff writer. Email: cho@sfchronicle.com Twitter: @Cat_Ho

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Coronavirus vaccines: Everything we know, and dont know, so far - San Francisco Chronicle

Infectious disease experts say the misconception that coronavirus is "just like the flu" is both dangerous and wrong.

Between 2014 and 2018, influenza and pneumonia on average killed 1,632 Tennesseans and 1,466 Georgians each year, according to the U.S. Centers for Disease Control and Prevention. So far in 2020, at least 13,862 people combined in both states have died due to the coronavirus, according to the COVID tracking project.

"It is a more worrisome virus, and to say [the coronavirus] is just the flu is both wrong and contributes to the problem," said Dr. Mark Anderson, an infectious disease specialist at CHI Memorial Hospital. "It lessens people's concern about it they're less likely to adopt the proper precautions, and that leads to wild, unchecked spread."

Anderson said that although there are similarities in how the two respiratory diseases present, there are also some distinct differences between the viruses.

For one, medical professionals have much more experience recognizing and treating influenza, Andrson said. And more importantly, they are able to prevent the flu through vaccinations something that's in the works but not yet available for COVID-19.

"We have vaccinations that in some years are highly effective for influenza, some years not. But almost every year, there's some degree of protection," he said. "We have drugs that work against influenza pretty well, and that can radically alter the clinical course, and those can also be used in certain circumstances for prevention, as well."

Andrew Pekosz, a virologist at the Johns Hopkins Bloomberg School of Public Health, said in an online article that COVID-19 is more serious because it can cause more severe illness and most of the population has no immunity.

"Many more people are susceptible to COVID-19 because there is little preexisting immunity to the virus that causes it SARS-CoV-2. Through vaccinations and previous infections, a portion of the population has some immunity to influenza, which helps limit the number of cases we see each year," Pekosz said.

While both are highly contagious and primarily spread from person to person through infected respiratory droplets, influenza infections typically follow a similar course abrupt onset of muscle aches and fever, with cough developing a day or two later. Symptoms usually last five days to a week, and possibly less for people who got their flu shots.

On the other hand, disease progression for the coronavirus is much more unpredictable, Anderson said.

Although COVID-19 can present like the flu, it can also mimic the common cold, causing sinus congestion, sore throat and a cough that may or may not be associated with a fever, as well as loss of taste and smell. Some people experience gastrointestinal illness, and in rare cases, clotting issues that can lead to stroke or inflammation of the tissue that surrounds the brain and spinal cord.

Pekosz said another factor is that more COVID-19 survivors report long-term effects of the virus than influenza survivors.

"Lingering symptoms like weakness, shortness of breath, trouble focusing and, in some cases, kidney and heart problems are much more common after COVID-19 than after influenza," he said.

Although many COVID-19 patients experience mild or no symptoms, Anderson said that complicates our ability to control the coronavirus.

"A huge thing is the fact that it's transmitted by asymptomatic people, and a small percentage of them transmit it dramatically," Anderson said, adding that in general, people are able to transmit COVID-19 in the two days leading up to showing symptoms. "Once we gained this appreciation of the pre-symptomatic spread, that's when I think people began to get much more concerned about what this virus was going to do."

Knowing what we know now, Anderson said people should have been more concerned about the coronavirus when it first emerged. He thinks Americans may have been too complacent, because the world managed to avoid a pandemic with SARS and MERS two other coronaviruses that cause severe illness and came before COVID-19.

"I think we were lulled a little bit by the fact that we've had scares before which didn't materialize into a pandemic," he said. "As we often say in medicine, things just look so clear through the retrospective scope."

Contact Elizabeth Fite at efite@timesfreepress.com or follow her on Twitter @ecfite.

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Not 'just like the flu': Experts say misconceptions, complacency, helped coronavirus spread - Chattanooga Times Free Press

The first time, she was just 22 years old with a full-time job in publishing that didn't pay enough to cover her rent and grocery bills in Tokyo. "I was really poor," said Kobayashi, who spent three days unconscious in hospital after the incident.

Now 43, Kobayashi has written books on her mental health struggles and has a steady job at an NGO. But the coronavirus is bringing back the stress she used to feel.

"My salary was cut, and I cannot see the light at the end of the tunnel," she said. "I constantly feel a sense of crisis that I might fall back into poverty."

Experts have warned that the pandemic could lead to a mental health crisis. Mass unemployment, social isolation, and anxiety are taking their toll on people globally.

"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," said Michiko Ueda, an associate professor at Waseda University in Tokyo, and an expert on suicides.

"That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."

While the reasons for Japan's high suicide rate are complex, long working hours, school pressure, social isolation and a cultural stigma around mental health issues have all been cited as contributing factors.

The pandemic appears to have reversed that trend, and the rise in suicides has disproportionately affected women. Although they represent a smaller proportion of total suicides than men, the number of women taking their own lives is increasing. In October, suicides among women in Japan increased almost 83% compared to the same month the previous year. For comparison, male suicides rose almost 22% over the same time period.

There are several potential reasons for this. Women make up a larger percentage of part-time workers in the hotel, food service and retail industries -- where layoffs have been deep. Kobayashi said many of her friends have been laid off. "Japan has been ignoring women," she said. "This is a society where the weakest people are cut off first when something bad happens."

Compounding those worries about income, women have been dealing with skyrocketing unpaid care burdens, according to the study. For those who keep their jobs, when children are sent home from school or childcare centers, it often falls to mothers to take on those responsibilities, as well as their normal work duties.

Increased anxiety about the health and well-being of children has also put an extra burden on mothers during the pandemic.

Akari, a 35-year-old who did not want to use her real name, said she sought professional help this year when her premature son was hospitalized for six weeks. "I was pretty much worried 24 hours," Akari said. "I didn't have any mental illness history before, but I could see myself really, really anxious all the time."

Her feelings got worse as the pandemic intensified, and she worried her son would get Covid-19.

"I felt there was no hope, I felt like I always thought about the worst-case scenario," she said.

In March, Koki Ozora, a 21-year-old university student, started a 24-hour mental health hotline called Anata no Ibasho (A Place for You). He said the hotline, a nonprofit funded by private donations, receives an average of over 200 calls a day, and that the vast majority of callers are women.

"They lost their jobs, and they need to raise their kids, but they didn't have any money," Ozora said. "So, they attempted suicide."

Most of the calls come through the night -- from 10 p.m. to 4 a.m. The nonprofit's 600 volunteers live around the world in different timezones and are awake to answer them. But there aren't enough volunteers to keep up with the volume of messages, Ozora said.

They prioritize the texts that are most urgent -- looking for keywords such as suicide or sexual abuse. He said they respond to 60% of texts within five minutes, and volunteers spend an average of 40 minutes with each person.

Anonymously, over online messaging, people share their deepest struggles. Unlike most mental health hotlines in Japan, which take requests over the phone, Ozora says many people -- especially the younger generation -- are more comfortable asking for help via text.

In April, he said the most common messages were from mothers who were feeling stressed about raising their kids, with some confessing to thoughts of killing their own children. These days, he says messages from women about job losses and financial difficulties are common -- as well as domestic violence.

"I've been accepting messages, like 'I'm being raped by my father' or 'My husband tried to kill me,'" Ozora said. "Women send these kinds of texts almost every day. And it's increasing." He added that the spike in messages is because of the pandemic. Before, there were more places to "escape," like schools, offices or friend's homes.

Japan is the only G-7 country where suicide is the leading manner of death for young people aged 15 to 39. And suicides among those under 20 had been increasing even before the pandemic, according to health ministry.

As pandemic restrictions take children out of school and social situations, they're dealing with abuse, stressful home lives, and pressures from falling behind on homework, Ozora said. Some children as young as five years old had messaged the hotline, he added.

Morisaki says he thinks there's a big correlation between the anxiety of children and their parents. "The children who are self-injuring themselves have the stress, and then they can't speak out to their family because probably they see that their moms or dads are not able to listen to them."

In Japan, there is still a stigma against admitting loneliness and struggle. Ozora said it's common for women and parents to start the conversation with his service with the phrase: "I know it's bad to ask for help, but can I talk?"

Ueda says the "shame" of talking about depression often holds people back.

"It's not something that you talk about in public, you don't talk about it with friends or anything," she said. "(It) could lead to a delay in seeking help, so that's one potential cultural factor that we have in here."

Akari, the mother of the premature baby, agrees. She had previously lived in the US, where she says it seems easier to seek help. "When I lived in America, I knew people who went through therapy, and it's a more common thing to do, but in Japan it's very difficult," she said.

But both Ozora and Kobayashi say it has not been nearly enough: reducing the suicide rate requires Japanese society to change.

"It's shameful for others to know your weakness, so you hide everything, hold it in yourself, and endure," Kobayashi said. "We need to create the culture where it's OK to show your weakness and misery."

A succession of Japanese celebrities have taken their lives in recent months. While the Japanese media rarely details the specifics of such deaths -- deliberately not dwelling on method or motive -- the mere reporting on these cases often causes an increase in suicide in the general public, according to experts such as Ueda.

Hana Kimura, a 22-year-old professional wrestler and star of the reality show "Terrace House," died by suicide over the summer, after social media users bombarded her with hateful messages. Hana's mother, Kyoko Kimura, says she was conscious that media reports on her daughter's death may have affected others who were feeling suicidal.

"When Hana died, I asked the police repeatedly not to disclose any concrete situation of her death, but still, I see the reporting of information only the police knew," Kimura said. "It's a chain reaction of grief."

Kimura said the pandemic led her daughter to spend more time reading toxic social media messages, as she was unable to wrestle because of coronavirus restrictions. Kimura is now setting up an NGO called "Remember Hana" to raise awareness about cyberbullying.

"She found her reason to live by fighting as a professional wrestler. It was a big part of her. She was in a really tough situation as she could not wrestle," Kimura said. "The coronavirus pandemic made society more suffocating."

In recent weeks, Japan has reported record-high daily Covid-19 cases, as doctors warn of a third wave that could intensify in the winter months. Experts worry that the high suicide rate will get worse as the economic fallout continues.

"We haven't even experienced the full economic consequences of the pandemic," Ueda said. "The pandemic itself can get worse, then maybe there's a semi-lockdown again; if that happens, then the impact can be huge."

But as cases rise, some worry harsher restrictions will be needed -- and are concerned about how that could affect mental health.

"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," Ueda said. "That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."

Despite having to deal with a salary cut and constant financial insecurity, Kobayashi says she is now much better at managing her anxiety. She hopes that by speaking publicly about her fears, more people will do the same and realize they are not alone, before it's too late.

"I come out to the public and say that I have been mentally ill and suffered from depression in the hope that others might be encouraged to speak out," Kobayashi said. "I am 43 now and life starts to get more fun in the middle of my life. So, I feel it's good that I am still alive."

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In Japan, more people died from suicide last month than from Covid in all of 2020. And women have been impacted most - CNN

HOUSTON, TX - NOVEMBER 26: (EDITORIAL USE ONLY) Dr. Joseph Varon hugs and comforts a patient in the COVID-19 intensive care unit (ICU) during Thanksgiving at the United Memorial Medical Center on November 26, 2020 in Houston, Texas. According to repo

HOUSTON, Texas - A touching moment between a doctor and a distraught patient suffering from coronavirus is being shared across social media.

According to Yahoo!, Dr. Joseph Varon, chief of staff at United Memorial Medical Center in Houston, has been working for 251 days straight due to the ongoing COVID-19 pandemic. Thanksgiving Day was no exception.

With a ward full of coronavirus patients, Dr. Varon showed the true compassion of health care workers. Dressed in full PPE, the doctor is seen comfortingan elderly patient in the hospitals intensive-care unit.

MORE NEWS:Veteran who took delivery job for money to fix roof helped by woman who saw him struggling

I am grateful to witness a wonderful moment and I thank all the medical staffs for their hard work even during the holiday season, wrote photographer Go Nakamura on Facebook, who captured the tender moment.

According to reports, Texas has reached over 1,220,000 cases, including over 21,500 deaths.

New estimates by theCenters for Disease Control and Preventionshow that the spread of thecoronavirusin the U.S.may be worse than was previously known.

| THE LATEST ON THE COVID-19 PANDEMIC |

There may have been as many as 53 million coronavirus cases in the U.S. by the end of September, the CDC reported. That would be nearly eight times as many cases as had been reported by that time.

The CDC says that government mandates that require people to wear masks in public help slow the spread of COVID-19.

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Doctor hugs elderly coronavirus patient on Thanksgiving in viral photo - FOX 10 News Phoenix

By Shoshana Dubnow

Sonia Brownshusband died onJune 10. Two weeks later, the 65-year-old registered nurse was back at work. Her husbands medical bills and a car payment loomed over her head.

She wanted to make sure all those things were taken care of before she retired, her son David said.

He and his sister begged her not to go back to work during the coronavirus pandemic explaining their concerns about her age and diabetes but she didnt listen.

She was like the Little Engine That Could. She just powered through everything, her son said.

But her invincibility couldnt withstand COVID-19, and on July 29 she died after contracting the deadly virus.

Browns death is far from unusual. Despite evidence from theCenters for Disease Control and Preventionthat adults 65 and older are at a higher risk from COVID-19, Kaiser Health News and The Guardian have found that 338 health care workers in that age group continued to work and likely died of complications from the virus after exposure on the job. Some were in their 80s oftentimes physicians or registered nurses who cherished decades-long relationships with their patients and didnt see retirement as an option.

The workers had a variety of motivations for risking their lives during the pandemic. Some felt pressured by employers to compensate for staffing shortages as the virus swept through departments. Others felt a higher sense of duty to their profession. Now their families are left to grapple with the same question: Would their loved ones still be alive if they had stayed home?

Aleyamma Johnwas what her son, Ginu, described as a prayerful woman. Her solace came from working and caring for others. Her 38-year nursing career started inMumbai, India. She emigrated with her husband toDubaiin theUnited Arab Emirates, where she worked for several years and had her two children. In 2002, the family moved toNew York, and she took a job atNYC Health+ Hospitals in Queens.

In early March, as cases surged acrossNew York, Johns son asked his 65-year-old mother to retire. Her lungs were already weakened by an inflammatory disease, sarcoidosis.

We told her very clearly, Mom, this isnt something that we should take lightly, and you definitely need to stay home.

I dont feel like the hospital will allow me to do that, she responded.

Her son described the camaraderie his mother shared with her co-workers, a bond that grew deeper during the pandemic. Many of her fellow nurses got sick themselves, and John felt she had to step up.

Some of her co-workers were quarantined (and did) not come into work, he said. Her department took a pretty heavy hit.

By the third week of March, she started showing symptoms of COVID-19. A few days in, she suggested it might be best for her to go to the hospital.

I think she knew it was not going to go well, her son said. But she found it in her heart to give us strength, which I thought was just insanely brave.

John ended up on a ventilator, something she had assured her son wouldnt be necessary. Her family was observing a virtualPalm SundayserviceApril 5when they got the call that she had died.

We prayed that she would be able to come back, but that didnt happen, her son said.

His mother and her husband, Johnny, who retired a few years ago, had been waiting to begin their next adventure.

If organizations cared about their staff, especially staff who were vulnerable, if they provided for them and protected them, all of this could have been prevented, the son said.

In non-pandemic times,Sheena Milesconsidered herself semi-retired. She worked every other weekend atScott Regional HospitalinMorton, Mississippi, mainly because she loved nursing and her patients. WhenScott Countyemerged as a hot spot for the virus, Sheena worked four weekends in a row.

Her son, Tom Miles, a member ofMississippis House of Representatives, called her one night to remind her she did not need to go to work.

You dont understand, Sheena Miles told her son. I have an oath to do this. I dont have a choice.

Over Easter weekend, she began exhibiting COVID-19-like symptoms. By Thursday, her husband drove her to theUniversity of Mississippi Medical CenterinJackson.

She walked in and she never came out, Tom Miles said.

He said his mom laid her life down for the residents ofMorton.

She knew the chances that she was taking, he said. She just felt it was her duty to serve and to be there for people.

Serving the community also was at the heart of Dr.Robert Ray Hullsfamily medicine clinic inRogers, Arkansas. He opened the clinic in 1972 and, according to his son Keith, had no intentions of leaving until his last breath.

He was one of the first family physicians in northwestArkansas, the son said. Several people asked him if he was going to retire. His answer was always no.

At the age of 78,Dr. Hullcontinued to make house calls, black bag in hand. His wife worked alongside him in the office. His son said the whole staff took proper precautions to keep the virus at bay, so when his father tested positive for COVID-19, it came as a shock.

Dr. Hulls son wasnt able to visit him at the hospital before he died onJune 7. The son said the funeral was even harder. Due to COVID-19 restrictions on crowd sizes, he had to ask patients fromArkansas,OklahomaandMissourito stay home.

Theres not a coliseum, arena or stadium that would have held his funeral, the son said. Everybody knew my dad.

Nancy MacDonald, at 74, got bored at home. Thats why her daughter, Bethany, said retirement never stuck for her. So in 2017, MacDonald took a job as a receptionist atOrchard View Manor, a nursing home inEast Providence, Rhode Island.

Although technically she worked the night shift, her co-workers could rely on her to pick up extra shifts without question.

If somebody called her and said, Oh, Im not feeling well. I cant come in, she was right there. That was just the way she was, her daughter said.

Nursing homes across the country have struggled to contain breakouts of COVID-19, andOrchard Viewwas no exception. By mid-April, the facility reportedly had 20 deaths. MacDonalds position was high-contact; residents and staff were in and out of the reception area all day.

At the onset of the pandemic,Orchard Viewhad a limited supply of PPE. MacDonalds daughter said they prioritized giving it to workers on the floor, primarily those handling patient care. Her mothers position was on the back burner.

When they gave her a(n N95) mask, they also gave her a brown paper bag, she said. When she left work, they told her to put the mask in the bag.

MacDonalds managers reiterated that she was an essential employee, so she continued showing up. In conversations with her daughter, however, she was fearful about what might happen. At her age, she was considered high risk. MacDonald saw the isolation thatOrchard Viewresidents experienced when they contracted the coronavirus. She didnt want that to be her.

She was afraid she was going to get sick, her daughter said. She was afraid to die alone.

Following her death onApril 25, theOccupational Safety and Health Administrationopened an investigation into the facility. So far,Orchard Viewhas been fined more than $15,000 for insufficient respiratory protection and recording criteria.

A spokesperson forOrchard Viewtold Kaiser Health News the facility had extensive infection control. The facility declined to comment further.

Bethany MacDonaldbelieves health care systems often exclude receptionists, janitors and technical workers from conversations on protecting the front line.

It doesnt matter what the job is, they are on the front line. You dont have to be a doctor to be on the front line, she said.

Kaiser Health Newsis a national health policy news service. It is an editorially independent program of theHenry J. Kaiser Family Foundation,which is not affiliated withKaiser Permanente.

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These health care workers could have retired during the coronavirus pandemic. They risked their lives instead. - OregonLive

Need to stay updated on coronavirus news in Texas? Our evening roundup will help you stay on top of the day's latest updates. Sign up here.

Texas health officials reported more than 14,000 new coronavirus infections Wednesday in what appeared to be an all-time high for daily cases.

The record comes one day before the Thanksgiving holiday. Public health authorities have urged people to celebrate apart this year, warning that family gatherings may hasten the spread of infections at a time when many Texas hospitals report overwhelming volumes of COVID-19 patients.

The seven-day average of new cases in Texas continues to surpass 10,000, having tripled since the beginning of October. Testing is also at record levels. Roughly 10% of coronavirus tests yielded positive results on Nov. 24, according to Texas Department of State Health Services data.

The state public health agency says its daily coronavirus statistics are provisional and subject to change.

Meanwhile, the number of Texans hospitalized with COVID-19 has more than doubled since the beginning of October, and Texas has reported more than 20,900 coronavirus deaths since the pandemic began.

The situation is particularly dire in El Paso, where officials have pleaded for more morgue workers as coronavirus fatalities climb. Experts say widespread fatigue has hastened viral transmission and worry the holidays could exacerbate an already dangerous situation.

Hospital administrators in North Texas, West Texas and the Panhandle have expressed concern about climbing numbers of coronavirus hospitalizations. Rural hospital administrators have reported difficulty transferring patients as larger hospitals in Lubbock, Amarillo and other larger cities run short on beds.

More than 8,500 patients with COVID-19 were hospitalized on Nov. 25, according to state health officials. That was below Texas all-time high for coronavirus hospitalizations, which reached nearly 11,000 in late July.

The Department of State Health Services has said it plans to update its daily COVID-19 counts over the holiday weekend but that daily case numbers may appear lower as some local health departments report data more slowly.

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Texas' coronavirus infections set new record ahead of Thanksgiving - The Texas Tribune

Multiple state reports dated November 22 and obtained by CNN show a critical assessment from the task force at a time when it says Americans must undertake "significant behavior change," urging state and local officials to take proactive steps toward those ends.

North Dakota is yet again the state with the highest number of new cases per 100,000 population since at least mid-October, followed by Wyoming, then South Dakota, Minnesota, Iowa, Nebraska, Montana, Wisconsin, Utah and New Mexico in the top 10.

However, the task force offered good news to North Dakota, which it said is "showing signs of early stabilization with a plateauing of cases and stabilization of hospitalizations at a high level."

"This is the moment to further accelerate mitigation requirements to drive down the pandemic," the report said, calling for more aggressive testing as well.

There is still not a statewide mask mandate in North Dakota.

But the reports shared bleaker assessments for many other states.

Wisconsin, the task force said, "continues to see extraordinarily high rates of cases and test positivity in an ongoing health emergency," noting that hospitalizations and deaths "are several-fold greater than the spring or summer peaks." The report commended additional measures from Democratic Gov. Tony Evers and suggested "restricting indoor dining and limiting or closing areas of congregation without masking."

"At this point, the rapid increases in cases, hospitalizations, and deaths throughout the state support the importance of taking additional steps. These increased mitigation measures are a short-term sacrifice to protect the vulnerable," the report said.

Maryland, the task force report said, "is showing alarming signs of a viral surge."

"We share the strong concern of Maryland's leaders that the current situation is critical and that improved observance of social distancing measures is urgently needed to limit overrunning of hospital capacity and additional preventable deaths. The Governor's active measures are critical and are commended," the Maryland report said.

In Ohio, the task force suggested, the state "needs to continue its aggressive mitigation efforts and potentially expand the depth and breadth of interventions to further drive down this surge."

There was bad news for Georgia, which the task force said is "in the early stages of full resurgence."

"This is the moment to dramatically increase mitigation," the Georgia report said.

Minnesota, the task force said, "is seeing a continued dramatic rise in cases, hospitalizations, and deaths, all of which are at their highest points ever in the pandemic," calling for "observance of intensified mitigation measures."

In multiple states with rising cases, including Minnesota, Washington, Vermont and Delaware, the task force recommended some short-term interventions, including "restricting indoor dining and limiting or closing areas of congregation without masking." But, the reports said, those measures "had limited success in preventing spread at private gatherings," calling for reinforced messaging about social gatherings, including avoiding large groups and using masks.

The task force shared this dire prediction for Connecticut: "Connecticut continues to see rapid rises in cases, test positivity, and hospitalizations that will lead to increasing deaths."

The report for Pennsylvania expressed concern about hospital shortages.

"The continued increase in transmission remains concerning, especially given local hospital shortages and further increases anticipated over the upcoming holidays. Recent restrictions are warranted and commendable," the Pennsylvania report said.

The task force praised Iowa this week after Republican Gov. Kim Reynolds instituted some masking policy.

"Encouraged by the steps the governor is taking to decrease transmission; this is the first week where the rise in cases is less than previous weeks. Covid-related hospitalizations will continue in the coming weeks; however, with increased strong mitigation, cases could decline to the yellow zone within four to five weeks, like in states that strongly mitigated during the summer surge," the Iowa report said.

The task force raised questions about supply levels at Louisiana and Ohio hospitals.

"There are early signs of reduced N95, gown, and glove supply in specific hospitals' reporting. Please contact all hospitals reporting less than one week's supply to confirm data; contact the regional FEMA office for support if this supply issue is confirmed," the reports said.

Days before the Thanksgiving holiday, the task force urged this messaging in multiple reports: "We need to protect those we are thankful for in our families and communities. Ensure indoor masking around vulnerable family members during any gatherings."

And multiple reports encouraged states to make plans for testing university students.

"Ensure all universities returning in the winter move to mandatory weekly testing of all on and off campus students. Planning for that must begin now," reports said.

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Coronavirus task force calls on states to 'further accelerate mitigation' - CNN

And in Minnesota, Joyce Sutphen gave thanks for

snow that comes down from Canadacovering the leaves we didnt rakeand how sometimes after that, weget a heat wave and a second chanceto put things right in the world

Not all states responded. The New York Times request came with some prosaic conditions 100 words or less on a newspaper deadline, a tall order for an exacting art form. Some states have no poet laureate. New Jersey abolished the post in 2003 amid controversy, and Idaho replaced it in the 1980s with a broader writer-in-residence appointment. The last full-time poet to hold that job, Diane Raptosh, who has also served as poet laureate of Boise, offered that states poem.

Still other states were between poets. In California, Mr. Gioias term ended in 2018 and the governor has yet to appoint a successor. Illinois had been without an official poet since 2017; we received submissions from its last laureate and the poet who succeeded him on Wednesday.

But the many writers who did respond reflected a widespread, if weary, appreciation, both for regional grit and more universal blessings. Many wrote, in these socially distanced times, of the humanity and fellowship around them.

Hawaiis poet was grateful for tight-knit island communities, Wyomings for neighbor helping neighbor / despite long distances, and Alabamas for a state where people rally to help each other out in times of crisis.

And North Carolinas for North Carolinians and the many ways we have gathered together to take care of each other. And South Dakotas for food, resources, / each other love and fears first real test. And Oklahomas for the after-tornado swarm of helping strangers / for those who smell of oil, of diesel, of dirt, of sweat.

Paisley Rekdal of Utah wrote of something unusual: crowds in the canyons. Bobby LeFebre of Colorado reached out on social media to crowdsource that states thanks for love, familia, health, work, creator, community, cultura / resilience, art, abolitionists, education, imagination, clarity / life, truth, weed, and much more.

Beth Ann Fennelly of Mississippi was grateful to be counted on: One Mississippi, Two. Grateful for the word yall. Grateful for the emphatic all yall.

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Verses vs. Coronavirus: What These Poets Laureate Are Thankful For - The New York Times