Category: Covid-19

The onset of summer has triggered fears of the resurgence of Covid-19 as SARS-CoV-2, the coronavirus that causes Covid-19, has continued to mutate. There have been concerns around a group of variants called FLiRT, named after the technical names for their mutations, and the LB.1 variant, which has an additional mutation on FLiRT.

The FLiRT strains are sub-variants of Omicron, which was dominant in the third wave of infections in India in January 2022. FLiRT strains together account for over 60% of Covid-19 cases in the United States, with a variant known as KP.3 accounting alone for 33.1% of infections by early June, according to data from the US Centers for Disease Control and Prevention (CDC).

What impact could these mutations have and what precautions should be taken? We explain.

FLiRT is a group of variants which include KP.2, JN.1.7, and any other variants starting with KP or JN. They are descendants of the JN.1 variant, which dominated infections in the US during late 2023 and early 2024.

Its symptoms resemble those of earlier variants, including fever, cough, fatigue and digestive issues with a heightened transmission rate. Of concern is its ability to evade immunity, gained from vaccines and previous infections.

The LB.1 strain, a mutation of the FLiRT group, was responsible for 17.5% of Covid-19 cases in the US this year as summer began. Both FLiRT and LB.1 are highly transmissible.

Preliminary research data from the Infectious Diseases Society of America shows most common FLiRT variants are mutations which can infect people who are vaccinated. They spread more easily than JN.1, while LB.1 is poised to be more infectious and transmissible than its predecessors.

The uptick in cases has been chiefly reported from the US, the United Kingdom and Singapore, with an increased rate of hospitalisation. CDC data for June 16 to 22 showed that the number of emergency room visits had increased to over 23%, while Covid-19 deaths had also risen by 14.3% in recent weeks. However, the share of Covid-19 deaths as a part of all deaths remains low, at 0.8%.

The Singapore Ministry of Health reported that the number of Covid-19 cases had risen to 25,900 cases between May 5 to 11 over the previous weeks 13,700 cases, while the number hospitalised increased from 181 to 250 over the same period.

The Indian Express in May reported that 290 cases of the KP.2 variant and 34 cases of the KP.1 variant had been detected in India.

Ever since Covid-19 began circulation in late 2019, the virus has continued to exist in and around humans. What has changed is how humans gradually acquired immunity to it compared to when it first appeared.

The US removed its mask mandates in early 2022, while the CDC stopped reporting daily case numbers on its data tracker by May 2023, viewing the situation as no longer being a public health emergency. There are also fewer tests being done for it, resulting in lower reporting of numbers.

However, Covid-19 strains continue to mutate and evolve. Over time, the immunity against the virus, developed through infections and vaccines, starts wearing off. Paul Hunter, a professor of medicine at the University of East Anglia in the UK, told Deutsche Welle: Sterilizing immunity following an infection or vaccination only lasts four to six months on average, so immunity gained from infections during winter or the autumn vaccination campaign will have already been lost for the most part.

This results in the need for continued booster doses of the vaccine. The US Food and Drug Administration (FDA) has appealed to drug manufacturers to target the new variant as well. In particular, the elderly and those with comorbidities are more vulnerable to the infection.

Preventative measures prescribed since the beginning of the pandemic in 2020 should be adhered to, including maintaining social distancing, using well-fitted respiratory masks like N95 or KN95 indoors to protect against all variants, and increasing ventilation while indoors.

People vulnerable to the infection on account of their comorbidities, as well as those in areas where the spread of the infection has been reported, are advised to take extra precautions. Booster doses against the vaccine can help provide immunity against the current strain.

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Explained: New Covid-19 variants FLiRT and LB.1, driving surge in US, UK - The Indian Express

The so-called FLiRT variants of SARS-CoV-2 coronavirus that cause COVID-19 have been the dominant forms of the virus circulating this year globally, according to the World Health Organization

FLiRT is an acronym for the locations of the mutations the variants share on the virus spike protein. One of them, called KP.3, has become the most commonly circulating variant in the United States over the past month, according to the U.S. Centers for Disease Control and Prevention.

Here is what you need to know about FLiRT.

HOW ARE FLIRT VARIANTS DIFFERENT FROM PREVIOUS VARIANTS?

The FLiRT variants, which also include KP.3s parental lineage JN.1, have three key mutations on their spike protein that could help them evade antibodies, according to Johns Hopkins University.

ARE FLIRT VARIANTS MORE CONTAGIOUS OR LIKELY TO CAUSE MORE SEVERE ILLNESS?

Dr. Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau Hospital in Oceanside, New York, and a spokesperson for the Infectious Diseases Society of America said in May that he had not seen evidence of an uptick in disease or hospitalizations, based on the data he tracks and experience with his own patients.

There have been some significant changes in the variants, but I think in recent times its not been as important, probably because of the immunity many, many people already have from prior illness and vaccination.

CDC data suggests that COVID-related hospitalizations have risen slightly since April and the number of patients in emergency departments who have tested positive for COVID has increased since May, in line with trends a year ago.

DO CURRENT VACCINES WORK AGAINST THE FLIRT VARIANTS?

The current vaccines should still have some benefit against the new variants, Glatt said.

Since 2022, health regulators have asked vaccine makers to design new versions of the COVID-19 vaccines to better target circulating variants.

Europes regulator has said vaccine makers should target the JN.1 variant. U.S. regulators asked for the vaccines to target variants within the JN.1 lineage, but said the preferred strain to target would be the KP.2 strain, which was dominant in June.

(Reuters)

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FLiRT COVID variants: What are they and are they more contagious? - DD News

As COVID-19 has become endemic, new symptoms keep on arriving regularly. One of them noticed more frequently is the condition in which swollen tongues are seen that develop bumps, ulcers, and white patches. This is called 'COVID tongue.' Doctors have found that in people with COVID tongue, the top of their tongue becomes white and patchy, or they look red and appear swollen. They sometimes find bumps or open areas called ulcers on their tongue. Besides, people with 'COVID tongue' may also experience a loss of taste and a burning sensation in their mouth.

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According to Dr. Mehdizadeh, 'COVID tongue' can not be prevented. He also said that the remedies utilized in the literature include multivitamins and minerals, and anti-septic oral rinse.

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What is the reason behind 'COVID tongue'?COVID-19 attacks the bumps on the tongue, i.e., papilla, by using an angiotensin-converting enzyme receptor (ACE-2). Consequently, COVID-19 tongue symptoms can occur, including inflammation and swelling.

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What is 'COVID tongue'? What are its symptoms and how can it be prevented? Know in detail - The Economic Times

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Early in the pandemic, patients with asthma were considered at a higher risk for COVID-19 infection and illness-related hospitalization. In addition, social distancing measures were shown to help lower rates of emergency visits and hospitalizations for pediatric patients who have asthma. Whether symptomatic asthma in pediatric patients is associated with population-level COVID-19 illness exposure or reduction strategies is not well understood. Authors of a study published in JAMA Network Open evaluated whether symptomatic asthma was positively associated with population COVID-19 overall mortality, and would then be, conversely, associated with population-level completion of the COVID-19 primary vaccination series with state face mask mandates.

For this cross-sectional study, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines were followed. Additionally, the follow data were included: state-level data regarding parent-reported current asthma symptom prevalence in their children from the National Survey of Childrens Health from 2018-2019 and 2020-2021; age-adjusted COVID-19 overall mortality ratesa proxy for SARS-CoV-2 exposurefrom the CDC during 2020 and 2021; the proportion of population aged 5 years and older who completed the primary COVID-19 vaccination series in 2020 and 2021 (also from the CDC); and face mask requirements in enclosed spaces through August 2021, which was gathered from 20 states and the District of Columbia. Data were analyzed in February 2024.

Additionally, the authors calculated state-level change scores for parent-reported childhood asthma symptom prevalence for 2020 to 2021 compared with 2018 to 2019, then assessed state-level time trends. Trend associations were evaluated with concurrent state-level variables, according to the authors.

The data demonstrated that the mean state-level prevalence of parent-reported childhood asthma symptoms had decreased from approximately 7.77% (95% CI, 7.34%-8.21%) from 2018 to 2019, and to 6.93% (95% CI, 6.53%-7.32%) from 2020 to 2021 (P < .001), with an absolute mean change in score of approximately -0.85%. Additionally, the mean (SD) age-adjusted state-level COVID-19 mortality rate was 80.3 (30.2) per 100,000 in 2020, and this rate increased to 99.3 (33.9) in 2021. Further, the mean state-level COVID-19 primary series vaccination rate through December 2021 was approximately 72.3% (10.3%).

The investigators also observed that with each 10% increase in COVID-19 vaccination coverage, the prevalence of parent-reported child asthma symptoms decreased by 0.36%. Additionally, the prevalence of child asthma symptoms reported by their parents were not associated with state-level COVID-19 mortality, or with face mask requirements. State-level COVID-19 vaccination rates were inversely correlated with the state-level COVID-19 mortality rate in 2021 (r =0.75;P<.001); however, this was not true for 2020 (r=0.75;P<.001). There were also positive associations with mask mandates (r=.49;P<.001).

According to the investigators, this study is the first to evaluate population-level and parent-reported childhood asthma symptoms prevalence and COVID-19 vaccination. The findings demonstrate that higher COVID-19 vaccination rates may provide protection against pediatric patients symptomatic asthma, and that vaccination might also provide some benefits against SARS-CoV-2 infection and other human coronaviruses through cross-reactive antibody responses in individual children. This suggests that community-level immunity in states that have higher vaccination rates may also contribute to the reduction of childrens risk to asthma. Alternatively, simultaneous exposure to high population-level burden of COVID-19-attributed disease and sustained state-level face mask requirements were not associated with parallel trends in patient-reported symptomatic childhood asthma.

The authors note that there are limitations to the study, such as the lack of state-level estimates of COVID-19 vaccination rates among children with a history of asthma in the analysis because of the unavailability of the data. Because of this, differences in symptomatic asthma among vaccinated pediatric patients compared with unvaccinated children could not be made. Despite this, the investigators confirm that reduction in symptomatic asthma among pediatric patients in 2020 and the overall individual-level COVID-19 mortality reduction with vaccination offer outside support for the state-level findings. Further, the lack of association of COVID-19 vaccinationthat was primarily administered in 2021along with population-level COVID-19 mortality in 2020 acts as a negative control. According to the investigators, the findings should be confirmed with additional research to help determine whether asthma symptom prevalence in pediatric patients may be reduced by the sustained efforts of vaccination against COVID-19.

Reference

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Higher COVID-19 Vaccination Rates May Provide Protection Against Symptomatic Asthma in Pediatric Patients - Pharmacy Times

In a recent research letter published in the journal JAMA Network Open, scientists in Italy compared the rates of respiratory medication usage and wheezing due to bronchiolitis among children born during the coronavirus disease 2019 (COVID-19) pandemic-associated lockdowns in Italy and those born in the winter months before the pandemic, when the incidence of respiratory syncytial virus infections was high.

Research letter: Wheeze Among Children Born During COVID-19 Lockdown. Image Credit:Herlanzer/ Shutterstock

Emerging evidence from epidemiological studies shows that the lockdowns and social distancing measures implemented in many countries to curb the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also reduced the incidence rates of other respiratory viruses. Other disease mitigation measures, such as frequent handwashing and masking, have also contributed to lowering the rates of respiratory illnesses.

The respiratory syncytial virus is responsible for close to 80% of bronchiolitis cases in children, and respiratory syncytial virus infections generally occur in the winter months. It also increases the risk of asthma and wheezing. Here, the researchers aimed to understand whether children born during the COVID-19-associated lockdowns, when their exposure to the respiratory syncytial virus would have been low, had a lower risk of wheezing or asthma.

The present research included children born during the COVID-19-associated lockdown in Italy, which spanned the months of February to April 2020. The comparison cohort included children born in the same months during 2016 and 2017, for whom the data was obtained from the Pedianet database, which contains data from 150 pediatricians and family doctors in Italy.

The International Statistical Classification of Diseases Ninth Revision (ICD-9) codes in the health records were used to define wheezing, while the incidence rates of asthma were inferred from medications prescribed for asthma.

The researchers calculated the cumulative incidence of wheezing in person-months. Mediation analyses were conducted to determine the association between the onset of wheezing and whether the child was born during the COVID-19-related lockdown or the pre-pandemic winter months.

The study also examined how bronchiolitis mediated this association to determine the potential role of respiratory syncytial virus infections in increasing the risk of wheezing. All the estimations were adjusted for sociodemographic factors such as area deprivation index, sex, and geographic location.

The study found that children born during the pandemic-enforced lockdowns had a lower requirement of respiratory medications and experienced fewer episodes of wheezing than children born during the same months but in the pre-pandemic years of 2016 and 2017.

The researchers included 2,192 children born during 2020 in the pandemic-associated lockdown months and over 3,800 children born before the pandemic. The two cohorts did not differ in area deprivation index scores, sex, or the occurrence of atopic disease.

The 30-month follow-up observations reported that the incidence of wheezing in the lockdown cohort was 9.4% (206 out of 2192 children), while that in the historical cohort was 15% (582 out of 3,889 children). The lockdown cohort saw a wheezing episode rate of 67.6 per 10,000 person-months, while the historical cohort experienced a wheezing episode rate of 110 every 10,000 person-months.

Furthermore, the number of bronchiolitis cases was almost negligible during the lockdown as compared to the occurrence of bronchiolitis during the pre-pandemic period (6.6 versus 82.4 per 10,000 person-months).

Additionally, the findings showed that the risk of wheezing was 44% lower in children born during the months when the COVID-19-associated lockdowns were implemented. The preventative measures implemented during the lockdown to limit the spread of SARS-CoV-2 were believed to lower the risk of wheezing by 30%, not accounting for the impact of bronchiolitis on wheezing risk.

The use of nebulized glucocorticosteroids and nebulized 2 agonists was lower among children born during the lockdown as compared to those born in the pre-pandemic years, indicating that the incidence of asthma was also lower in children born during the COVID-19-related lockdown months.

While the present study was not able to ascertain the incidence of respiratory syncytial virus infections, given its retrospective nature, based on the findings from other extensive cohort studies, the authors believe that the prevention of respiratory syncytial virus infections during the early years of the infant lowers the five-year risk of asthma by 26%. These findings also highlight the importance of the universal immunoprophylaxis against respiratory syncytial virus.

Overall, the study found that children born during the COVID-19-associated lockdown months experienced significantly lowered rates of wheezing and asthma as compared to children born during the same months in previous years. The results suggest that protection from respiratory syncytial virus infections and bronchiolitis in the first year of growth could lower the risk of wheezing and asthma in the later years.

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COVID-19 lockdown reduced childhood wheezing and bronchiolitis cases - News-Medical.Net

Their names sound benign, but their danger is real: KP.1. LB.1. JN.1. KP.2. The latest variants of the COVID-19 disease run together like a less-than-appetizing version of alphabet soup. But what they all spell out, according to SSM Health physician Dr. Shephali Wulff, an expert on infectious diseases, is the need for everyone to get a new coronavirus vaccine this fall.

We have three years of evidence that these vaccines are safe and effective, and that people who have been vaccinated are less likely to end up in the hospital or die from COVID, said Wulff, SSM Healths VP of Quality and Safety.

The urgency for this is borne out by the numbers this summer. COVID-19 is ramping up across 39 states at a time of year when the diseases prevalence is relatively low with more people spending time outdoors.

Theres a difference, though. Many people have been skipping additional vaccines and some have never gotten one, expecting numerous COVID-19 infections to help them develop antibodies and a degree of immunity.

If anything, the official COVID-19 infection numbers may be lower than the actual totals, she said.

Prevalence data is flawed because folks are not testing, or they are testing at home, which does not get reported, she said.

Summer, she notes, is not always disease-free. She cites the circulation of respiratory viruses such as rhino/enterovirus and other coronaviruses as staples of the summer season, and the fact that flu season is extending longer than it used to.

Travel and large gatherings may be partially to blame for the uptick, she said. In addition, peoples immunity from last falls vaccines may be waning. All of that, she says, makes it imperative to get a new vaccine this year, just like people do with an annual flu shot.

Wulff said the public can expect new vaccines to be available in the fall, probably late September or early October. Pfizer, Moderna and Novavax all are developing vaccines to guard against infection by some of the more recent variants.

People 65 and older remain especially vulnerable to the coronavirus, but only 40 percent got a COVID-19 vaccine last fall. Seniors account for the majority of hospitalizations and deaths due to the virus.

Yet children under 5 remain susceptible to COVID-19 as well, and only 14 percent of that population was vaccinated last year.

Wulff noted that the vaccine is covered by most insurances, including Medicaid and Medicare. Departments of public health also offer the vaccines. Have a conversation with your physician about the vaccine, she urged.

Find a physician for your family.

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New COVID-19 vaccines in the fall important for everyone - SSM Health

A new report from the Government Accountability Office (GAO) said the Federal Emergency Management Agency (FEMA) has yet to identify lessons learned from the COVID-19 pandemic.

The report examined the status of obligations and expenditures related to COVID-19 and how FEMA estimated spending from January 2020 to March 2024. For fiscal years 2020 through 2024, Congress passed both annual and supplemental appropriations for the Disaster Relief Fund (DRF) totaling $97 billion, the GAO said.

The COVID-19 pandemic was the first time a president authorized the use of the DRF, meant to provide aid during natural disasters, to respond to a nationwide public health emergency. Since March 2020, the president has issued 59 major disaster declarations for all 50 states, the District of Columbia, five territories, and three Tribes. FEMA manages the DRF.

Initially, FEMA officials told GAO officers that $17.6 billion for COVID-19 assistance was allocated for the pandemic response in 2020, but a FEMA official told the GAO that the first few months of the pandemic "blew that [funding] out of the water."

"As of March 2024, FEMA had committed to spend $125.3 billion from the fund for COVID-19related assistance like vaccinations, testing sites, and moreand had spent $103.6 billion of it," the GAO wrote. New York, Texas, and California had been given at least $15 billion each, the report states.

The funds have been used for a variety of activities, including reimbursements for funeral expenses, vaccination and testing sites, and personal protective equipment for medical staff. FEMA has said it expects to fulfill funding obligations for the pandemic through August 2026.

According to the report, FEMA has estimated that obligations would total $142.2 billion through the end of fiscal year 2024 and $171.6 billion for the entire disaster. The agency, however, has not been within 10% of the annual estimate by the end of any fiscal year since 2021.

To remedy this, the GAO recommends more work from FEMA to describe lessons learned during the first 4 years of the pandemic.

"In the future, FEMA may face challenges responding to a catastrophic event that is similar in scope or duration to COVID-19 and that could increase the risk of exceeding DRF resources," the GAO wrote. "By identifying and documenting lessons learned for estimating obligations based on its experience with COVID-19, FEMA can better position itself to adapt to similar estimation challenges in the future."

By identifying and documenting lessons learned for estimating obligations based on its experience with COVID-19, FEMA can better position itself to adapt to similar estimation challenges in the future.

FEMA, however, said it does not agree with the recommendation that it produce a document of lessons learned related to estimating obligations for declared catastrophic disasters based on its experience with COVID-19. FEMA officials also told the GAO they have no plans to do so.

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GAO report critical of FEMA's handling of pandemic - University of Minnesota Twin Cities

New coronavirus hospitalizations haveclimbed on Long Island over the last few weeks, leading many physicians to continue urging people to get a booster.

But some experts say the timing of the next jab is based on an individual's personal health picture and other factors.

On Long Island on Friday, the rate was1.17 per 100,000, up from 0.33 that day in the prior year.As of Tuesday, 213 were newly hospitalized for COVID-19 in New York, and 48 of those cases were out of Long Island, state data shows.

As of Tuesday, the seven-day statewide average of new COVID-19 hospitalizations was the highest since March, coming in at a rate of 0.77for every 100,000 people, state data shows. In July of last year, the highest seven-day average was 0.31 per 100,000 residents.

The current figures do not outpace those of 2022, and those who currently contract the virus tend to be less likely to die because of available treatments such as the antiviral Paxlovid and prior vaccination, experts say.

Still, physicians say the current uptick likely fueled by factors such as waning vaccine immunity and new, more evasive coronavirus subvariants is concerning.

Getting a booster, they say,is important.However, some experts say the timing of getting the shot varies and is based on factors such as whether a person is immunocompromised, over 65, or is caring fora vulnerable person.

Experts say there will likely be an updated vaccine in the fall that might be better suited to fight against the newer subvariants, leaving many with a choice.

In exact timing [of getting another vaccination], I think it's all dependent on how vulnerable you think you are, what your plans are for the summer and what your plans are for the fall, said Dr. Stuart Ray,a medicine and infectious diseases professor at Johns Hopkins University.

In the future, Ray hopes to use genetic information to predict the risk of a severe COVID-19 infection for vulnerable groups, such as immunocompromised people.

Experts say a vaccine dose provides protection for a few months, and an additional dose can usually be spaced out by three months.

Dr. Bruce Farber,chief of epidemiology and public health with Northwell Health,said he would tell people to wait until the possible updated vaccine, except for certain groups that include those who are highly immunosuppressed and those who are unvaccinated.

I'm recommending, for the most part, with rare exceptions, to just hang in there until then, he said in a phone interview.

But Dr. Alan Bulbin of Catholic Health said people may be able to get vaccinated now and in the fall.If you are one of these at-risk groups, there's no downside in my mind of getting the already existing vaccine, he said.Any immunity, at this point is better than none, said Bulbin, infectious disease director at St. Francis Hospital.

Yet many Americans have thus far avoided getting an updated coronavirus vaccine. As of mid-May, roughly 22% of all adults hadthe 2023-24 coronavirus vaccine, according to weekly estimates from the Centers for Disease Control and Prevention.

Dr. Paul Mustacchia, chair of the Department of Medicine at Nassau University Medical Center, warned that the coronavirus can be unpredictable. Now is a good time to get vaccinated if it has been several months since the last dose, especially those who are obese or chronically ill, he said.

The primary concern is that we don't often know how COVID is going to behave, he said.

Education: Howard University

Tiffany Cusaac-Smith came to Newsday in 2023 after being a race and history reporter at USA TODAY, where she wrote enterprise and spot articles examining how the past shapes the present. Previously, she worked as the race and justice reporter at the USA TODAY Network of New York, covering issues such as criminal justice reform, housing, environmental justice, health care and politics. At The Journal News/lohud.com in Westchester County, she covered Yonkers, the state's third-largest city. She also worked at The Associated Press in Atlanta.

Honors and Awards: Criminal justice reporting fellowship with the National Press Foundation; New York News Publishers Association award for distinguished investigative reporting; Contributed reporting for Best of Gannett honor; Member of Table Stakes, a program funded by the Knight-Lenfest Local News Transformation Fund and managed by the American Press Institute to transform local news.

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COVID-19 hospitalizations up in New York, on Long Island in recent weeks, state figures show - Newsday

No matter who wins in November, preparing for the next pandemic needs to be a top priority for America's leaders. An essential first step must be holding the last pandemic's main culpritthe Chinese governmentaccountable.

COVID-19 resulted in over 28 million excess deaths around the world, including 1.1 million in America. As our new Nonpartisan Commission on China and COVID-19 report shows, the financial cost to our country amounted to 18 trillion dollars. Despite these astronomical damages, however, our government has so far failed to hold China to account for its unacceptable negligence and malfeasance.

The strong preponderance of evidence supports our assessment that a research-related incident in Wuhan was most likely the source of the initial outbreak. But our assertion of Chinese culpability holds regardless of how the initial spillover happened, whether from a laboratory accident or, as some allege, as a result of China's illegal wildlife trade. Either way, what followed was a coverup.

Beijing could have contained the outbreak early on byalerting its own citizensand the worldto the threat. Instead, the Chinese Communist Party (CCP) maximized COVID-19's spread and impact by destroying samples, hiding records, imprisoning journalists, gagging scientists, blocking international investigations, and lying to and seeking to co-opt the World Health Organization.

>>>Holding China Accountable for Its Role in the Most Catastrophic Pandemic of Our Time: COVID-19

That's why accountability today is so important to our safety tomorrow. Without it, every authoritarian state official facing similar circumstances in the future will be incentivized to follow the CCP's COVID-19 playbook of lies and obfuscation.

To that end, our report lays out a blueprint for the next administration to hold China accountable. One of our most important recommendations is that the U.S. government empower American victims of COVID-19 to hold Chinese entities liable through mass tort class action lawsuits.

Establishing liability is an essential tool for fostering accountability in any functioning domestic legal system. The same principle can be applied appropriately in the international context. But while America's Foreign Sovereign Immunities Act (FSIA) provides a limited path forward for potential plaintiffs, the bar for these types of actions remains dauntingly high.

This restrictiveness makes sense in normal circumstances and helps prevent international chaos. But these are not normal circumstances. Our world remains dangerously and unnecessarily at risk for future pandemics because we've collectively failed to establish accountability for the last one.

Congress can fix this problem with a single-paragraph amendment to the FSIA. Republicans and Democrats should work together to ensure that U.S. federal courts are granted jurisdiction over cases where injured American citizens are seeking monetary damages against a foreign state, with the important caveat that the foreign state must have directly through malfeasance or indirectly through negligence sparked a pandemic leading to over a million excess deaths in America and failed to carry out or allow a comprehensive and unfettered investigation.

>>>China and the Global Culture War: Western Civilizational Turmoil and Beijings Strategic Calculus

Congress should take this action for three essential reasons. First, it would give teeth to ongoing American and international efforts exploring the pandemic's origins that the CCP is currently impeding. Second, it would remind China that misleading the world comes with a cost. Third, and most important, it would establish a precedent encouraging all countries to respond to pathogenic outbreaks with transparency and accountability.

Although these steps may seem aggressive, particularly in the context of worsening relations between the United States and China, we have already lived through the consequences of the status quo. Twenty-eight million people are dead as a result of a totally avoidable pandemic. If we do not take tough action now, future pandemics will almost certainly be far worse.

Our children's safety shouldn't be a partisan issue. Fighting for answers about what went wrong with COVID-19 shouldn't be something we put off until the next pandemic is upon us. By holding the Chinese government accountable today, our leaders can save countless American and other lives tomorrow.

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Its Not Too Late To Hold China Accountable on COVID - Heritage.org

A. Measuring opinion-based affective polarization regarding COVID-19 vaccination using thermometer scores

We assessed opinion-based affective polarization regarding COVID-19 vaccination in a multistep process. To begin with, we asked respondents to indicate on an 11-point scale ranging from 0 complete rejection to 10 complete support how strongly they oppose or support COVID-19 vaccination (Mean (M)Sample FRA=6.83, (M)Sample GER=7.8, (M)Sample ITA=7.7, (M)Sample SPA=7.96, (M)Sample SWI=7.26, (M)Sample UK=8.14).

The left panel in Fig.2 shows the mean levels of support for COVID-19 vaccination across our six countries. Generally, support is very high with mean levels of 7 on the scale from 0 to 10. The lowest level of support is found in France and the highest in the UK and Spain. The violin plots in the right panel of Fig.1 again illustrate this finding as the distribution is skewed in favor of COVID-19 vaccination. However, the distribution shows that a consistent minority opposes COVID-19 vaccination in all six countries. That is, the issue has triggered the formation of two groups: one for and one against it.

Mean support for COVID-19 vaccination and its distribution.

In a next step, we applied the most widely used measurement approach for affective polarization, the feeling thermometer8,40, in which respondents are asked to rate their feelings about a specific subject on a temperature scale9,40. First, we dichotomized the variable on the position regarding COVID-19 vaccination and classified respondents who indicated a value from 0 to 4 as opponents of COVID-19 vaccination (anti-vaccination group) and those who indicated a value from 6 to 10 as supporters of COVID-19 vaccination (pro-vaccination group). We excluded respondents who indicated a value of 5 as they were neutral on the issue. Second, we asked respondents of the respective groups to rate their feelings toward a) supporters of COVID-19 vaccination and b) opponents of COVID-19 vaccination on a scale from 5 (very cold and negative) to+5 (very warm and positive). We transformed this scale to range from 0 to 10 and subsequently used the absolute difference between the two ratings to obtain a measure for affective polarization ((M)Sample FRA=5.1, (M)Sample GER=6.05, (M)Sample ITA=6.12, (M)Sample SPA=6.44, (M)Sample SWI=5.32, (M)Sample UK=6.03). The descriptive results are reported below using bar graphs for readability. Formal t-tests are reported in the supplementary material, section C, Tables 1214.

Figure3 shows the thermometer scores for the two groups separated by group membership (supporters vs. opponents) and country. The feelings toward COVID-19 vaccination supporters (left panel in Fig.3) show a clear pattern: Supporters feel very positive and warm toward other supporters ((M)Supp FRA=8.9, (M)Supp GER=9.18, (M)Supp ITA=8.96, (M)Supp SPA=8.93, (M)Supp SWI=8.93, (M)Supp UK=9.05). Conversely, opponents feel somewhat cold and negative toward supporters, with values below the neutral value of 5 ((M)Opp FRA=4.86, (M)Opp GER=4.43, (M)Opp ITA=4.17, (M)Opp SPA=4.79, (M)Opp SWI=4.65, (M)Opp UK=4.47). These values are statistically significant and different at the 95% level.

Thermometer ratings of feelings toward COVID-19 vaccination supporters and opponents by group and country.Notes: Figure3 shows the mean thermometer ratings of feelings toward vaccination supporters and opponents separated by group and country, with 95% confidence intervals. Reading example for France in the left panel: In France, vaccination opponents have an average thermometer rating of feelings toward vaccination supporters of 6.15, while vaccination supporters have an average thermometer rating of feelings toward vaccination supporters of 7.04 on a scale of 010. The difference is statistically significant.

Looking at the thermometer scores for COVID-19 vaccination opponents, we see a mirror image. Opponents feel relatively positive and warm toward other opponents ((M)Opp FRA=6.55, (M)Opp GER=6.73, (M)Opp ITA=6.77, (M)Opp SPA=5.78, (M)Opp SWI=6.85, (M)Opp UK=5.96). Yet, these positive in-group feelings are comparatively lower among opponents than among supporters. It seems that there is less group cohesion among opponents than among supporters of COVID-19 vaccination. Furthermore, supporters express very cold and negative feelings toward opponents, as expected ((M)Supp FRA=2.46, (M)Supp GER=2.07, (M)Supp ITA=2.27, (M)Supp SPA=1.76, (M)Supp SWI=2.73, (M)Supp UK=2.32). All differences between supporters and opponents are statistically significant at the 95% level.

Figure4 reveals the absolute difference between both thermometer ratings, separated by group and country. Supporters show a relatively high average difference in feelings toward the in-group and the out-group ((M)Supp FRA=6.63, (M)Supp GER=7.17, (M)Supp ITA=7.01, (M)Supp SPA=7.35, (M)Supp SWI=6.46, (M)Supp UK=6.86). Opponents also show a difference in feelings for their in- and out-group, but this difference is less pronounced ((M)Opp FRA=2.65, (M)Opp GER=2.95, (M)Opp ITA=3.18, (M)Opp SPA=2.93, (M)Opp SWI=2.87, (M)Opp UK=3.02). All differences in affective polarization are significant at the 95% level. The highest levels of affective polarization are found in Germany and Spain among supporters and in Italy and the United Kingdom among opponents. Both groups express affective polarization regarding COVID-19 vaccination, but it is stronger among the pro- than among the anti-vaccination group. As expected, affective polarization is asymmetric, implying that both in-group attachment and out-group dislike are stronger among the pro-vaccination group than among the anti-vaccination group.

Affective polarization of COVID-19 vaccination supporters and opponents.Notes: Figure4 shows the mean level of affective polarization (thermometer measure) by group and country, with 95% confidence intervals. Reading example: In France, vaccination opponents show an average affective polarization of 2.65 and vaccination supporters of 6.63 on a scale from 0 to 10. The difference is statistically significant.

To further evaluate our findings, we used a second common measure of affective polarization: character trait ratings14,17,40. Here, respondents from the pro-vaccination camp and the anti-vaccination camp (as coded above) are asked to rate various character traits of the twodifferent groups. Although trait ratings are a typical measure of affective polarization, they reflect more than just negative affect but also shed light on the perceived stereotypical appearance of a group9. In this vein, these trait ratings allow us to identify whether respondents assign negative or positive characteristics to their respective in-group and out-group. Research has shown that trait ratings and thermometer scores, although conceptually somewhat distinct, correlate fairly well with each other and show little systematic differences40. In our full sample, the affective polarization scores for both measures correlate at (r)Sample=0.62 (r)Sample FRA=0. 61, (r)Sample GER=0.64, (r)Sample ITA=0.67, (r)Sample SPA=0.57, (r)Sample SWI=0.59, (r)Sample UK=0.65).

In our study, we asked respondents to rate the extent to which two positive character traits (openness to compromise and critical thinking) and two negative character traits (selfishness and narrow-mindedness) apply to a) supporters of COVID-19 vaccination and b) opponents of COVID-19 vaccination on a scale from 1 (does not apply at all) to 5 (fully applies). In addition to the assigned values, we also calculated the absolute differences between the scores assigned to the in- and the out-group for each trait. Subsequently, we combined these differences into an additive score for affective polarization ((M)Sample FRA=1.72, (M)Sample GER=2.08, (M)Sample ITA=1.92, (M)Sample SPA=1.99, (M)Sample SWI=1.87, (M)Sample UK=2.01).

This alternative measure reveals a similar picture of affective polarization regarding COVID-19 vaccination as the feeling thermometer. Figure5 is analogous to Fig.3 and shows the character trait ratings for supporters and opponents of COVID-19 vaccination by group and country. For the sake of readability, we combine the two positive and negative traits each (see supplementary material, section D, Fig.1 for the individual character trait ratings). The upper panel of Fig.5 shows the ratings of the two negative traits combined. As we can see in the upper left panel, supporters do not believe that other supporters are selfish and narrow-minded ((M)Supp FRA=1.87, (M)Supp GER=1.77, (M)Supp ITA=2.15, (M)Supp SPA=2.16, (M)Supp SWI=2.00, (M)Supp UK=1.68). Conversely, opponents tend to assign these negative traits to supporters ((M)Opp FRA=2.63, (M)Opp GER=3.00, (M)Opp ITA=3.33, (M) Opp SPA=2.79, (M)Opp SWI=3.04, (M)Opp UK=2.81). The opposite picture emerges when we look at the upper right panel: Consistent with in-group favoritism, opponents do not believe that other opponents are selfish or narrow-minded ((M)Opp FRA=1.87, (M)Opp GER=1.94, (M)Opp ITA=2.08, (M)Opp SPA=2.49, (M)Opp SWI=1.98, (M)Opp UK=2.23). Supporters, however, believe that opponents are selfish and narrow-minded ((M)Supp FRA=3.83, (M)Supp GER=4.10, (M)Supp ITA=4.08, (M)Supp SPA=3.94, (M)Supp SWI=3.96, (M)Supp UK=3.91). All differences are significant at the 95% level.

Perceived character traits of COVID-19 vaccination supporters and opponents by group and country.Notes: Figure5 shows the mean perceived character traits for vaccination supporters and opponents separated by group and country, with 95% confidence intervals. For example, in the top left-hand panel for France: In France, vaccination opponents perceive vaccination supporters to have negative traits with an average of 2.63 while vaccination supporters perceive vaccination supporters to have negative traits with an average of 1.87 on a scale of 15. The difference is statistically significant.

The lower part of Fig.5 shows the ratings of the positive traits combined. Here, an analogous but less consistent trend is observed compared to the ratings of the negative traits. Supporters assign positive traits to their in-group ((M)Supp FRA=2.99, (M)Supp GER=3.64, (M)Supp ITA=3.45, (M)Supp SPA=3.69, (M)Supp SWI=3.56, (M)Supp UK=3.79). Conversely, opponents do not ascribe these traits to supporters ((M)Opp FRA=2.61, (M)Opp GER=2.48, (M)Opp ITA=2.83, (M)Opp SPA=2.85, (M)Opp SWI=2.49, (M)Opp UK=2.78). All differences between supporters and opponents are significant at the 95% level.

Opponents see themselves as more open to compromise and able to think critically ((M)Opp FRA=2.80, (M)Opp GER=3.48, (M)Opp ITA=3.03, (M)Opp SPA=3.14, (M)Opp SWI=3.27, (M)Opp UK=2.86). Yet, supporters do not think that these positive traits apply to opponents ((M)Supp FRA=2.78, (M)Supp GER=2.21, (M)Supp ITA=2.59, (M)Supp SPA=2.50, (M)Supp SWI=2.49, (M)Supp UK=2.27). All differences are significant at the 95% level, except those for France.

Although less pronounced, Fig.5 provides further evidence that supporters and opponents of COVID-19 vaccination tend to view their in-group positively and their out-group negatively. Figure6, which shows the absolute difference in character trait ratings by group and country, corroborates these observations. While both groups show a difference in ascribed character traits toward the in-group and the out-group, the average difference is again slightly but statistically significantly (at the 95% level) greater among vaccination supporters ((M)Supp FRA=2.04, (M)Supp GER=2.31, (M)Supp ITA=2.09, (M)Supp SPA=2.18, (M)Supp SWI=2.03, (M)Supp UK=2.24) than among vaccination opponents ((M)Opp FRA=1.25, (M)Opp GER=1.49, (M)Opp ITA=1.51, (M)Opp SPA=1.23, (M)Opp SWI=1.61, (M)Opp UK=1.22).

Affective polarization among COVID-19 vaccination supporters and opponents.Notes: Figure6 shows the mean level of affective polarization (according to the character trait ratings) by group and country, with 95% confidence intervals. Reading example: In France, vaccination opponents have an average affective polarization of 1.25, while vaccination supporters have an affective polarization of 2.04 on a scale from 1 to 5. The difference is statistically significant.

Overall, our data suggest a divide around peoples opinions on COVID-19 vaccination. Supporters and opponents dislike each other and tend to attribute positive traits to their in-group and negative traits to the respective out-group. Thus, our data indicates the presence of opinion-based affective polarization regarding COVID-19 vaccination in six European democracies in early 2022. Importantly, however, this affective polarization is asymmetric, as the pro-vaccination group tends to be more polarized than the anti-vaccination group. Naturally, this finding raises the question of potential correlates of this form of polarization. As a first step in this direction, exploratory analyses reported in the supplementary material, section E, Figs. 24 show that older age, lower social trust, higher levels of conscientiousness, and a general support for COVID-19 vaccination are associated with higher levels of opinion-based affective polarization regarding COVID-19 vaccination.

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Asymmetric affective polarization regarding COVID-19 vaccination in six European countries - Nature.com