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Life After the Covid Pandemic | FlaglerLive – FlaglerLive.com

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By Lawrence O. Gostin

After 2 years of a seemingly relentless pandemic that has upended work, education, and social interactions, the questions many are asking are when will we get back to normal and what will life be like after the cOVID-19 pandemic? In truth, science cannot fully predict what SARS-CoV-2 variants will arise and the trajectory of the pandemic. Yet, history and informed scientific observations provide a guide to how—and when—society will return to prepandemic patterns of behavior. There will not be a single moment when social life suddenly goes back to normal. Instead, gradually, over time, most people will view cOVID-19 as a background risk and abandon the trappings of pandemic caution.

The Great Influenza Pandemic of 1918 offers a historical guide to transitioning from a pandemic to an endemic infection. That pandemic began to subside after an estimated 500 million people—one-third of the world’s population—became infected, conferring high population immunity. (Approximately 50 million died worldwide, including 675 000 in the US.) The virus also mutated and became less pathogenic. Influenza H1N1 eventually reached an equilibrium, spreading among pockets of susceptible individuals without taking the lives of most.

SARS-CoV-2 may be following a similar trajectory. An estimated 94% of people in the US now have at least some vaccine- or disease-induced immunity against cOVID-19. The highly contagious Omicron variant may speed transition to an endemic phase, with more than 100 million US residents becoming infected. Omicron also appears less pathogenic than previous variants. Thus far, booster doses of messenger RNA cOVID-19 vaccines are conferring robust protection, with cOVID-19 hospitalizations 16 times higher for unvaccinated adults than for fully vaccinated persons in December 2021.

cOVID-19 will not be eliminated, and certainly not eradicated, in the foreseeable future. Intermittent surges will occur, driven by viral evolution and colder weather keeping individuals indoors. Ongoing vaccination will be needed because of waning immunity and viral mutations. cOVID-19 will also require surveillance similar to the Global Influenza Surveillance and Response System, a global platform for monitoring influenza epidemiology and disease that is used in formulating seasonal influenza vaccines.

A Cautionary Tale

There are major caveats to when the pandemic will wane, including the unknown duration of vaccine- or disease-induced immunity. Billions of people worldwide still are unvaccinated, facilitating rapid viral mutations. In 1920, a variant of influenza emerged that caused an outbreak so severe it could have been considered another pandemic wave. And a pandemic H1N1 strain emerged in 2009.

Although the Omicron variant appears to cause milder disease, future mutations may not be less severe. Viral evolution is not linear as many assume, with various strains likely to emerge. Vaccinating the world’s population will remain a major priority, along with effective cOVID-19 therapeutics.

Scientific uncertainty also exists about the causes, and frequency, of long cOVID, or post-cOVID conditions, in which chronic symptoms persist beyond the infection’s initial phase. Reinfections are now common, raising concerns about chronic disease. Research into risk factors and clinical management of long cOVID will be important.

Living With cOVID-19

Endemic is an epidemiologic term, whereby overall infection rates stabilize. The US Centers for Disease Control and Prevention (CDC) defines endemic as “the constant presence or usual prevalence of a disease or infectious agent in a population within a geographic area.” Endemicity is also determined by when countries decide to move from emergency response toward longer-term control programs. Several high-income countries are already developing postpandemic plans. During endemic phases, most people return to prepandemic patterns of behavior, depending on personal risk tolerance.

cOVID-19 management will likely resemble influenza-like illness surveillance. In the US influenza surveillance system—which itself requires modernization as well as improvement of data systems—the CDC partners with states, laboratories, and hospitals to detect influenza outbreaks, viral strains, and disease severity. cOVID-19 management will require rapid identification of case clusters and variants. Outbreaks may trigger testing, contact tracing, and isolation. Isolation duration might be reduced based on case and hospitalization rates as well as social and economic needs. South Africa, for example, recently announced it will not require isolation of asymptomatic SARS-CoV-2–positive cases.

Periodic cOVID-19 vaccinations, modified as new variants circulate, will remain a major control strategy. Vaccine mandates may resemble those for influenza, covering high-risk settings such as hospitals and nursing facilities. Proof of vaccination for dining, entertainment, shopping, and travel may eventually be retracted. It is unclear whether, or when, the CDC will add cOVID-19 to its recommended list of school vaccinations. Currently, only California and Louisiana require cOVID-19 vaccinations for school entry, although some localities mandate them for activities such as sports.

Mandates regarding the wearing of masks and social distancing may soon be relaxed, depending again on levels of risk. cOVID-19 mitigation strategies could be rapidly reimplemented to counter outbreaks, and then retracted when the threat subsides—requiring effective communication. Absent mandates, pandemic behaviors such as wearing masks may continue for vulnerable or risk-adverse individuals, especially in crowded places such as movie theaters and concert venues.

The public may no longer accept the most severe cOVID-19 strategies such as school closures, lockdowns, and travel bans. Denmark recently removed all cOVID-19 restrictions and Colorado’s governor declared “the emergency is over.” Highly restrictive measures pose significant social, educational, and economic costs.

A Return to Socialization

cOVID-19 risk mitigation resulted in profound social isolation and loneliness, evidenced by increased anxiety, depression, substance abuse, and suicidal thoughts. The public yearns for simple joys, such as embracing family members or friends, dining out, or seeing a smile unhidden by a protective mask. Humans are intrinsically social beings. It was not long after the 1918 pandemic when the US resumed intense socialization, with the Roaring 20s bringing people together in crowded dance halls, movie palaces, and speakeasies.

Some pandemic behaviors may continue, at least in part, if there is social utility. Hybrid working (remote and in-person) could outlast the pandemic, offering many employees a better balance between family and career and more choice in where to live. Air travel may also remain stagnant for the immediate future. By December 2021, international travel was 72% below 2019 levels, and it may not recover until 2024.

Eroding Public Health

It seems intuitive that a pandemic would increase reliance in, and trust of, public health agencies. That intuition appears mistaken. Trust in public health agencies declined significantly during the pandemic in the context of intense politicization over mitigation measures and confusing CDC guidance. States have enacted more than 100 new laws limiting health emergency powers, banning mask or vaccination mandates, and limiting governors’ emergency powers. The judiciary also curtailed public health powers, including the US Supreme Court’s decision to block the Occupational Safety and Health Administration’s vaccine-or-test mandate. The Supreme Court also overturned social distancing orders that placed limits on religious services.

The cOVID-19 pandemic has challenged society to reexamine the balance between personal freedom and public health in a postpandemic era. It may be too soon to shift to an endemic phase while Omicron-related hospitalizations remain high and effective therapeutics are scarce. The US has far higher death rates and lower vaccination rates than peer nations. But a gradual transition to normal will likely occur in the coming months, bringing back social activities that individuals have dearly missed. The ability of public health agencies to help society return safely to a new normal will remain critically important.

larry gostin

larry gostinLawrence O. Gostin is University Professor, Georgetown University’s highest academic rank conferred by the University President. He directs the O’Neill Institute for National and Global Health Law and is the Founding O’Neill Chair in Global Health Law. He served as Associate Dean for Research at Georgetown Law from 2004 to 2008. He is Professor of Medicine at Georgetown University and Professor of Public Health at the Johns Hopkins University. He is also the Director of the World Health Organization Collaborating Center on National and Global Health Law. This article originally appeared at the JAMA Health Forum.

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Long COVID: Half of patients hospitalised have at least one symptom two years on – Australian Hospital + Healthcare Bulletin

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Long COVID: Half of patients hospitalised have at least one symptom two years on

Two years on, half of a group of patients hospitalised with COVID-19 in Wuhan, China, still have at least one lingering symptom, according to a study published in The Lancet Respiratory Medicine. The study followed 1192 participants in Wuhan infected with SARS-CoV-2 during the first phase of the pandemic in 2020.

While physical and mental health generally improved over time, the study found that COVID-19 patients still tend to have poorer health and quality of life than the general population. This is especially the case for participants with long COVID, who typically still have at least one symptom including fatigue, shortness of breath and sleep difficulties two years after initially falling ill.1

The long-term health impacts of COVID-19 have remained largely unknown, as the longest follow-up studies to date have spanned around one year.2 The lack of pre-COVID-19 health status baselines and comparisons with the general population in most studies has also made it difficult to determine how well patients with COVID-19 have recovered.

Lead author Professor Bin Cao, of the China-Japan Friendship Hospital, China, said, “Our findings indicate that for a certain proportion of hospitalised COVID-19 survivors, while they may have cleared the initial infection, more than two years is needed to recover fully from COVID-19. Ongoing follow-up of COVID-19 survivors, particularly those with symptoms of long COVID, is essential to understand the longer course of the illness, as is further exploration of the benefits of rehabilitation programs for recovery. There is a clear need to provide continued support to a significant proportion of people who’ve had COVID-19, and to understand how vaccines, emerging treatments and variants affect long-term health outcomes.”3

The authors of the new study sought to analyse the long-term health outcomes of hospitalised COVID-19 survivors, as well as specific health impacts of long COVID. They evaluated the health of 1192 participants with acute COVID-19 treated at Jin Yin-tan Hospital in Wuhan, China, between 7 January and 29 May 2020, at six months, 12 months and two years.

Assessments involved a six-minute walking test, laboratory tests and questionnaires on symptoms, mental health, health-related quality of life, if they had returned to work and healthcare use after discharge. The negative effects of long COVID on quality of life, exercise capacity, mental health and healthcare use were determined by comparing participants with and without long COVID symptoms. Health outcomes at two years were determined using an age-, sex- and comorbidities-matched control group of people in the general population with no history of COVID-19 infection.

Two years after initially falling ill, patients with COVID-19 are generally in poorer health than the general population, with 31% reporting fatigue or muscle weakness and 31% reporting sleep difficulties. The proportion of non-COVID-19 participants reporting these symptoms was 5% and 14%, respectively.

COVID-19 patients were also more likely to report a number of other symptoms including joint pain, palpitations, dizziness and headaches. In quality of life questionnaires, COVID-19 patients also more often reported pain or discomfort (23%) and anxiety or depression (12%) than non-COVID-19 participants (5% and 5%, respectively).

Around half of study participants had symptoms of long COVID at two years, and reported lower quality of life than those without long COVID. In mental health questionnaires, 35% reported pain or discomfort and 19% reported anxiety or depression. The proportion of COVID-19 patients without long COVID reporting these symptoms was 10% and 4% at two years, respectively. Long COVID participants also more often reported problems with their mobility (5%) or activity levels (4%) than those without long COVID (1% and 2%, respectively).

The authors acknowledged limitations to their study, such as moderate response rate; slightly increased proportion of participants who received oxygen; it was a single centre study from early in the pandemic.

References:

1. – National Institute for Health and Care Excellence – Scottish Intercollegiate Guidelines Network – Royal College of General Practitioners. COVID-19 rapid guideline: managing the long-term effects of COVID-19. https://www.nice.org.uk/guidance/ng188
2. – Soriano – JB Murthy – S Marshall – JC Relan – P Diaz JV – on behalf of the WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021; 22: e102-e107
3. – Huang L – Yao Q – Gu X – et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021; 398: 747-758

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2SLGBTQ+ lobby group head speaks on the trauma of conversion therapy

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Although conversion therapy has now been outlawed in Canada, many are still victims causing them to go through a lot of trauma in the process.

According to Jordan Sullivan, Project Coordinator of Conversion Therapy Survivors Support and Survivors of Sexual Orientation and Gender Identity and Expression Change Efforts (SOGIECE), survivors of conversion therapy identify the need for a variety of supports including education and increased awareness about SOGIECE and conversion practices.

Also needed is access to affirming therapists experienced with SOGIECE, trauma (including religious trauma), safe spaces and networks, and access to affirming healthcare practitioners who are aware of conversion therapy or SOGIECE and equipped to support survivors.

“In January of 2021 when I was asked to be the project coordinator, I was hesitant because I wasn’t sure that my experience could be classified as SOGIECE or conversion therapy. I never attended a formalized conversion therapy program or camp run by a religious organization. Healthcare practitioners misdiagnosed me or refused me access to care.

In reality, I spent 27 years internalizing conversion therapy practices through prayer, the study of religious texts, disassociation from my body, and suppression or denial of my sexual and gender identities. I spent six years in counselling and change attempts using conversion therapy practices. I came out as a lesbian at age 33, and as a Trans man at age 51. I am now 61 and Queerly Heterosexual, but I spent decades of my life hiding in shame and fear and struggled with suicidal ideation until my mid-30s.

At times I wanted to crawl away and hide, be distracted by anything that silenced the emptiness, the pain, the wounds deep inside. I realized that in some ways, I am still more comfortable in shame, silence, and disassociation, than in any other way of being and living, but I was also filled with wonderment at the resiliency and courage of every single one of the participants.

However, many of us did not survive, choosing to end the pain and shame through suicide. Many of us are still victims in one way or another, still silenced by the shame, still afraid of being seen as we are. Still, many of us are survivors, and while it has not been an easy road, many of us are thrivers too,” said Jordan.

In addition, Jordan said conversion practices and programs are not easily defined or identified, and often capture only a fragment of pressures and messages that could be considered SOGIECE.

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Some in B.C. cross U.S. border for their next COVID-19 vaccine – Global News

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Global News Hour at 6 BC

There is evidence of the lengths some British Columbians will go to get a second booster dose of the COVID-19 vaccine — crossing the border to Point Roberts, WA for a shot. The movement comes thanks to the different approach to the fourth shot south of the border. Catherine Urquhart reports.

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