As more and more countries ease Covid restrictions and prepare to “live with the virus,” experts warn Covid-19 will remain a permanent fixture in our lives and could still cause widespread and serious disease, possibly even giving rise to another coronavirus pandemic in the future.
Endemicity “is a pattern, not an intrinsic trait of a virus,” Dr. Aris Katzourakis, an evolutionary virologist at the University of Oxford, told Forbes, and it’s possible endemic Covid could become pandemic again.
Worrisome mutations in “endemic strains can certainly seed new” outbreaks and potentially new pandemics, he explains.
Animals could be a potential source of these new coronaviruses with “pandemic potential,” Dr. Elizabeth Halloran, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, told Forbes, pointing to the family of influenza viruses able to “recombine in other animal hosts” and then spread between humans.
The potential for endemic Covid to seed new pandemics adds to the experts who overwhelmingly say it is premature to treat Covid as an endemic disease at the moment—which broadly means a stable and predictable number of infections—and worry the word is being mistakenly or misleadingly used to paint an overly optimistic picture of what life after the pandemic might look like.
“There is a misconception that endemicity is just a natural endpoint… that the disease will, on its own, become a minimal health burden,” Katzourakis says.
The virus will still need to be carefully managed to mitigate its impact on public health and Dr. John Swartzberg, an infectious disease expert at the University of California at Berkeley, told Forbes the term endemic “says nothing about how much disease [there is] or how severe the disease may be.”
Endemic infectious diseases can become epidemic and pandemic and vice versa,” says Swartzberg.
What We Don’t Know
How likely another Covid pandemic is. A lot remains unknown about the ongoing Covid-19 pandemic and the coronavirus behind it. While most scientists believe there is more evidence supporting the idea the coronavirus spread from animals into humans in China, we still don’t know crucial details about the virus’ origins and scientists are unsure where the fast-spreading omicron variant—which has a constellation of unusual mutations not present in other variants—came from and how it was able to emerge unnoticed. As Halloran notes, animal reservoirs can play important roles in the evolution of viruses—the coronavirus has been found in a wide array of species including mink, domestic cats and dogs, hamsters and deer—and little is known about how serious this might be or the implications it could have in managing the virus. Vaccines will also play a key role in reducing the risk of a future Covid pandemic, Swartzberg said. “Vaccinating the world’s population will reduce the chance of a new variant occurring… [which]
Though a lot of uncertainties remain, Swartzberg told Forbes “it is not uncommon for infectious diseases that are contagious to shift back and forth between endemic, epidemic, and pandemic.”
Infectious diseases affecting humans rarely go away for good, particularly once they are established. The drivers of past pandemics like cholera, plague—which caused the Black Death—and various strains of influenza are still around and infecting people today, as are other pathogens like Ebola virus, polio, malaria and HIV, which is considered a pandemic by some experts (the World Health Organization calls HIV a “global epidemic”). Just one human disease has been successfully eradicated as the result of deliberate effort: smallpox. It is “incredibly unlikely” humans will be able to eradicate Covid, Katzourakis told Forbes. Halloran told Forbes many working in the field have known eradicating Covid would be “impossible” for years. Swartzberg concurred and said eliminating the disease—effectively removing it from a specific area, like with polio in the U.S.—is “also not now feasible.”
Endemic Covid does not mean the disease will be infrequent or mild. Many of the world’s biggest killers are endemic diseases, including malaria and tuberculosis. Tuberculosis kills around 1.5 million people around the world every year, according to the WHO, and around 630,000 people die from malaria.
Rare Cases of Monkeypox Diagnosed in Britain | Health | thesuburban.com – The Suburban Newspaper
TUESDAY, May 17, 2022 (HealthDay News) — Four men in England have been infected with a “rare and unusual” monkeypox virus.
Investigators from the U.K. Health Security Agency are investigating the cases and whether there is any connection between the men, according to the Associated Press. None of the individuals had traveled to the African countries where the virus is endemic. Three of the men are in London, and one is in Northeast England.
Three earlier cases were announced last week. In those cases, two of the patients lived in the same household. The third person had previously traveled to Nigeria, one of the countries where the virus is endemic in animals. Most people who get monkeypox recover quickly, within several weeks. The virus has symptoms that include fever, muscle ache, chills, and fatigue. A rash similar to that found in chickenpox and smallpox can form on the face and genitals in more severe cases.
The latest four cases all happen to be in men who identify as gay, bisexual, or men who have sex with men. However, monkeypox does not easily spread between people, and it is not known to be transmitted sexually. In Western and Central Africa, the virus is typically spread by touching or being bitten by an infected wild animal. However, it could be spread among people with extremely close contact, the British health officials said.
“The evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact,” said Susan Hopkins, M.D., chief medical advisor for the U.K. Health Security Agency, the AP reported. “We are particularly urging men who are gay or bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay.”
Public health officials consider the risk to the general population to be low. They are working with hospitals and international partners to determine if there is a similar rise in cases in other places. This includes tracing people who had contacts with the monkeypox cases, including airline passengers, the AP said. Doctors who see patients with unexplained rashes should seek advice from a specialist, public health officials said.
Long COVID: Half of patients hospitalised have at least one symptom two years on – Australian Hospital + Healthcare Bulletin
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.
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
Image credit: ©stock.adobe.com/au/ink drop
2SLGBTQ+ lobby group head speaks on the trauma of conversion therapy
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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