Emergence of a Deadly Coronavirus

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It’s flaring back up in China.
https://www.reuters.com/business/health ... 022-03-14/

China has put several of its industrial hubs under lockdown to confront its worst coronavirus outbreak in two years, restricting the movement of tens of millions of residents in measures that threaten to disrupt global supply chains.

China, one of the few countries in the world to maintain a “zero-covid” strategy, is battling a surge of cases in at least 19 provinces that is testing the government’s commitment to minimizing infections as much as possible.

The surge — and accompanying lockdowns that could severely harm the recovering economy — may force the country to rethink its approach to the virus as much of the world begins to ease pandemic restrictions. Hong Kong’s key Hang Seng index plummeted by 5 percent on Monday over covid worries.

The National Health Commission on Monday reported 2,125 new locally transmitted coronavirus cases across the country. Since last week, cities have ground to a halt to stop the outbreak, which comes as the country enters a critical year for transitions in the Chinese leadership, with President Xi Jinping set to take a controversial third term.

In Shenzhen, officials ordered the city’s more than 17 million people to stay at home starting on Monday through March 20, after just 150 new cases were reported over the weekend.

Authorities in the northeastern province of Jilin on Monday barred its 24 million residents from leaving, marking the first time officials have sealed an entire province since January 2020 when Hubei was put under lockdown.

Health officials said hospitals were overrun because of the rapid increase in cases since Friday. The province recorded more than 4,605 coronavirus cases on Saturday, while 3,868 residents have tested positive in preliminary tests but were not yet included in the official tally, officials said.

All middle and elementary schools in Jilin must revert to online classes, while students and employees at universities must remain on campus, officials said. Authorities are building four temporary hospitals to house more than 10,000 coronavirus patients.

In the locked-down provincial capital of Changchun, Toyota also halted operations at its plant on Monday.

In Shanghai, the country’s most populous city with more than 24 million people, authorities have sealed off housing compounds and halted intercity bus service while requiring all new arrivals to have a negative coronavirus test to enter. Residents have been told not to leave unless absolutely necessary.

In Qingdao in Shandong province, the Laixi district of more than 700,000 people was put under lockdown after officials found more than 1,600 locally transmitted cases since March 4 through mass testing. In Hebei province, the district of Guangyang, home to 500,000 people, has also been put under lockdown.

In neighboring Hong Kong, authorities are trying to contain an outbreak that has killed almost 4,000 people. In Shenzhen’s Futian district, which borders Hong Kong, authorities inspected homes, checking in closets and under beds for possible covid cases, including residents illegally crossing over from Hong Kong, according to the Caixin media outlet.

Several officials have been punished for the latest outbreak, underlining the political importance of containing the virus.

Zeng Guang, an adviser to China’s Center for Disease Control and Prevention, said in a post on the microblog Weibo last month that the government was developing a road map to “coexistence” with the virus. His post was later removed.

Just as the U.S. has finally turned the corner on a wave of COVID-19 cases caused by the omicron variant, multiple countries in Europe are showing an increase in infections – fueling concerns about the possibility of another global surge.

The United Kingdom, the Netherlands, Germany, Switzerland and Italy were among those that saw an upswing in cases this past week, according to data from Johns Hopkins University.

Germany saw a spike in cases from a low of 1,570 cases per million people on March 2, to 2,330 cases per million people as of March 12, and cases in the Netherlands are up from a recent low of 1,956 cases per million people Feb. 27 up to 3,955 cases per million people March 12, the data shows.

Among the countries whose data has charted an increased in cases, some have also seen a rise in hospitalizations, including Ireland, the United Kingdom and the Netherlands.

The possibility of a new variant or a spike in cases always exists given the nature of viruses, said Ogbonnaya Omenka, an assistant professor and director of diversity at the Butler University College of Pharmacy and Health Science.

Another factor at play in the rise of cases and a possible next wave: human behavior surrounding virus prevention measures. Omenka said human activities are among the factors that "can influence how things unfold."

England, Spain and France are among European countries that recently announced a shift in pandemic strategy: treating the virus as a part of daily life without full shutdowns.

The possible European surge also comes alongside conflict in Ukraine after the Russian invasion, leading to rising concerns about a public health crisis in the region sparked by densely crowded shelters and forced travel across borders. The WHO said earlier this month that the conflict may cause a surge in infections, straining scarce resources and contributing to more suffering and death.

Should I say it?

Older COVID-19 hospital patients on antidepressants, anti-anxiety drugs and other types of psychotropic medications were much more likely to develop dementia than those who were not, a newly released study by Northwell Health researchers found.

The study found that 24% of patients 65 and older who were using these medications before contracting the coronavirus developed dementia, compared with 9% of patients who were not using psychotropic drugs, which are medications that affect the mind, emotions and behavior.

Previous studies have linked COVID-19 and, separately, psychiatric conditions to increased likelihood of dementia, but this is the first that associates psychotropic drugs in older COVID-19 patients to dementia, said Dr. Liron Sinvani, lead author of the study and assistant professor in the Institute of Health System Science at the Feinstein Institutes for Medical Research, which is Northwell’s Manhasset-based research center.

Sinvani warned, "We cannot show causality. We can’t say the psychotropic medications caused the dementia. We know there’s an association."

More research is needed, said Sinvani, who led a team of Feinstein researchers.

But, she said, the "interplay" of COVID-19, psychiatric conditions and the medications may have "hastened" the development of dementia.

"Whereas these patients may have developed dementia in 20 or 30 years, all of a sudden now they’re developing it very quickly after COVID," she said Saturday in a phone interview.

The peer-reviewed study, published Friday in the medical journal Frontiers in Medicine, was of 1,755 people ages 65 and older who were hospitalized with COVID-19 between March 1 and April 20, 2020. The large majority were hospitalized on Long Island, Sinvani said.

A quarter had used at least one psychotropic drug before their COVID-19 diagnosis. More than half of those using psychotropic drugs were on antidepressants. Others were on antipsychotics, mood stabilizers, anticonvulsants, Parkinson’s disease medications or benzodiazepines, which can be used to treat anxiety, insomnia and muscle spasms and reduce seizures.

It’s unclear to what extent the psychiatric or neurological condition for which people were taking the drugs may have helped lead to dementia, Sinvani said. Researchers compared some people with the conditions who were using the psychotropic medications with those who were not, and those using the drugs were about three times more likely to develop dementia, she said. But that was a much smaller group of patients, not enough to draw definitive conclusions, she said.

Typically, about 1% or 2% of adults 65 and older develop dementia every year, Sinvani said. Research has found that number increases to nearly 3% for older adults with COVID-19, she said.

This study focused on hospitalized patients with more serious cases of COVID-19, which is likely why the rates of dementia were significantly higher, even in patients not on psychotropic drugs, Sinvani said.

Severe COVID-19 is more likely to have an impact on the brain, said Dr. Yun Freudenberg-Hua, a study co-author and associate professor of psychiatry and molecular medicine at the Zucker School of Medicine at Hofstra/Northwell.

"People having mild symptoms may not have this higher risk," she said.

Sinvani cautioned against avoiding psychotropic medications because of the study results. All drugs have potential negative side effects, she said.

Although alternatives to medication should always be considered, "If an older adult truly has depression or depressive symptoms and this medication improves their quality of life and their lifestyle, then yes, they need to be on this medication, because at this point, we don’t know enough to say they shouldn’t," Sinvani said.

Freudenberg-Hua said doctors with older adult patients who had severe COVID-19 and used psychotropic medications should be especially alert for signs of cognitive decline.

Psychotropic medicines are sometimes used off-label to manage the symptoms of dementia, but Sinvani said that, even before COVID-19, they should have only been used as a last resort, after other methods failed.

One of the enduring mysteries of the Covid-19 pandemic, a global health crisis that has led to over 6 million fatalities, is that children have been spared by the virus — for the most part — and have not experienced anywhere near the severity of illness that adults have.

When Covid emerged in late 2019 and began to spread around the world, scientists scrambled to understand the virus and how to combat it, with hospitals trying different techniques to save the worst-off Covid patients in intensive care units.

Scientists are still somewhat baffled as to why children are not badly affected by Covid, although studies are slowly shedding light on how, and why, children’s responses to Covid differ from those among adults.

“A number of theories have been suggested, including a more effective innate immune response, less risk of immune over-reaction as occurs in severe Covid, fewer underlying co-morbidities and possibly fewer ACE-2 receptors in the upper respiratory epithelium — the receptor to which SARS-CoV-2 [Covid] binds,” Dr. Andrew Freedman, an academic in infectious diseases at the U.K.’s Cardiff University Medical School, told CNBC in emailed comments, adding that nonetheless the phenomenon was not “fully understood.”

He noted more research will be required before we have a definitive answer but a body of evidence has already emerged showing that Covid poses a much smaller risk to kids, and why that might be.

There have been several recent studies looking at the difference between adults’ immune response to Covid, and children’s, and these have found fundamental differences between the two with the latter having a more robust and “innate” immune response.

Research carried out by the Wellcome Sanger Institute and University College London, and published in the Nature journal in December, found a stronger “innate” immune response in the airways of children, characterized by the rapid deployment of interferons — which are released in the presence of viral or bacterial threats and help to restrict viral replication early on — UCL said.

Meanwhile in adults, the researchers saw a less rapid immune response which meant the virus “was better able to invade other parts of the body where the infection was harder to control.”

Another advantage children have is their greater exposure to viruses, particularly during term time when viruses are able to spread easily among children at school. The most common virus children get are innocuous colds and these are commonly caused by several types of virus including rhinoviruses (the most common cause of the common cold) as well as respiratory syncytial virus (RSV) and coronaviruses.

Coronaviruses are a family of viruses that usually cause mild to moderate upper-respiratory tract illnesses in humans but several, including Covid-19 and SARS and MERS, have emerged as global health threats.

Ralf Reintjes, professor of epidemiology at the Hamburg University of Applied Sciences, explained to CNBC that children’s immune systems have a number of advantages when it comes to fighting infections.

“First of all, they’re younger so their immune systems are challenged a lot anyway ... when they’re one year or two years old until up to 10 or 12 years old, they they go through lots of infections,” Reintjes told CNBC on Monday.

“They get lots of contact with other coronaviruses at this time so their immune system is in training anyway, and is very young and fit,” he said, adding that when children’s immune systems are then confronted with Covid-19, having had a lot of practice fighting off various infections and coronaviruses, they have much stronger immune response than adults who tend to get less of those kinds of infections.

The phenomenon is not unique to Covid-19 either, Dr Andrew Freedman said, with children often able to fight off other kinds of infection better than adults, albeit not in all case

Research published in late 2021 looking into the overall risk posed by the virus to children found that this was very low for the absolute majority of children and young people aged below 18.

The study, carried out by researchers from several British universities, studied deaths among children and young people in England from March 2020 to February 2021 — the first year of the pandemic — differentiating between those who died of Covid and those who died of an alternative cause but had coincidentally tested positive for the disease.

It found that of the 3,105 children and young people who died from all causes during the first pandemic year in England, 25 had died of Covid, corresponding to an overall mortality rate of 2 deaths per million children in England.

Of the 25 children that sadly died of Covid, 19 had chronic underlying health conditions, including some children with multiple comorbidities and life-limiting conditions.

While the other six children that died appeared to have no underlying health conditions, researchers cautioned there may have been an unidentified comorbidity or undiagnosed genetic predisposition to severe disease with Covid infection.

While the study found that the overall risk to children was “extremely low” it did note that those above the age of 10, of Asian and Black ethnicity, and those with comorbidities (neurological conditions were the commonest comorbidity) were over-represented in the mortality data compared to other children.

The study concluded that Covid “is very rarely fatal” even among those children with underlying comorbidities. Indeed, within the year that was studied, an estimated 469,982 children in England had Covid, meaning that a child’s chance of surviving an infection was found to be 99.995%.

Pediatric Covid case and mortality data from the U.S. show similarly low risks to children.

The U.S. Centers for Disease Control and Prevention reported last week that a total of 966,575 deaths had been caused by Covid in the U.S. during the pandemic. Between 2020 and 2022 there were 921 deaths among 0-17 year olds that were caused by Covid, out of 73,508 deaths in this age group that were caused by all causes.

Children continue to represent around a fifth of all Covid cases; for the week ending March 17, children accounted for 18.3% of reported weekly cases. Children under the age of 18 make up 22.2% of the U.S. population.

Live long enough in a pandemic and you will see the entire narrative landscape shift, even flip, sometimes more than once.

As recently as a month ago, Americans of a certain cast of mind could have still looked to China — and indeed all of East Asia, Southeast Asia, and Oceania — with some plausible pandemic envy. Those early lockdowns in Wuhan were brutal, yes; some of the surveillance testing, contact tracing, and quarantine measures imposed in places like South Korea and Singapore were very restrictive, true; closed borders and reentry policies in Australia and New Zealand went further than those of any country in Europe or the Americas; and while the Sinovac vaccines weren’t as effective as those made by Moderna or Pfizer, the success of true “zero COVID” policies through the region meant that in many places, shots got into arms without anything like a major COVID surge ever having taken place.

All of that seemed like an unimaginable triumph. Now, after a brutal Omicron wave punishing its largely unvaccinated elderly, Hong Kong has a cumulative death toll approaching Canada’s. (In February, it was 25 times lower.) Omicron spikes elsewhere in the region — in South Korea, in Singapore — have proved less threatening, given higher rates of vaccination among the elderly. But panicked lockdowns imposed again in China suggest that the country’s leadership, at least, believes an enormous amount of pandemic vulnerability remains — enough to justify a total shutdown of Shenzhen, a city of almost 20 million and such a critical economic and manufacturing hub that American observers immediately started raising their expectations for inflation.

Narrative turnabouts are not new with Omicron. Some are familiar: The disease wasn’t spread through the air, then it was; masks weren’t worth it, early on, then became not just essential but badges of personal vigilance, then only useful if they were KN95s. Some narrative shifts were more obscure: Omicron was said to be “mild,” though it is roughly as severe as the original strain in immunologically naïve populations. Others have been somewhat memory-holed, as when much of the public-health Establishment spent the fall of 2020 suggesting that herd immunity would be reached when 60 or 70 percent of the country was infected or vaccinated, a threshold we have now long since surpassed with nothing like herd immunity in sight; or when it spent the summer of 2021 insisting that breakthrough cases were exceedingly rare and breakthrough deaths essentially nonexistent, when in fact probably a quarter of all American deaths since Delta have been among the vaccinated. Some reversals were technical, as when rapid tests were first considered imprecise, became indispensable during Omicron, then had their efficacy in preventing transmission called into question. Some had to do with policy: School closures were once part of a first-response wave of restrictions, but a growing understanding of the relatively low risk to kids and real costs of keeping them home has meant schools are now broadly viewed as among the most important places to remain open. And some had to do with personal behavior, as when many of the same people who spent 2020 yelling at Thanksgiving travelers and arguing that responsibility to protect others should dominate one’s personal behavior spent 2021 reasoning that vaccines had absolved us all of that responsibility. Many of those who once reacted in horror to “Let it rip” proponents began wondering if anything at all could have stopped the early spread in its tracks.

Our experience of the pandemic has been littered with bad-faith argumentation and instigation, but most of these narrative reversals are not that, or even signs of what Harvard’s William Hanage has called the “motivated reasoning” of the pandemic. One narrative replacing another is one description of the scientific method, and among the many astonishing features of this pandemic is how quickly science was able to process and respond — perhaps without adequate speed, but at least fast enough for vaccines to be designed within two days, manufactured within two months, and rolled out to the vast majority of the world within two years. But the unsteady narratives of COVID-19 are reminders that, as sure as we might have been about how to interpret our experience of it, the stories we told ourselves about what we were dealing with and what we should be doing to protect ourselves were often incomplete, clouded by much more uncertainty and ignorance, wishful thinking and reflexive panic, than we were ever comfortable acknowledging.

There is one data point that might serve as an exceptional interpretative tool, one that blinks bright through all that narrative fog: excess mortality. The idea is simple: You look at the recent past to find an average for how many people die in a given country in a typical year, count the number of people who died during the pandemic years, and subtract one from the other. The basic math yields some striking results, as shown by a recent paper in The Lancet finding that 18.2 million people may have died globally from COVID, three times the official total. As skeptical epidemiologists were quick to point out, the paper employed some strange methodology — modeling excess deaths even for countries that offered actual excess-death data and often distorting what we knew to be true as a result. A remarkable excess-mortality database maintained by The Economist does not have this problem, and, like the Lancet paper, the Economist database estimates global excess mortality; it puts the figure above 20 million.

As a measure of pandemic brutality, excess mortality has its limitations — but probably fewer than the conventional data we’ve used for the last two years. That’s because it isn’t biased by testing levels — in places like the U.S. and the U.K., a much higher percentage of COVID deaths were identified as such than in places like Belarus or Djibouti, making our pandemics appear considerably worse by comparison. By measuring against a baseline of expected death, excess mortality helps account for huge differences in the age structures of different countries, some of which may have many times more mortality risk than others because their populations are much older. And to the extent that the ultimate impact of the pandemic isn’t just a story about COVID-19 but also one about our responses to it — lockdowns and unemployment, suspended medical care and higher rates of alcoholism and automobile accidents — excess mortality accounts for all that, too. In some places, like the U.S., excess-mortality figures are close to the official COVID data — among other things, a tribute to our medical surveillance systems. In other places, the numbers are so different that accounting for them entirely changes the picture of not just the experience of individual nations but the whole world, scrambling everything we think we know about who did best and who did worst, which countries were hit hardest and which managed to evade catastrophe. If you had to pick a single metric by which to measure the ultimate impact of the pandemic, excess mortality is as good as we’re probably going to get.

A year ago, it seemed easy enough to divide pandemic outcomes into three groups — with Europe and the Americas performing far worse than East Asia, which appeared to have outmaneuvered the virus through public-health measures, and much of the Global South, especially sub-Saharan Africa, which looked to have been spared mostly by its relatively young population. Today, a crude count of official deaths, not excess mortality, suggests the same grouping: North America and Europe have almost identical death counts with official per capita totals eight times as high as Asia, as a whole, and 12 times as high as Africa. South America’s death toll is higher still — ten times as high as Asia and 15 times as high as Africa.

The excess-mortality data tells a different story. There is still a clear continent-by-continent pattern, but the gaps between them are much smaller, making the experiences of different parts of the world much less distinct and telling a more universal story about the devastation wrought by this once-in-a-century contagion. According to The Economist, Europe, Latin America, and North America have all registered excess deaths ranging from 270 to 370 per 100,000 inhabitants; excess mortality in Asia is estimated between 130 to 330; in Africa, the range is 79 to 220. These numbers are not identical, but, all things considered, they are remarkably close together. The highest of the low-end estimates is barely three times the lowest; the highest of the high-end estimates is not even twice as high as the lowest.

If you adjust for age, as the Economist database does separately, the differences among continents grow more dramatic — suggesting a reversal of outcomes, rather than a convergence. Outside of Oceania, Europe and North America were among the best in the world at preventing deaths among the old, and they were several times better at protecting their elderly, of whom they had many more, than Africa and South Asia. East Asia performed better, but only slightly: Canada is in line with China, Germany just marginally worse than South Korea, Iceland in the range of Japan. By almost any metric, Oceania remains an outlier: The Economist estimates zero excess deaths among the elderly in New Zealand, for instance, and gives the whole region an excess-mortality range of negative 31 to positive 37 per 100,000 residents, meaning it’s possible fewer people died there than would’ve had we never even heard of SARS-CoV-2.

In the country-by-country data, the divergences grow even bigger. Perhaps most striking, given both self-flagellating American narratives about the pandemic and current events elsewhere on the globe, is that the worst-hit large country in the world was not the U.S., which registered the most official deaths of any country but ranks 47th in per capita excess mortality, or Britain, which ranks 85th, or even India, which ranks 36th. It is Russia, which has lost, The Economist estimates, between 1.2 million and 1.3 million citizens over the course of the pandemic, a mortality rate more than twice as high as the American one.

Russia is not an outlier. While we have heard again and again in the U.S. about the experience of the pandemic in western Europe — sometimes in admiration, sometimes to mock — it has been eastern Europe that, of any region in the world, has the ugliest excess-mortality data. This, then, is where the pandemic hit hardest — in the countries of the old Warsaw Pact and formerly of the Soviet bloc. In fact, of the ten worst-performing countries, only one is outside eastern Europe.

Because The Economist allows you to explore how excess mortality evolved over time, country by country, the data also clearly showcases the pandemic as a tale of two years — a mitigation year, 2020, and a vaccination year, 2021. Early in the vaccine-distribution phase, with the U.K. and U.S. moving most quickly, it was striking how so few of the countries that had done well in preventing spread in 2020 were doing well in providing vaccines quickly. Over the course of 2021, many of those gaps disappeared, with countries across East Asia and Oceania eventually accelerating their vaccine distribution and parts of Europe that were slow at the outset starting to catch up too. But the U.S. took the opposite course. In 2020, the U.S. had done a bit worse than average among its OECD peers. In 2021, when pandemic outcomes were often determined by the relative uptake of American-made vaccines, the U.S. did much, much worse than that. In country after country in Europe, the pandemic killed a fraction as many last year as it had the year before. In the U.S., it killed more. A year ago, it was possible to defend the American record as merely below average — worse than it should have been but not, judging globally, cataclysmically bad. Today, it is cataclysmically bad, which is both outrageous and ironic, given that it is largely American vaccine innovation that has changed the pandemic landscape for the rest of the world — the rest of the rich world, at least.

On February 1, 2021, just after the inauguration of Joe Biden, the U.S. had registered, according to The Economist, 178 excess deaths per 100,000 inhabitants, quite close to Britain’s 166, Belgium’s 162, and Portugal’s 201. Fast-forward a year and those gaps have exploded. The U.S. has now registered 330 excess deaths per 100,000 — meaning our total has roughly doubled. In Britain, the excess mortality grew only 30 percent; in Portugal, it was 17 percent.

The gaps between deaths in the U.S. and countries that had done better in the first year of the pandemic, like Germany or Iceland, have gotten even bigger. If the U.S. had the same cumulative excess mortality of Germany, it would have had 600,000 fewer deaths. If it had the excess mortality of Iceland, it would have had a million fewer deaths — and would have only lost about 100,000 Americans in total.

How did this happen? The answer is screamingly obvious, if also, in its way, confusing: The U.S. drove an unprecedented vaccine-innovation campaign in 2020, which empowered much of the world to turn the page on the pandemic’s deadliest phases, then, in 2021, utterly failed to take advantage of its power itself. But what is perhaps even more striking is that American vaccination coverage isn’t just bad, by the standards of its peers, but getting worse.

Cases of COVID-19 have surged at Cornell University in recent days, creating a sense of déjà vu for a school that sounded the alarm in early winter when an omicron outbreak closed facilities and moved finals online.

The last three of days of recorded data on the university's website show a measurable spike in positive tests among undergraduate students, whose population boasts a 97% vaccination rate.

In that time period, at least 503 cases of the virus have been detected among all students, staff and faculty, more than 80% of which are from the undergrad body. The more than 400 students who tested positive between Tuesday and Thursday this week account for roughly 3% of all undergraduate students.

Cornell called a "red alert" for students in mid-December, moving all finals online, cancelling on-campus events and closing facilities as COVID-19 omicron infections surged. The university's current alert level is "yellow."

This rising transmission is likely due to a number of factors, including relaxing mask requirements, the emergence of the BA.2 variant, and increased social activities," a message from the provost and other leaders read.

Ashley Rivas had to grow up fast during the pandemic.

At age 15 in early April 2020, she shielded her 8-year-old sister from the details of their mother’s hospitalization due to COVID-19, a newly known virus that also had forced schools to close statewide.

When their mother was in the hospital, the teen helped her father sanitize the house and washed clothes for the family. She also took on the role of caretaker for her sister, helping her with homework in between their online classes. After her mother was released from the hospital two weeks later, she brought her food and cared for her while she was recovering.

Rivas, now 17, is expected to be among about 35,000 Long Island students graduating in June, representing a milestone for a class that has weathered two years of pandemic learning. The students Newsday spoke to said they matured faster during the pandemic, when they had to take care of family members sickened with the coronavirus, and became more disciplined because of their virtual and, later on, hybrid schedules.

Some seniors said they have gotten back to normal since the school mask mandate ended on March 2. They look forward to resumed field trips, get-togethers with friends, the prom, graduation and adulthood. Others noted school is still not the same amid the uncertainty, lamenting lost opportunities to grow friendships, along with the missed basketball games and concert rehearsals that could not to be rescheduled.

Dena Papadopoulos, a mental health counselor at Roslyn Heights-based North Shore Child & Family Guidance Center, said this senior year has been marked by amplified excitement, but also anxiety.

“There is that … general anticipatory anxiety that 'I'm excited for college' or 'I'm excited about the next step,' but 'I'm also anxious because I don't know exactly what to expect' ” in any given senior year, she said. Now, “It's more intensified.”

To protect her mother, who still has a dry cough, Rivas continues to wear a mask in class for the most part.

“It's still not the same,” she said of school. “It's always in the back of your mind that there's a global pandemic going on. And you have to be careful.”

Zakkiyya Fraser, 17, a senior at Valley Stream Central High School, remembered looking to adults for answers in the early days of the pandemic.

And not getting them.

Itbtook Fraser some time to learn to accept the unknown. “It's like you become a mini adult,” she said.

“The pandemic may have made us grow up in a [different] way,” she added. “Having that mindset of still being a child but having to function almost as an adult has been very challenging, I think, for all high school students.”

When school turned remote and, later on, hybrid, Fraser said she pushed herself to become more independent. The routine structured by a typical school day was no longer there, and the inconsistency of learning online was difficult for her to adjust.

Ian Hua, a William Floyd High School senior, can relate.

Still, Hua said he feels “overwhelmingly lucky” compared to other student cohorts who were affected by the pandemic differently.

“There were seniors that had their final events taken away. They had no prom. They had no graduation,” Hua said. “Then there are younger kids that never had a first year of kindergarten. … Honestly, I feel very thankful.”

Timothy Hogan, a senior at East Islip High School, didn’t begin to appreciate school until it was shut down.

“Whether it's family, school, your friends, going out to see a movie or to shop, you can't take those things for granted,” Hogan said.

Sharing similar sentiments, Daniel Frankenberry, 18, said he grew closer to his family.

Looking back, Frankenberry felt like part of his high school years was stolen.

The better part of “my second half of sophomore year just didn't exist,” the Garden City High School senior said.

His junior year was spent under such heavy restrictions — plastic shields around desks, social distancing and masking — that he said regular interactions were greatly reduced.

All that said said this stuff is important to a lot of people thus a part of the emergence of the coronavirus. These are blue state students who experienced more intense and longer lasting mitigation then other areas of the country. Assuming things return to a point where this generation is unique in not experiencing these things I would be curious on how these people would look at it well in the future.

Klara Nowacki, 3, lost all her hair after her COVID-19 infection. Evelyn Van Winckel, who turns 8 on Sunday, was in so much pain weeks after contracting the virus that her parents couldn’t hug her. Samantha Petraglia, 14, has been hospitalized about a dozen times and was on a feeding tube for several months.

All three Long Island kids are believed to have long COVID, the often-debilitating effects of COVID-19 that linger months after initial infection.

Doctors are still struggling to understand what causes long COVID in adults and how to treat some of its symptoms, but experts said long COVID in children is even less understood. Studies estimate that between 10% and 30% of adults who contract the coronavirus develop long-term symptoms, but “in pediatrics the number is clearly unknown,” said Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Children’s Hospital.

Many kids with long COVID likely were never tested for the coronavirus, said Dr. Alexandra Yonts, director of the Post-COVID Program at Children's National Hospital in Washington, D.C., one of only about a dozen pediatric post-COVID programs nationwide.

That lack of an initial COVID-19 test is one reason long COVID “probably is not being diagnosed as much as it truly is happening,” Yonts said.

Doctors at Children’s National have seen a spike in kids with common long COVID symptoms such as fatigue, brain fog, concentration problems, abdominal pains and chronic headaches, she said.

“All of those things we are seeing in much, much higher numbers than we would have pre-COVID,” Yonts said.

"In some cases, it’s possible COVID-19 sparked conditions that were latent and otherwise may not have emerged until many years later, she said.

Evelyn was diagnosed with long COVID in December. But because so much about long COVID is uncertain and unclear, including the criteria to define the condition, some doctors are reluctant to diagnose children with long COVID and attribute symptoms to the effects of the virus, said Dr. Jill Cioffi, medical director of ambulatory primary care pediatrics at Stony Brook Children's.

“How do you say this is long-haul COVID when you really don’t know what long-haul COVID is?” she said.

Many symptoms common in long COVID, such as fatigue or brain fog, often don’t show up on tests, said Dr. James Schneider, chief of pediatric critical care at Cohen Children’s Medical Center in New Hyde Park.

“There are no definitive blood tests or definitive bio markers,” Schneider said. “But we know it exists.”

The long-lasting effects of COVID-19 in some kids reinforces the importance of getting eligible children vaccinated and boosted, to reduce their chances of contracting the virus, he said.

amantha, of Commack, had fever, cough, rashes, and pain and itches in her toes in March 2020, around the same time her mother, Amy Petraglia, tested positive for COVID-19.

The symptoms went away, but several months later, Samantha, known as "Sammi," started feeling dizzy, experienced migraine headaches and heart palpitations, and developed rashes on her skin worse than the initial ones, Amy Petraglia said.

“She had pain all over her body,” Petraglia said.

Over the next few months, Sammi was diagnosed with several illnesses, including a blood circulation disorder known as postural orthostatic tachycardia syndrome, and gastroparesis, which made it difficult for her to digest food.

She was hospitalized about a dozen times and required the use of a feeding tube for several months, Petraglia said. Doctors told Petraglia they suspected COVID-19 caused the conditions, but they have been unable to say for sure.

Medicine, supplements, infusions of iron, physical activity, a high-salt diet and lots of water have helped keep symptoms under control, she said.

Yonts said that, after they first get infected with the coronavirus, most kids who have COVID-19 symptoms initially start to feel better, until the long-term symptoms appear typically two to five weeks later.

At Stony Brook, doctors noticed that at least three out of four kids hospitalized with multisystem inflammatory syndrome — a condition that strikes a small number of kids, emerges a few weeks after COVID-19 infection and can inflame multiple parts of the body — ended up with myocarditis, an inflammation of the heart muscle, Cioffi said.

But fewer than 10% of other children with COVID-19 later developed long-term symptoms, she said.

Cioffi said one barrier in diagnosing kids, especially younger children, is that they have a harder time articulating what’s wrong. She’s noticed how, even though lack of taste and smell is a common COVID-19 symptom, she’s never seen it in children under 10.

“You really wonder if that’s because they just don’t know how to report it, or if they don’t notice it like an adult does,” she said.

The same is true for long COVID symptoms, she said. And parents may not connect their kids’ symptoms with the effects of the virus, she said. They may think, “ ‘Oh, maybe they didn’t sleep well last night’ or ‘they had that birthday party two days ago,’ ” Cioffi said. “It’s not necessarily, ‘Oh, that’s because they had a COVID infection.’ So I think you have underreporting based upon that.”

Klara, the 3-year-old girl from Ronkonkoma who is now bald, underwent a battery of tests to try to find a reason why her fine, blond hair fell out over a period of a few weeks last fall, said her mother, Sylwia Nowacki.

One test was for antibodies to COVID-19, and she tested positive, meaning she had been infected with the coronavirus, Nowacki said.

"Her antibodies were still high," she said. "That's how they knew it was recent."

Doctors told her the hair loss may have been because of the effects of COVID-19, but they’re not positive, she said.

The increasing popularity of home COVID-19 tests means that official reports of the number of people who have contracted the coronavirus during the current rise in cases may be a vast underestimate, experts say.

Official caseloads have been undercounts throughout the pandemic, because many people with COVID-19 don’t get tested, said Sean Clouston, an associate professor of public health at Stony Brook University. Home tests — results of which are not typically reported to health authorities — exacerbate the undercount, he said.

The state continues to count tests that are performed by doctors, pharmacists and other health professionals and are sent to laboratories for analysis.

“By understanding what the percent positivity is in all tests that are reported, we still will have an understanding of how much transmission is happening,” Hirschwerk said.

The percentage of coronavirus test results that come back positive has been steadily rising over the past few weeks as the highly contagious omicron subvariant BA.2 spreads.

Clouston said it’s likely that the percentage of people who test positive with home tests is somewhat lower than the percentage who test positive in tests conducted by health professionals. Someone who goes out of their way to travel for a test may be more likely to have COVID-19 symptoms than someone who tests at home, he said.

Abstract
Background: Relatively little is known about the long-term impacts of SARS-CoV-2 biology, including whether it increases the risk of cancer. This study aims to identify the molecular interactions between COVID-19 infections and cancer processes. Materials and Methods: We integrated recent data on SARS-CoV-2-host protein interactions, risk factors for critical illness, known oncogenes, tumor suppressor genes and cancer drivers in EpiGraphDB, a database of disease biology and epidemiology. We used these data to reconstruct the network of molecular links between SARS-CoV-2 infections and cancer processes in various tissues expressing the angiotensin-converting enzyme 2 (ACE2) receptor. We applied community detection algorithms and Gene Set Enrichment Analysis (GSEA) to identify cancer-relevant pathways that may be perturbed by SARS-CoV-2 infection.

Results: In lung tissue, the results showed that 4 oncogenes are potentially targeted by SARS-CoV-2, and 92 oncogenes interact with other human genes targeted by SARS-CoV-2. We found evidence of potential SARS-CoV-2 interactions with Wnt and hippo signaling pathways, telomere maintenance, DNA replication, protein ubiquitination and mRNA splicing. Some of these pathways were potentially affected in multiple tissues.

Conclusions: The long-term implications of SARS-CoV-2 infection are still unknown, but our results point to the potential impact of infection on pathways relevant to cancer affecting cell proliferation, development and survival, favoring DNA degradation, preventing the repair of damaging events and impeding the translation of RNA into working proteins. This highlights the need for further research to investigate whether such effects are transient or longer lasting. Our results are openly available in the EpiGraphDB platform at https://epigraphdb.org/covid-cancer and the repository https://github.com/MRCIEU/covid-cancer (https://doi.org/10.5281/zenodo.6391588).

In a daylong virtual meeting, a panel of experts advising the Food and Drug Administration came out in general support of efforts to develop new COVID-19 vaccines tailored to variants.

The committee wasn't asked to vote on any specific recommendations to the agency but instead discussed the framework for making decisions about when to change the viral strain or strains used for future vaccines, including boosters.

"I think we're in uncharted territory because with SARS-CoV-2 a lot of things have happened that have never happened before," said Dr. Arnold Monto, professor emeritus at the University of Michigan and acting chair of the committee.

It's likely the panel will reconvene in May or June to consider a more specific proposal for reformulation of COVID-19 vaccines.

The process used to tweak annual flu vaccines to match circulating strains is one model that may inform the process for COVID-19, but there are still many unknowns about how the coronavirus may change and stark differences between the influenza virus and SARS-CoV-2.

The critical consideration is whether a variant-specific booster should be made available this fall. The rise of the omicron variant, and lately a subvariant called BA.2, has sharpened the question. The vaccines now in use in the U.S. are based on the form of the virus that circulated at the beginning of the pandemic and are less effective against some later strains.

"Although we've seen a major decline in the number of COVID-19 cases in the country, the virus continues to circulate and it will continue to do so and will potentially cause waves of an increased numbers of cases," said Dr. Peter Marks, head of the FDA's Center for Biologics Evaluation and Research, at the start of the meeting. "This is of particularly concern as we head into the fall and winter season."

Marks also noted that the coronavirus will have had another more time to evolve by the time fall arrives in the U.S.

During the morning session, Israeli researchers presented data on the waning protection of a single booster dose of the Pfizer-BioNTech vaccine and the increased protection of a second booster against infections, which was fleeting, and severe illness, which was longer lasting. The rapid spread of the omicron variant contributed to the decline in protection from immunization with one booster.

Rapid genetic changes in the coronavirus are driving its ability to evade the immune response from vaccination and prior infections. The continuing changes complicate decisions about which strains to include in new vaccines.

"In general, from everything we've seen, we should expect a lot of evolution going forward, and we should have methods to keep up with this evolution in terms of our vaccination platforms," said Trevor Bedford, who studies viral evolution at the Fred Hutchinson Cancer Center in Seattle.

He said that predicting where the virus is headed is "quite difficult." The coronavirus has been evolving must faster than the flu. Significant new variants of the coronavirus have emerged in just months instead of the years it can takes for the flu to make such jumps.

Based on the rate of the coronavirus' evolution so far and uncertainty about what lies ahead, Bedford estimates a dangerous new variant like omicron could emerge within about a year and a half or maybe not for more than a decade.

There isn't much time to make vaccine changes in time for an immunization push this fall. "If you're not on your way to a clinical trial by the beginning of May, I think it's going to be very difficult to have enough product across manufacturers to meet demand," said Robert Johnson, deputy assistant secretary of the federal Biomedical Advanced Research and Development Authority.

FDA's Marks acknowledged that there is a compressed timetable for deciding upon booster makeup, but there may be "some wiggle room" that could allow for a determination in May or June.

There's a lot riding on the decision. "We simply can't be boosting people as frequently as we are," Marks said, adding that the second booster dose authorized recently by FDA was "a stopgap measure" to help protect the most vulnerable people.

The goal for a reformulated booster sometime later this year, Marks said, would be to "boost again in order to protect against a wave that could come at the time we're at highest risk."

The entirety of Shanghai is now under lockdown after a previous experiment to shut the city down one half at a time failed to contain a growing COVID-19 outbreak. Some residents have now been under lockdown for over three weeks, with a succession of smaller lockdowns limited to particular districts or compounds. In China, lockdowns are stricter than in many other countries: It can entail a complete ban on leaving one’s home or being limited to one excursion every few days for food.

National coronavirus cases continue to climb steadily, with numbers doubling roughly every five days. Shanghai remains the epicenter of the outbreak, with over 83 percent of cases, although numbers are also growing in neighboring provinces. Mass testing in the city is uncovering a very high number of asymptomatic cases, suggesting that other regions with lower rates of testing probably have large numbers of undetected cases. (China also uses a very particular definition of “asymptomatic” cases, excluding many that would be considered symptomatic in other countries.) The number of deaths remains officially very low, though deaths in old age facilities are likely being underreported.

But the main concern for most Shanghai residents isn’t COVID-19—it’s food. While supply chains and food deliveries, either through commercial services or government-provided packages, held up reasonably well during previous lockdowns, the Shanghai situation has been a disaster. Supermarket shelves are empty, government deliveries inadequate, and commercial services completely overwhelmed; ordering online requires getting up in the early hours of the morning and hoping you’re one of the lucky few who gets through before orders are suspended.

The food scarcity is severe enough that some people are foraging, resulting in cases of food poisoning.

Chinese water is not drinkable from the tap, and households usually rely on regular deliveries of bottled water; only a small percentage of upper-middle-class homes have filters as an alternative. Boiling water tackles bacteria but doesn’t remove other pollutants.

It’s unclear why the logistics of this lockdown have failed. One reason may be inconsistency, with delivery services and shops uncertain about what the measures would be from one day to the next. A desire to keep the city isolated has also affected trucking, with some drivers forced to undergo two-week quarantines, and freight prices soaring. Drivers are demanding extra pay of up to 2,000 yuan—over $300, a substantial amount in a poorly paid industry—or refusing trips to Shanghai altogether. Shanghai is also the most important port in China, and the delays there are causing supply chain issues downstream.

Conditions in Shanghai’s isolation wards are worsening, with reports of food and water shortages and fighting among residents. The authorities have just reversed policy on one of the worst decisions, the separation of children from uninfected parents, after a wave of online anger. The sporadic killing of dogs in coronavirus-hit households—not official policy, except briefly in one city—has also prompted rage. Lockdowns of hospitals and prioritization of COVID-19 testing have also caused serious health care problems, while an angry call from an official at the Chinese Center for Disease Control and Prevention complaining about government policies went viral before being censored.

Starting April 18, Philadelphia will require people to again wear masks in public places after health officials reported a rise in COVID-19 cases.

COVID-19 cases have increased more than 50% in the previous 10 days, 0fficials with Philadelphia's Department of Public Health announced Monday. On April 11, the department said the city was averaging 142 new cases per day.

"Our city remains open; we can still go about our daily lives and visit the people and places we love while masking in indoor public spaces," Mayor Jim Kenney said in a statement. "I'm optimistic that this step will help us control the case rate."

Under these rules, there is no vaccine or testing requirement for places that serve food or drink. Masks must be worn in schools, child care settings, restaurants and government buildings. It's unclear when the mandate will be lifted.

The bump in COVID-19 cases may be a sign of a larger outbreak to come, according to the city's health commissioner, Dr. Cheryl Bettigole.

"This looks like we may be at the start of a new COVID wave like Europe just saw," Bettigole told Fox 29 in Philadelphia.

In the U.S., COVID cases in the Northeast are increasing again, which has some people worried about yet another surge. This is also one of the most heavily vaccinated parts of the country. While the COVID vaccines have been very effective at stopping hospitalization and death, it's now clear they haven't ended the pandemic. And yet the scientists I spoke with in the early part of 2021 were nearly unanimous in thinking they would end the pandemic through herd immunity. Why did they get it so wrong?

Two major reasons: First, scientists vastly underestimated the ability of the virus to mutate quickly. And second, they overestimated their ability to tweak the mRNA vaccines into forms that could conquer new variants. But we can learn from our mistakes, and rather than expect the public to "live with the virus" protected by leaky vaccines, scientists need to keep improving our vaccines, possibly exploiting the more than 100 candidates already part or all the way through clinical trials.

Coronaviruses usually don't mutate very fast. They don't carry their genetic material in easily swapped out segments the way influenza viruses do — requiring a reformulated vaccine every year. And coronaviruses have a proofreading mechanism that slows the mutation process.

What makes COVID different is that its massive spread has given it so many more chances to evolve. "We'd all said that we didn't see rapid viral evolution as a threat," said immunologist Danny Altmann of the Imperial College, London. "Why are we so stupid? We were so stupid because we've thought about viruses on the scale of SARS or MERS. We haven't thought about viruses in the lungs of millions or billions of people."

COVID's evolution has also taken an unexpectedly convoluted path. Last summer, scientists assumed that any new variants would branch off the wildly transmissible delta variant, in which case a delta-specific vaccine might improve the situation and perhaps still allow us to end the pandemic. Instead, omicron branched off from a pocket of the original strain still simmering in Africa, making it far removed from delta.

The Pfizer and Moderna vaccines were supposed to be easy to update, and they are, but scientists got disappointing news when they tested omicron-specific boosters in animals and found they worked no better than the original boosters. Although the existing boosters are pretty good, they are not nearly good enough to prevent thousands of breakthrough infections, some of them pretty nasty.

The reason that the omicron-specific booster didn't work better might come down to a problem with our immune systems — a phenomenon that Altmann calls immune imprinting and others have called original antigenic sin. In a worst-case scenario, vaccines could actually make an infection worse by prompting the production of ineffective antibodies. That's happened with Dengue fever vaccines.

Altmann thinks a second booster shot makes sense right now, especially in the United States, where we might see a new wave of the omicron sub-variant BA.2. And he agrees with the FDA decision to authorize a second shot for those over 50. There's enough evidence out of Israel showing the second booster can offer at least a couple of months of increased protection against severe disease and death.

But he does foresee the potential for longer-term problems. He said that asking people to take the same booster every 4-6 months for a changing virus "isn't good immunology or vaccinology or public health."

One problem is that there's no data one way or another whether the booster will do anything to prevent mild or asymptomatic infections and therefore it's unclear whether young, healthy people should get boosted to protect the community — or to avoid long COVID.

And while CDC director Rochelle Walensky has recently said that an infection with omicron can substitute for one shot, the level of protection from a previous infection is complex and hard to predict.

Some experts quoted in the New York Times recently suggested that the reason BA.2 is spreading slower in the U.S. than it did in the U.K. comes down to the fact that the U.S. had many more omicron infections with the other sub-variant, BA.1, over the winter. But that's speculation. Altmann said he's seen a number of people get re-infected with omicron once or even twice, suggesting this variant doesn't provide good immunity even to itself. The situation is now extraordinarily complex, with most of the population having very different immunity profiles from a hodgepodge of infections, shots and boosters.

What would be a better public health strategy? He suggested we keep exploring the more than 100 vaccines that have gone partway through clinical testing, looking for one that might have broader protection against parts of the virus that aren't changing as fast as the spike protein, and that show better durability.

It's become clear that our current vaccines won't end the pandemic. But that's no reason to give up hope; a vaccination campaign with better vaccines still might.