vox--2020-07-14--The other infectious diseases spreading in the shadow of the pandemic

Share All sharing options for : The other infectious diseases spreading in the shadow of the pandemic In recent decades , the world has made dramatic progress in lowering the number of deaths from infectious diseases , including tuberculosis , HIV , malaria , and polio .
But as campaigns are paused or cut back and as people miss routine care due to the coronavirus pandemic , these illnesses are getting a rare opportunity to come roaring back .
A new study in The Lancet Global Health estimates that deaths from tuberculosis could increase by 20 percent over five years @ @ @ @ @ @ @ percent — if Covid-19 runs rampant in areas where these illnesses are prevalent .
Others suggest that the impacts could be even worse .
Tuberculosis deaths had been down worldwide almost 50 percent over the past two decades ( to 1.3 million a year ) .
But the disease is likely infecting more people in many countries right now .
One team of researchers , for example , estimated we could see as many as 1.4 million extra TB deaths over the next five years .
We know that previous disruptions to anti-malaria @ @ @ @ @ @ @ outbreaks ) led to thousands of additional deaths from the mosquito-borne virus .
And polio , which has been on the cusp of global eradication in recent years , could come surging back in places that have been working diligently for decades to eliminate it .
Even in the US , where we have vanquished many of the most devastating infectious diseases , once-rare illnesses may rebound .
As people stay at home and forgo routine medical care , including scheduled vaccinations for children , preventable diseases like measles and whooping cough will @ @ @ @ @ @ @ And that puts not only more people at risk , but also more strain on the healthcare system .
“ Any country is vulnerable when faced with multiple threats , ” Claire Standley , a faculty member at Georgetown University ’ s Center for Global Health Science and Security , told Vox in an email .
“ Those most at risk are the ones with limited human , material , and financial resources to support outbreak response.
” And this is already playing out .
The Democratic Republic of Congo is currently fighting @ @ @ @ @ @ @ s largest outbreak of measles .
And Yemen is battling Covid-19 in the midst of devastating armed conflict as well as a massive cholera outbreak .
This is not only an unmitigated disaster for the people who live in these countries .
“ An outbreak anywhere is a threat everywhere , ” Standley says .
“ If disease threats proliferate elsewhere in the world , that poses a risk ” of it spreading outside a nation ’ s borders too .
All of this comes as resources are drying up or being shifted @ @ @ @ @ @ @ Trump administration moves to withdraw from the World Health Organization , which will likely take hundreds of millions of dollars — as well as many experienced personnel — out of the fight against infectious diseases around the world .
The Bill and Melinda Gates Foundation , which has focused on combating HIV , malaria , polio , and other infectious diseases for decades , is now giving “ total attention ” to the pandemic .
And as the globe feels the grip of an international recession , other critical funding may slow down @ @ @ @ @ @ @ the purse strings , the pandemic has created new challenges for determining how to allocate always-limited resources — and what to prioritize .
Is it better to pull staff off of a polio campaign — knowing more people will get that paralyzing and sometimes deadly virus — to improve contact tracing for Covid-19 ?
What about efforts to combat malaria ( which has been killing 405,000 people a year ) or HIV ( which leads to some 770,000 deaths a year ) ?
We don ’ t yet know exactly what the collateral @ @ @ @ @ @ @ from other infectious diseases now — or in the years to come .
But public health experts say it ’ s clear that there could be lasting damage .
“ We can not afford to sacrifice the progress we have made on mitigating other infectious diseases in order to mitigate this one , ” Ingrid Katz , of the Harvard Global Health Institute and the Center for Global Health at Massachusetts General Hospital , wrote to Vox .
“ It is imperative that we continue to fight against all infectious diseases alongside the @ @ @ @ @ @ @ what we know about how the coronavirus pandemic is hurting the efforts to quell other infectious diseases — and why that puts everyone more at risk .
How Covid-19 is hurting essential vaccination and preventative treatment After Covid-19 began spreading globally earlier this year , many people chose to skip routine health care appointments — including vaccinations , like those that protect children against measles , a highly contagious virus that can occasionally cause neurological damage and death .
In the US , for example , routine vaccines for children began to drop @ @ @ @ @ @ @ was declared a national emergency .
By mid-May , a report by the Centers for Disease Control and Prevention found there had been a “ substantial reduction ” in pediatric vaccines in the US .
“ This will likely lead to higher rates of vaccine-preventable disease in the next year , ” Bruce Ribner , medical director of Emory University Hospital ’ s Serious Communicable Diseases Unit , who was not involved in the research , wrote Vox in an email .
Current physical distancing practices are keeping other infectious diseases ( along @ @ @ @ @ @ @ as they normally would .
With summer camps and schools closed , rates of contagious childhood illnesses are likely to stay low .
But that is temporary .
“ As social distancing requirements are relaxed , children who are not protected by vaccines will be more vulnerable to diseases such as measles , ” the CDC report authors wrote .
For measles , we need vaccination rates of 90-95 percent to prevent outbreaks .
But another recent CDC study found that the rate of measles vaccination coverage for May 2020 in one state @ @ @ @ @ @ @ 71 percent .
The study authors urge health care providers and caretakers to ensure any missed vaccines are obtained as quickly as possible to ensure best protection — and to protect others , such as infants , who are not able to get some vaccines , including one for measles .
Many other countries rely on mass-vaccination events , such as those at schools or at community centers , to help fight measles and other infectious diseases — including deadly parasites that are still endemic in many places .
For example , Standley @ @ @ @ @ @ @ the parasite that causes schistosomiasis ( which is still endemic in 52 countries ) , a preventative drug typically gets distributed to children at school .
But now that schools have been closed due to the pandemic , the parasite will not only cause additional infections and deaths , but the closures will also lead to a larger setback in efforts to eliminate it entirely , she says .
Even many country-wide disease campaigns have been canceled altogether .
Since the pandemic started , 27 countries have suspended their measles campaigns , and @ @ @ @ @ @ @ notes .
Millions of children have now missed their polio vaccines and are thus currently unprotected against the paralyzing illness .
In addition to missing vaccines , people around the world have been hesitant to seek other care , including tests for TB and HIV , at medical facilities because they are worried about catching Covid-19 .
“ These fears are not unfounded , ” Standley says .
But this is extremely problematic for disease detection , which can be crucial for stopping transmission .
It “ may result in many treatable conditions @ @ @ @ @ @ @ and death , Standley says .
This is especially crucial in places where these infectious diseases were still spreading frequently before the pandemic .
“ I worry about countries with high rates of tuberculosis , like India , Kenya , and Ukraine , ” Katz says .
For example , in early April , India saw an 80 percent drop in TB reporting , she says .
The July 13 study in The Lancet Global Health ( which was funded in part by the Bill and Melinda Gates Foundation ) , notes that @ @ @ @ @ @ @ and HIV are common , additional deaths from these diseases could be “ of the same order of magnitude as the direct impact from Covid-19.
” “ The Covid-19 pandemic and actions taken in response to it could undo some of the advances made against major diseases , ” Timothy Hallett , a global health researcher at the Imperial College London and one of the study co-authors , said in a statement .
“ Even short-term disruptions [ in control and treatment ] could have devastating consequences for the millions of people who @ @ @ @ @ @ @ , an international health funding organization , has found that , as of mid-June , Covid-19 has disrupted 85 percent of HIV programs , 78 percent of TB programs , and 73 percent of malaria programs in over 106 countries in which it supports disease-fighting programs .
These programs include prevention , treatment , and testing .
As the fund notes , “ if people aren ’ t diagnosed , they can ’ t be put on treatment and could continue to infect others .
For example , a person with active TB @ @ @ @ @ @ @ year.
” “ The scale is daunting , ” Peter Sands , executive director of the Global Fund , wrote in a July 13 commentary in The Lancet Global Health .
His group has been working on ways to help countries adapt their local programs , for example , buying motorcycles and more PPE for volunteers so that they can distribute mosquito nets to individual households rather than having people congregate at a central location to pick them up .
In areas where resources , like ventilators or ICU beds , are limited @ @ @ @ @ @ @ will be rationed and saved for the otherwise healthiest people .
A TB diagnosis , for example , could , in theory , make someone lower priority for Covid-19 treatment should they become critically ill from the novel virus .
So , Standley notes , this might give them a reason to avoid seeking care or diagnosis for another illness — even one like TB that is usually treatable and could otherwise spread to others .
Can we afford to fight other infectious diseases right now ?
Can we afford not to ?
@ @ @ @ @ @ @ , it ’ s hard to allocate limited resources — whether that is trained health care workers or basic medical equipment , like masks or testing machines .
For now , in most places , Covid-19 is getting priority for what resources can be mobilized .
In Africa , the WHO coordinates a network of polio testing laboratories across 15 countries .
The network has now dedicated half of its capacity to running Covid-19 tests instead of those for polio .
In Pakistan , many workers who usually focus on polio eradication are @ @ @ @ @ @ @ tracing for Covid-19 .
( And thousands of other polio workers there have simply been laid off ) .
International philanthropies are also being pulled in two directions .
The Bill and Melinda Gates Foundation has , for decades , put much of its work toward fighting infectious diseases around the world .
But now , speaking of the pandemic , Bill Gates told the Financial Times , “ This has the foundation ’ s total attention.
” “ We ’ ve taken an organization that was focused on HIV and malaria and @ @ @ @ @ @ @ it to work on this , ” he said .
( The Gates Foundation is also the second-largest funder — after the United States — of the WHO . )
“ The pandemic is affecting all areas of our work , and we can not deliver on our mission without addressing it , ” a spokesperson for the foundation told Vox in an email .
But , they noted , the foundation is still working on other diseases — and the more than $ 350 million it has pledged for Covid-19 response has @ @ @ @ @ @ @ That is important , says Standley .
“ These [ new ] efforts can not come at the expense of other health programming , or we will just be shifting the burden of morbidity and mortality , ” she says .
The Global ’ s fund $ 1 billion they have committed so far to help HIV , malaria , and TB programs during the pandemic “ only mitigates a small part of the problem , ” Sands wrote .
By their calculation , it will take close to $ 28.5 billion to @ @ @ @ @ @ @ and prevent a potentially devastating impact on HIV , tuberculosis , and malaria in [ just ] the highest-burden countries.
” In some cases , funding might dry up altogether , putting everyone at greater risk .
The US provided about 15 percent of the WHO ’ s total funding last year ( including a pledge of $ 158 million to help eradicate polio ) .
The WHO has spent decades helping to bring down the rates of HIV infection , tuberculosis , and malaria , as well as contributing to many other @ @ @ @ @ @ @ low- and middle-income countries rely on the WHO for many aspects of infection disease control , including testing , data collection , medical supplies , and more , ” Katz says .
“ By pulling out of the WHO , the US is hampering these countries ’ ability to respond to disease outbreaks , ” she says .
This , in turn , further “ increases the risk of infectious disease outbreaks in the United States.
” Because contagious diseases don ’ t stay put .
Other experts agree .
As Ribner notes @ @ @ @ @ @ @ ago that infections occurring overseas do not stay overseas , ” he says .
“ We can choose to be prepared and minimize the impact of these outbreaks , or we can choose to be reactive and allow unnecessary illness and suffering .
Hopefully we will learn that advance preparation is the most effective , and most efficient use of resources.
” How other infectious diseases could make the Covid-19 fight much worse The pandemic has hobbled even wealthy countries like the US and UK as they fail to stop an infectious disease @ @ @ @ @ @ @ equipment or roll out testing and contact tracing .
Now , as other diseases gain steam in the shadow of the coronavirus , they could lead to even more untenable strain .
“ Any country that has a health system unable to meet the health needs of all its citizens — and I include the United States in that description — is at risk of multiple simultaneous disease outbreaks that hamper the fight against any one disease , ” Kristina Talbert-Slagle , director of Yale College Global Health Studies Program , told Vox @ @ @ @ @ @ @ were running short on basic supplies , like masks , to protect health care workers in the US just from Covid-19 .
Some far more resource-poor countries , though , are already fighting outbreaks of more than one infectious disease , and the situation is dire .
In the Democratic Republic of Congo , in addition to Covid-19 , their measles outbreak has already killed more than 6,700 people there ( mostly children ) since 2019 , and Ebola has caused more than 2,200 deaths since 2018 .
With an already-strained health care @ @ @ @ @ @ @ larger risk of losing even more lives to those diseases — and of not being able to contain them .
Throughout all of this , some infectious diseases also add to the difficulty in diagnosing Covid-19 .
In Brazil , for example , where there has been an outbreak of Dengue fever , doctors have missed cases of Covid-19 , mistaking them for the mosquito-borne virus .
And many of the infectious diseases that are poised to start creeping back up might also make people even more vulnerable to severe Covid-19 and death @ @ @ @ @ @ @ yet been peer reviewed , suggests that HIV infection as well as current — and even previous — TB infections makes people substantially more likely to die from Covid-19 .
How more disease will worsen existing inequities The pandemic has underscored persisting inequities in health care in the US and around the globe .
And an increased infectious disease burden threatens to make them even worse .
“ It ’ s most likely that the poorest communities , who suffer the most from other preventable , treatable , or otherwise controllable diseases , @ @ @ @ @ @ @ ] ” brought by pandemic-driven setbacks , Standley says .
In high-income countries , according to a 2018 report from the WHO , only one of the top 10 causes of death is infectious ( lower respiratory infections , such as pneumonia ) — and it is sixth on the list , just above colorectal cancer .
For low-income countries , half of the top 10 causes of death are infectious diseases , including the top two ( lower respiratory infections and diarrheal diseases , respectively ) .
The other three are : @ @ @ @ @ @ @ sixth ) , and tuberculosis ( seventh ) , which are all likely to increase as a result of the pandemic .
And there are even more people who are sickened by these diseases but survive .
In the process , they often lose wages or are unable to care for others , and many suffer lasting disability .
The pandemic setbacks do not end with contagious illnesses that can threaten lives and livelihoods .
As Talbert-Slagle notes , if anyone is not getting routine care and normal screenings , they end up @ @ @ @ @ @ @ infectious diseases , but also non-infectious diseases , like diabetes , mental illnesses , cancer , chronic respiratory disease , and cardiovascular disease , ” she says .
All of these can put further ( and preventable ) strain on precious resources , personal and , when seen on a large scale , national .
This observation echoes familiar and persistent health care patterns here in the US , where marginalized communities have long received poorer care and seen worse health outcomes .
The pandemic has made these inequities even more apparent , @ @ @ @ @ @ @ die from Covid-19 than white Americans .
As Marya T. Mtshali , a lecturer in studies on women , gender , and sexuality at Harvard University , wrote for Vox : “ This can snowball into even larger problems that compound health care inequities… [ And ] can translate into a reluctance for Black people to engage with these institutions in times of need or to give up in frustration… This , of course , then further results in poorer health outcomes.
” This is a final and perhaps even more insidious threat @ @ @ @ @ @ @ for years to come , at home and abroad .
“ Lack of trust in health services can persist after the outbreak is over , especially if populations feel their needs were not addressed during the outbreak or they were otherwise marginalized , ” Standley says .
Or , as Talbert-Slagle puts it , the pandemic has fueled “ an outbreak of distrust in expertise.
” This threatens not only the fight against Covid-19 but also just about every arena of public health , from seeking care when you ’ re sick to @ @ @ @ @ @ @ time .
Katherine Harmon Courage is a freelance science journalist and author of Cultured and Octopus !
Follow her on Twitter at @ KHCourage .
Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive @ @ @ @ @ @ @ particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

Share All sharing options for: The other infectious diseases spreading in the shadow of the pandemic
In recent decades, the world has made dramatic progress in lowering the number of deaths from infectious diseases, including tuberculosis, HIV, malaria, and polio. But as campaigns are paused or cut back and as people miss routine care due to the coronavirus pandemic, these illnesses are getting a rare opportunity to come roaring back.
A new study in The Lancet Global Health estimates that deaths from tuberculosis could increase by 20 percent over five years — and deaths from malaria by 36 percent — if Covid-19 runs rampant in areas where these illnesses are prevalent. Others suggest that the impacts could be even worse.
Tuberculosis deaths had been down worldwide almost 50 percent over the past two decades (to 1.3 million a year). But the disease is likely infecting more people in many countries right now. One team of researchers, for example, estimated we could see as many as 1.4 million extra TB deaths over the next five years.
We know that previous disruptions to anti-malaria efforts (such as during recent Ebola outbreaks) led to thousands of additional deaths from the mosquito-borne virus. And polio, which has been on the cusp of global eradication in recent years, could come surging back in places that have been working diligently for decades to eliminate it.
Even in the US, where we have vanquished many of the most devastating infectious diseases, once-rare illnesses may rebound. As people stay at home and forgo routine medical care, including scheduled vaccinations for children, preventable diseases like measles and whooping cough will have more unprotected people to infect. And that puts not only more people at risk, but also more strain on the healthcare system.
“Any country is vulnerable when faced with multiple threats,” Claire Standley, a faculty member at Georgetown University’s Center for Global Health Science and Security, told Vox in an email. “Those most at risk are the ones with limited human, material, and financial resources to support outbreak response.”
And this is already playing out. The Democratic Republic of Congo is currently fighting Covid-19 alongside Ebola and the world’s largest outbreak of measles. And Yemen is battling Covid-19 in the midst of devastating armed conflict as well as a massive cholera outbreak.
This is not only an unmitigated disaster for the people who live in these countries. “An outbreak anywhere is a threat everywhere,” Standley says. “If disease threats proliferate elsewhere in the world, that poses a risk” of it spreading outside a nation’s borders too.
All of this comes as resources are drying up or being shifted away to fight the pandemic. The Trump administration moves to withdraw from the World Health Organization, which will likely take hundreds of millions of dollars — as well as many experienced personnel — out of the fight against infectious diseases around the world.
The Bill and Melinda Gates Foundation, which has focused on combating HIV, malaria, polio, and other infectious diseases for decades, is now giving “total attention” to the pandemic. And as the globe feels the grip of an international recession, other critical funding may slow down as well.
For those who hold the purse strings, the pandemic has created new challenges for determining how to allocate always-limited resources — and what to prioritize.
Is it better to pull staff off of a polio campaign — knowing more people will get that paralyzing and sometimes deadly virus — to improve contact tracing for Covid-19? What about efforts to combat malaria (which has been killing 405,000 people a year) or HIV (which leads to some 770,000 deaths a year)?
We don’t yet know exactly what the collateral damage will be in shifting resources away from other infectious diseases now — or in the years to come. But public health experts say it’s clear that there could be lasting damage.
“We cannot afford to sacrifice the progress we have made on mitigating other infectious diseases in order to mitigate this one,” Ingrid Katz, of the Harvard Global Health Institute and the Center for Global Health at Massachusetts General Hospital, wrote to Vox. “It is imperative that we continue to fight against all infectious diseases alongside the fight against Covid-19.”
Here’s what we know about how the coronavirus pandemic is hurting the efforts to quell other infectious diseases — and why that puts everyone more at risk.
How Covid-19 is hurting essential vaccination and preventative treatment
After Covid-19 began spreading globally earlier this year, many people chose to skip routine health care appointments — including vaccinations, like those that protect children against measles, a highly contagious virus that can occasionally cause neurological damage and death.
In the US, for example, routine vaccines for children began to drop off in mid-March, as the pandemic was declared a national emergency. By mid-May, a report by the Centers for Disease Control and Prevention found there had been a “substantial reduction” in pediatric vaccines in the US.
“This will likely lead to higher rates of vaccine-preventable disease in the next year,” Bruce Ribner, medical director of Emory University Hospital’s Serious Communicable Diseases Unit, who was not involved in the research, wrote Vox in an email.
Current physical distancing practices are keeping other infectious diseases (along with Covid-19) from spreading as much as they normally would. With summer camps and schools closed, rates of contagious childhood illnesses are likely to stay low.
But that is temporary.
“As social distancing requirements are relaxed, children who are not protected by vaccines will be more vulnerable to diseases such as measles,” the CDC report authors wrote. For measles, we need vaccination rates of 90-95 percent to prevent outbreaks. But another recent CDC study found that the rate of measles vaccination coverage for May 2020 in one state (Michigan) had dropped to about 71 percent. The study authors urge health care providers and caretakers to ensure any missed vaccines are obtained as quickly as possible to ensure best protection — and to protect others, such as infants, who are not able to get some vaccines, including one for measles.
Many other countries rely on mass-vaccination events, such as those at schools or at community centers, to help fight measles and other infectious diseases — including deadly parasites that are still endemic in many places.
For example, Standley notes, in some countries affected by the parasite that causes schistosomiasis (which is still endemic in 52 countries), a preventative drug typically gets distributed to children at school. But now that schools have been closed due to the pandemic, the parasite will not only cause additional infections and deaths, but the closures will also lead to a larger setback in efforts to eliminate it entirely, she says.
Even many country-wide disease campaigns have been canceled altogether. Since the pandemic started, 27 countries have suspended their measles campaigns, and 38 have suspended polio campaigns, Katz notes. Millions of children have now missed their polio vaccines and are thus currently unprotected against the paralyzing illness.
In addition to missing vaccines, people around the world have been hesitant to seek other care, including tests for TB and HIV, at medical facilities because they are worried about catching Covid-19. “These fears are not unfounded,” Standley says.
But this is extremely problematic for disease detection, which can be crucial for stopping transmission. It “may result in many treatable conditions going undiagnosed” and in additional illness and death, Standley says.
This is especially crucial in places where these infectious diseases were still spreading frequently before the pandemic. “I worry about countries with high rates of tuberculosis, like India, Kenya, and Ukraine,” Katz says. For example, in early April, India saw an 80 percent drop in TB reporting, she says.
The July 13 study in The Lancet Global Health (which was funded in part by the Bill and Melinda Gates Foundation), notes that in places where TB, malaria, and HIV are common, additional deaths from these diseases could be “of the same order of magnitude as the direct impact from Covid-19.”
“The Covid-19 pandemic and actions taken in response to it could undo some of the advances made against major diseases,” Timothy Hallett, a global health researcher at the Imperial College London and one of the study co-authors, said in a statement. “Even short-term disruptions [in control and treatment] could have devastating consequences for the millions of people who depend on programs.”
The Global Fund, an international health funding organization, has found that, as of mid-June, Covid-19 has disrupted 85 percent of HIV programs, 78 percent of TB programs, and 73 percent of malaria programs in over 106 countries in which it supports disease-fighting programs. These programs include prevention, treatment, and testing. As the fund notes, “if people aren’t diagnosed, they can’t be put on treatment and could continue to infect others. For example, a person with active TB can infect 10-15 other people in a year.”
“The scale is daunting,” Peter Sands, executive director of the Global Fund, wrote in a July 13 commentary in The Lancet Global Health. His group has been working on ways to help countries adapt their local programs, for example, buying motorcycles and more PPE for volunteers so that they can distribute mosquito nets to individual households rather than having people congregate at a central location to pick them up.
In areas where resources, like ventilators or ICU beds, are limited, people might also worry that care will be rationed and saved for the otherwise healthiest people. A TB diagnosis, for example, could, in theory, make someone lower priority for Covid-19 treatment should they become critically ill from the novel virus. So, Standley notes, this might give them a reason to avoid seeking care or diagnosis for another illness — even one like TB that is usually treatable and could otherwise spread to others.
Can we afford to fight other infectious diseases right now? Can we afford not to?
In the midst of the global pandemic, it’s hard to allocate limited resources — whether that is trained health care workers or basic medical equipment, like masks or testing machines. For now, in most places, Covid-19 is getting priority for what resources can be mobilized.
In Africa, the WHO coordinates a network of polio testing laboratories across 15 countries. The network has now dedicated half of its capacity to running Covid-19 tests instead of those for polio. In Pakistan, many workers who usually focus on polio eradication are now being deployed to do in-person contact tracing for Covid-19. (And thousands of other polio workers there have simply been laid off).
International philanthropies are also being pulled in two directions. The Bill and Melinda Gates Foundation has, for decades, put much of its work toward fighting infectious diseases around the world. But now, speaking of the pandemic, Bill Gates told the Financial Times, “This has the foundation’s total attention.”
“We’ve taken an organization that was focused on HIV and malaria and polio eradication, and almost entirely shifted it to work on this,” he said. (The Gates Foundation is also the second-largest funder — after the United States — of the WHO.)
“The pandemic is affecting all areas of our work, and we cannot deliver on our mission without addressing it,” a spokesperson for the foundation told Vox in an email. But, they noted, the foundation is still working on other diseases — and the more than $350 million it has pledged for Covid-19 response has not been pulled from other areas.
That is important, says Standley. “These [new] efforts cannot come at the expense of other health programming, or we will just be shifting the burden of morbidity and mortality,” she says.
The Global’s fund $1 billion they have committed so far to help HIV, malaria, and TB programs during the pandemic “only mitigates a small part of the problem,” Sands wrote. By their calculation, it will take close to $28.5 billion to “fund an effective response to Covid-19 and prevent a potentially devastating impact on HIV, tuberculosis, and malaria in [just] the highest-burden countries.”
In some cases, funding might dry up altogether, putting everyone at greater risk.
The US provided about 15 percent of the WHO’s total funding last year (including a pledge of $158 million to help eradicate polio). The WHO has spent decades helping to bring down the rates of HIV infection, tuberculosis, and malaria, as well as contributing to many other improvements in global health. “Many low- and middle-income countries rely on the WHO for many aspects of infection disease control, including testing, data collection, medical supplies, and more,” Katz says.
“By pulling out of the WHO, the US is hampering these countries’ ability to respond to disease outbreaks,” she says. This, in turn, further “increases the risk of infectious disease outbreaks in the United States.” Because contagious diseases don’t stay put.
Other experts agree. As Ribner notes, “We should have learned long ago that infections occurring overseas do not stay overseas,” he says. “We can choose to be prepared and minimize the impact of these outbreaks, or we can choose to be reactive and allow unnecessary illness and suffering. Hopefully we will learn that advance preparation is the most effective, and most efficient use of resources.”
How other infectious diseases could make the Covid-19 fight much worse
The pandemic has hobbled even wealthy countries like the US and UK as they fail to stop an infectious disease outbreak, struggling to supply personal protective equipment or roll out testing and contact tracing. Now, as other diseases gain steam in the shadow of the coronavirus, they could lead to even more untenable strain.
“Any country that has a health system unable to meet the health needs of all its citizens — and I include the United States in that description — is at risk of multiple simultaneous disease outbreaks that hamper the fight against any one disease,” Kristina Talbert-Slagle, director of Yale College Global Health Studies Program, told Vox in an email.
For months we were running short on basic supplies, like masks, to protect health care workers in the US just from Covid-19. Some far more resource-poor countries, though, are already fighting outbreaks of more than one infectious disease, and the situation is dire.
In the Democratic Republic of Congo, in addition to Covid-19, their measles outbreak has already killed more than 6,700 people there (mostly children) since 2019, and Ebola has caused more than 2,200 deaths since 2018. With an already-strained health care system, the country runs an even larger risk of losing even more lives to those diseases — and of not being able to contain them.
Throughout all of this, some infectious diseases also add to the difficulty in diagnosing Covid-19. In Brazil, for example, where there has been an outbreak of Dengue fever, doctors have missed cases of Covid-19, mistaking them for the mosquito-borne virus.
And many of the infectious diseases that are poised to start creeping back up might also make people even more vulnerable to severe Covid-19 and death. Preliminary findings, which have not yet been peer reviewed, suggests that HIV infection as well as current — and even previous — TB infections makes people substantially more likely to die from Covid-19.
How more disease will worsen existing inequities
The pandemic has underscored persisting inequities in health care in the US and around the globe. And an increased infectious disease burden threatens to make them even worse.
“It’s most likely that the poorest communities, who suffer the most from other preventable, treatable, or otherwise controllable diseases, will bear most of [the burden]” brought by pandemic-driven setbacks, Standley says.
In high-income countries, according to a 2018 report from the WHO, only one of the top 10 causes of death is infectious (lower respiratory infections, such as pneumonia) — and it is sixth on the list, just above colorectal cancer.
For low-income countries, half of the top 10 causes of death are infectious diseases, including the top two (lower respiratory infections and diarrheal diseases, respectively). The other three are: HIV/AIDS (fourth), malaria (sixth), and tuberculosis (seventh), which are all likely to increase as a result of the pandemic.
And there are even more people who are sickened by these diseases but survive. In the process, they often lose wages or are unable to care for others, and many suffer lasting disability.
The pandemic setbacks do not end with contagious illnesses that can threaten lives and livelihoods. As Talbert-Slagle notes, if anyone is not getting routine care and normal screenings, they end up more at risk for “not just infectious diseases, but also non-infectious diseases, like diabetes, mental illnesses, cancer, chronic respiratory disease, and cardiovascular disease,” she says. All of these can put further (and preventable) strain on precious resources, personal and, when seen on a large scale, national.
This observation echoes familiar and persistent health care patterns here in the US, where marginalized communities have long received poorer care and seen worse health outcomes. The pandemic has made these inequities even more apparent, with black Americans much more likely to die from Covid-19 than white Americans.
As Marya T. Mtshali, a lecturer in studies on women, gender, and sexuality at Harvard University, wrote for Vox: “This can snowball into even larger problems that compound health care inequities… [And] can translate into a reluctance for Black people to engage with these institutions in times of need or to give up in frustration… This, of course, then further results in poorer health outcomes.”
This is a final and perhaps even more insidious threat that will creep along behind the pandemic for years to come, at home and abroad. “Lack of trust in health services can persist after the outbreak is over, especially if populations feel their needs were not addressed during the outbreak or they were otherwise marginalized,” Standley says.
Or, as Talbert-Slagle puts it, the pandemic has fueled “an outbreak of distrust in expertise.” This threatens not only the fight against Covid-19 but also just about every arena of public health, from seeking care when you’re sick to getting your children vaccinated against measles on time.
Katherine Harmon Courage is a freelance science journalist and author of Cultured and Octopus! Follow her on Twitter at @KHCourage.


vox--2020-07-14--Okay, Google, how do I listen to Vox?

Okay, Google, how do I listen to Vox?

Mixtapes forever changed how we listen to music .
What if news got the same treatment ?
Enter “ Your News Update , ” a new way to listen to Vox podcasts on Google Assistant .
Starting now , you can hear quick daily updates from Today , Explained on Google smart speakers and Assistant-enabled devices , and there ’ s more on the way later this year from the Vox newsroom .
Here ’ s how it works : The Your News Update algorithm curates a selection of audio stories tailored to you .
What you hear each day @ @ @ @ @ @ @ , what you like , what you need to know that day , and the preferred sources you define in the Google Assistant app .
By selecting Vox as a preferred news source , the Assistant will regularly surface stories from Vox in your update .
Your News Update is available on all Assistant-enabled devices , including smart speakers , phones , and tablets .
Follow the steps below to select Vox as a preferred news source .
To listen , simply say to your device , “ Okay , Google , play @ @ @ @ @ @ @ Google , play Your News Update.
” Download either the Google Assistant ( free on Android or Apple ) or the Google Home app ( free on Android or Apple ) on your phone or tablet .
For Google Assistant , open the app and tap the icon in the top right corner .
Scroll down and select News .
Make sure your News playlist format is set to Your News Update .
Then search for Vox in the list of sources and tap the star so it turns blue .
For Google @ @ @ @ @ @ @ the icon in the top right corner .
Scroll down and select Assistant Settings > News .
Make sure your News playlist format is set to Your News Update .
Then search for Vox in the list of sources and tap the star so it turns blue .
Once you complete these steps , you ’ re ready to listen .
Start by telling your Google smart speaker , “ Okay , Google , play Google News.
” Move through your news feed by asking to “ skip ” or “ play the @ @ @ @ @ @ @ t forget to say “ Okay , Google ” first ) .
Tip : Shorter stories tend to play first ; longer stories come later .
Prefer to listen on a phone or tablet ?
Open the Google Assistant or the Google Home app , then tap the microphone icon to ask for Your News Update .
You can also tap the keyboard icon to type the request .
You can read more about Your News Update and learn more about how to listen to podcasts and news through the Google Assistant .
@ @ @ @ @ @ @ listen to Vox ’ s full slate of podcasts any time on your favorite device .
Update , July 14 , 3:20 pm Eastern : Google changed the commands to call up Your News Update on Assistant-enabled devices after we first published this article .
The new invocations to use are : “ Okay , Google , play Your News Update ” or “ Okay , Google , play Google News.
” Every day at Vox , we aim to answer your most important questions and provide you , and our audience around @ @ @ @ @ @ @ the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please @ @ @ @ @ @ @ .

Mixtapes forever changed how we listen to music. What if news got the same treatment? Enter “Your News Update,” a new way to listen to Vox on Google smart speakers and Assistant-enabled devices.
You’ll hear quick daily updates from your favorite Vox podcasts, like Today, Explained, plus new original content from our Politics and Policy, Culture, The Goods, Recode, and tech teams.
Here’s how it works: The Your News Update algorithm curates a selection of audio stories tailored to you. What you hear each day is ultimately determined by where you live, what you like, what you need to know that day, and the preferred sources you define in the Google Assistant app. By selecting Vox as a preferred news source, the Assistant will regularly surface stories from Vox in your update.
Your News Update is available on all Assistant-enabled devices, including smart speakers, phones, and tablets. Follow the steps below to select Vox as a preferred news source. To get the playlist, ask your Assistant to “Play Your News Update” or “Play Google News.” You can also find and hear all episodes in Vox Quick Hits.
How to make Vox a preferred news source
Download either the Google Assistant (free on Android or Apple) or the Google Home app (free on Android or Apple) on your phone or tablet.
For Google Assistant, open the app and tap the icon in the top right corner. Scroll down and select News. Make sure your News playlist format is set to Your News Update. Then search for Vox in the list of sources and tap the star so it turns blue.
For Google Home, open the app and tap the icon in the top right corner. Scroll down and select Assistant Settings > News. Make sure your News playlist format is set to Your News Update. Then search for Vox in the list of sources and tap the star so it turns blue.
Once you complete these steps, you’re ready to listen.
Start by telling your Google smart speaker, “Okay, Google, play Google News.” Move through your news feed by asking to “skip” or “play the next story” (but don’t forget to say “Okay, Google” first).
Tip: Shorter stories tend to play first; longer stories come later.
Prefer to listen on a phone or tablet? Open the Google Assistant or the Google Home app, then tap the microphone icon to ask for Your News Update. You can also tap the keyboard icon to type the request.
You can read more about Your News Update and learn more about how to listen to podcasts and news through the Google Assistant. And, of course, you can listen to Vox’s full slate of podcasts any time on your favorite device.


vox--2020-07-14--Live results for the July 14 primaries

Live results for the July 14 primaries

Voters in Maine , Alabama , and Texas are heading to the polls on Tuesday to choose nominees in several key US Senate and House races .
The most competitive race of the bunch is shaping up to be the Alabama Republican Senate runoff , where it will be determined whether former Sen. Jeff Sessions ( also President Donald Trump ’ s former attorney general ) will even make the general election battle for his old seat .
Once seen as the favorite in the Republican Senate primary , Sessions now has a competitive challenger in former college football coach @ @ @ @ @ @ @ original member of the Trump administration , but he fell out of favor with the president — who has instead given Tuberville his endorsement .
The winner of today ’ s GOP primary will ultimately face Sen. Doug Jones ( D ) , a moderate Democrat in a deep-red state who is in for a tough battle to keep his seat .
Much farther north , Maine ’ s Democratic Senate primary is happening Tuesday .
Three candidates — Maine Speaker of the House Sara Gideon , activist Betsy Sweet , and attorney @ @ @ @ @ @ @ who will be the nominee to go up against longtime Sen. Susan Collins ( R ) .
Gideon is widely expected to prevail ; the race has ostensibly been run like a general election between Collins and Gideon for months already .
Voters in the state ’ s rural and northern Second Congressional District will also choose a Republican nominee to face off against Democratic Rep. Jared Golden , a moderate first-term legislator .
And in Texas , there are more competitive Senate and House primaries .
The Senate primary runoff between Air @ @ @ @ @ @ @ Sen. Royce West has gotten competitive in recent months .
Hegar may have a financial advantage and the backing of the Democratic Senatorial Campaign Committee , but West has received endorsements and help from the Congressional Black Caucus PAC , and has the endorsement of the Houston Chronicle .
The winner will go on to face Republican Sen. John Cornyn , in a race that will be an uphill battle for Democrats to flip .
Vox is covering the results live , with our partners at Decision Desk HQ .
The race between @ @ @ @ @ @ @ Auburn and Texas Tech football coach Tommy Tuberville has pitted two fervent allies of Donald Trump against one another .
Sessions is a one-time member of the administration , but it ’ s former Auburn football coach Tuberville who has gained Trump ’ s endorsement .
The winner of the runoff will face Democratic Sen. Doug Jones , who became the first Democrat to win a Senate seat in the state since 1992 when he defeated Roy Moore , who has been accused of child molestation , in a 2017 special election .
@ @ @ @ @ @ @ 2016 , Jones is believed to be the most vulnerable Democratic incumbent this cycle .
Polls close at 7 pm ET ; Alabama state officials are anticipating a high volume of absentee ballots in the runoff , with over 40,000 ballots requested .
In-person polling places in the state are also open .
Collins is running unopposed in the Republican primary on Tuesday .
Meanwhile , Maine Speaker of the House Sara Gideon is widely considered the frontrunner in the Democratic race .
Gideon has two challengers running to her left — activist @ @ @ @ @ @ @ attorney Bre Kidman , who is the first openly non-binary person to run for US Senate .
Both Sweet and Kidman support progressive policies like Medicare-for-all and a Green New Deal .
Gideon supports a public option and has expressed support for a clean infrastructure plan and investing in renewables .
In Maine ’ s Second Congressional District , Republicans Adrienne Bennett , Eric Brakey , and Dale Crafts are all competing for the chance to unseat Rep. Jared Golden ( D ) .
Crafts is a former state representative ; Bennett previously @ @ @ @ @ @ @ ’ s press secretary ; Brakey is a former Maine state senator with a libertarian lean .
All three candidates have embraced Trump .
This House district is seen as fairly conservative and competitive , and Golden tacks close to the middle ; he was the only member of the House to split his vote on the impeachment vote against President Trump , voting for the first article of impeachment but against the second .
Polls close at 8 pm ET ; Maine state officials are also expecting a high volume of absentee @ @ @ @ @ @ @ In-person polls are also open .
Maine also has a system of ranked-choice voting , which could kick into effect if no candidate reaches the 50 percent threshold needed to win .
In Texas ’ s Democratic Senate runoff this Tuesday , Air Force veteran MJ Hegar and state Sen. Royce West will square off for the chance to face incumbent John Cornyn in November .
With the endorsement of the DSCC and about $ 1.6 million in the bank , Hegar has the advantage — but it ’ s still a competitive @ @ @ @ @ @ @ runoffs in two districts : Texas ’ s 13th and 22nd Congressional Districts .
In TX-22 , sheriff Troy Nehls and GOP activist Kathaleen Wall are competing for the nomination in this open seat that Democrats see as a potential pick-up , with incumbent Rep. Pete Olson ( R ) retiring .
The winner will face Democratic nominee Sri Preston Kulkarni in November .
Kulkarni is a second-time nominee in this district who has a shot at winning .
And in TX-13 , former White House doctor Ronny Jackson faces off against lobbyist @ @ @ @ @ @ @ runoff for the district ’ s GOP nomination will likely decide who will next hold the district ’ s seat in the House .
The district is home to Rep. Mac Thornberry , the ranking member on the House Armed Services Committee who is retiring after a quarter-century in Congress .
Polls close at 8 pm ET ; Texas has expanded absentee ballot access for voters over 65 , but courts have ruled the state does not have to relax requirements for all voters regardless of their age .
In-person polling places in @ @ @ @ @ @ @

Voters in Maine, Alabama, and Texas are heading to the polls on Tuesday to choose nominees in several key US Senate and House races.
The most competitive race of the bunch is shaping up to be the Alabama Republican Senate runoff, where it will be determined whether former Sen. Jeff Sessions (also President Donald Trump’s former attorney general) will even make the general election battle for his old seat.
Once seen as the favorite in the Republican Senate primary, Sessions now has a competitive challenger in former college football coach Tommy Tuberville. Sessions may be an original member of the Trump administration, but he fell out of favor with the president — who has instead given Tuberville his endorsement. The winner of today’s GOP primary will ultimately face Sen. Doug Jones (D), a moderate Democrat in a deep-red state who is in for a tough battle to keep his seat.
Much farther north, Maine’s Democratic Senate primary is happening Tuesday. Three candidates — Maine Speaker of the House Sara Gideon, activist Betsy Sweet, and attorney Bre Kidman — are vying to see who will be the nominee to go up against longtime Sen. Susan Collins (R). Gideon is widely expected to prevail; the race has ostensibly been run like a general election between Collins and Gideon for months already. Voters in the state’s rural and northern Second Congressional District will also choose a Republican nominee to face off against Democratic Rep. Jared Golden, a moderate first-term legislator.
And in Texas, there are more competitive Senate and House primaries. The Senate primary runoff between Air Force veteran candidate MJ Hegar and state Sen. Royce West has gotten competitive in recent months. Hegar may have a financial advantage and the backing of the Democratic Senatorial Campaign Committee, but West has received endorsements and help from the Congressional Black Caucus PAC, and has the endorsement of the Houston Chronicle. The winner will go on to face Republican Sen. John Cornyn, in a race that will be an uphill battle for Democrats to flip.
Vox is covering the results live, with our partners at Decision Desk HQ.
Alabama
The race between former Attorney General Jeff Sessions and former Auburn and Texas Tech football coach Tommy Tuberville has pitted two fervent allies of Donald Trump against one another. Sessions is a one-time member of the administration, but it’s former Auburn football coach Tuberville who has gained Trump’s endorsement. The winner of the runoff will face Democratic Sen. Doug Jones, who became the first Democrat to win a Senate seat in the state since 1992 when he defeated Roy Moore, who has been accused of child molestation, in a 2017 special election. In a state Trump won handily in 2016, Jones is believed to be the most vulnerable Democratic incumbent this cycle.
Polls close at 7 pm ET; Alabama state officials are anticipating a high volume of absentee ballots in the runoff, with over 40,000 ballots requested. In-person polling places in the state are also open.
Alabama Republican Senate runoff
Maine
Collins is running unopposed in the Republican primary on Tuesday. Meanwhile, Maine Speaker of the House Sara Gideon is widely considered the frontrunner in the Democratic race. Gideon has two challengers running to her left — activist and 2018 gubernatorial candidate Betsy Sweet and attorney Bre Kidman, who is the first openly non-binary person to run for US Senate. Both Sweet and Kidman support progressive policies like Medicare-for-all and a Green New Deal. Gideon supports a public option and has expressed support for a clean infrastructure plan and investing in renewables.
In Maine’s Second Congressional District, Republicans Adrienne Bennett, Eric Brakey, and Dale Crafts are all competing for the chance to unseat Rep. Jared Golden (D). Crafts is a former state representative; Bennett previously served as former Gov. Paul LePage’s press secretary; Brakey is a former Maine state senator with a libertarian lean. All three candidates have embraced Trump. This House district is seen as fairly conservative and competitive, and Golden tacks close to the middle; he was the only member of the House to split his vote on the impeachment vote against President Trump, voting for the first article of impeachment but against the second.
Polls close at 8 pm ET; Maine state officials are also expecting a high volume of absentee ballots, with over 100,000 requested. In-person polls are also open. Maine also has a system of ranked-choice voting, which could kick into effect if no candidate reaches the 50 percent threshold needed to win.
Maine Senate Democratic primary
Maine’s Second Congressional District Republican primary
Texas
In Texas’s Democratic Senate runoff this Tuesday, Air Force veteran MJ Hegar and state Sen. Royce West will square off for the chance to face incumbent John Cornyn in November. With the endorsement of the DSCC and about $1.6 million in the bank, Hegar has the advantage — but it’s still a competitive race.
There are also Republican House runoffs in two districts: Texas’s 13th and 22nd Congressional Districts. In TX-22, sheriff Troy Nehls and GOP activist Kathaleen Wall are competing for the nomination in this open seat that Democrats see as a potential pick-up, with incumbent Rep. Pete Olson (R) retiring. The winner will face Democratic nominee Sri Preston Kulkarni in November. Kulkarni is a second-time nominee in this district who has a shot at winning.
And in TX-13, former White House doctor Ronny Jackson faces off against lobbyist Josh Winegarner on Tuesday. The competitive runoff for the district’s GOP nomination will likely decide who will next hold the district’s seat in the House. The district is home to Rep. Mac Thornberry, the ranking member on the House Armed Services Committee who is retiring after a quarter-century in Congress.
Polls close at 8 pm ET; Texas has expanded absentee ballot access for voters over 65, but courts have ruled the state does not have to relax requirements for all voters regardless of their age. In-person polling places in the state will also be open.
Texas Senate Democratic runoff
Texas House Republican runoffs


vox--2020-07-14--What happens if Covid-19 symptoms don’t go away? Doctors are trying to figure it out.

What happens if Covid-19 symptoms don ’ t go away ?
Doctors are trying to figure it out .
Share All sharing options for : What happens if Covid-19 symptoms don ’ t go away ?
Doctors are trying to figure it out .
In late March , when Covid-19 was first surging , Jake Suett , a doctor of anesthesiology and intensive care medicine with the National Health Service in Norfolk , England , had seen plenty of patients with the disease — and intubated a few of them .
Then one day , he started to feel unwell @ @ @ @ @ @ @ .
He pushed through it , continuing to work for five days until he developed a dry cough and fever .
“ Eventually , I got to the point where I was gasping for air literally doing nothing , lying on my bed.
” At the hospital , his chest X-rays and oxygen levels were normal — except he was gasping for air .
After he was sent home , he continued to experience trouble breathing and developed severe cardiac-type chest pain .
Because of a shortage of Covid-19 tests , Suett wasn @ @ @ @ @ @ @ was able to get a test , more than a month after he got sick , it came back negative .
PCR tests , which are most commonly used , can only detect acute infections , and because of testing shortages , not everyone has been able to get a test when they need one .
It ’ s now been 14 weeks since Suett ’ s presumed infection and he still has symptoms , including trouble concentrating , known as brain fog .
( One recent study in Spain found that a @ @ @ @ @ @ @ neurological symptoms , including headaches and seizures . )
“ I don ’ t know what my future holds anymore , ” Suett says .
Doctors have dismissed some of his ongoing symptoms .
One doctor suggested his intense breathing difficulties might be related to anxiety .
“ I found that really surprising , ” Suett says .
“ As a doctor , I wanted to tell people , ‘ Maybe we ’ re missing something here.
’ ” He ’ s concerned not just for himself , but that many Covid-19 survivors @ @ @ @ @ @ @ acknowledged or treated .
Suett says that even if the proportion of people who don ’ t eventually fully recover is small , there ’ s still a significant population who will need long-term care — and they ’ re having trouble getting it .
“ It ’ s a huge , unreported problem , and it ’ s crazy no one is shouting this from rooftops.
” In the US , a number of specialized centers are popping up at hospitals to help treat — and study — ongoing Covid-19 symptoms .
@ @ @ @ @ @ @ protocols and a wide range of experts , from pulmonologists to psychiatrists .
Yet even as care improves , patients are also running into familiar challenges in finding treatment : accessing and being able to pay for it .
Scientists are still learning about the many ways the virus that causes Covid-19 impacts the body — both during initial infection and as symptoms persist .
One of the researchers studying them is Michael Peluso , a clinical fellow in infectious diseases at the University of California San Francisco , who is currently enrolling @ @ @ @ @ @ @ two-year study to study the disease ’ s long-term effects .
The goal is to better understand what symptoms people are developing , how long they last , and eventually , the mechanisms that cause them .
This could help scientists answer questions like how antibodies and immune cells called T-cells respond to the virus , and how different individuals might have different immune responses , leading to longer or shorter recovery times .
At the beginning of the Covid-19 pandemic , “ the assumption was that people would get better , and @ @ @ @ @ @ @ says .
“ But we know from lots of other viral infections that there is almost always a subset of people who experience longer-term consequences.
” He explains these can be due to damage to the body during the initial illness , the result of lingering viral infection , or because of complex immunological responses that occur after the initial disease .
“ People sick enough to be hospitalized are likely to experience prolonged recovery , but with Covid-19 , we ’ re seeing tremendous variability , ” he says .
It ’ @ @ @ @ @ @ @ who experience long-term symptoms , but often people who weren ’ t even initially hospitalized .
“ We know from lots of other viral infections that there is almost always a subset of people who experience longer-term consequences ” That ’ s why long-term studies of large numbers of Covid-19 patients are so important , Peluso says .
Once researchers can find what might be causing long-term symptoms , they can start targeting treatments to help people feel better .
“ I hope that a few months from now , we ’ ll @ @ @ @ @ @ @ biological target for managing some of these long-term symptoms.
” Lekshmi Santhosh , a physician lead and founder of the new post-Covid OPTIMAL Clinic at UCSF , says many of her patients are reporting the same kinds of problems .
“ The majority of patients have either persistent shortness of breath and/or fatigue for weeks to months , ” she says .
Additionally , Timothy Henrich , a virologist and viral immunologist at UCSF who is also a principal investigator in the study , says that getting better at managing the initial illness @ @ @ @ @ @ @ acute treatments may also help reduce severity and duration of post-infectious symptoms.
” In the meantime , doctors can already help patients by treating some of their lingering symptoms .
But the first step , Peluso explains , is not dismissing them .
“ It is important that patients know — and that doctors send the message — that they can help manage these symptoms , even if they are incompletely understood , ” he says .
“ It sounds like many people may not be being told that.
” Even though we @ @ @ @ @ @ @ specific damage Covid-19 can cause , doctors already know quite a bit about recovery from other viruses : namely , how complex and challenging a task long-term recovery from any serious infection can be for many patients .
Generally , it ’ s common for patients who have been hospitalized , intubated , or ventilated — as is common with severe Covid-19 — to have a long recovery .
Being bed-bound can cause muscle weakness , known as deconditioning , which can result in prolonged shortness of breath .
After a severe illness @ @ @ @ @ @ @ depression , and PTSD .
A stay in the ICU not uncommonly leads to delirium , a serious mental disorder sometimes resulting in confused thinking , hallucinations , and reduced awareness of surroundings .
But Covid-19 has created a “ delirium factory , ” says Santhosh at UCSF .
This is because the illness has meant long hospital stays , interactions only with staff in full PPE , and the absence of family or other visitors .
Theodore Iwashyna , an ICU physician-scientist at the University of Michigan and VA Ann Arbor , @ @ @ @ @ @ @ a group of 40 post-intensive care clinics on four continents .
In general , after patients are discharged from ICUs , he says , “ about half of people have some substantial new disability , and half will never get back to work .
Maybe a third of people will have some degree of cognitive impairment .
And a third have emotional problems.
” And it ’ s common for them to have difficulty getting care for their ongoing symptoms after being discharged .
In working with Covid-19 patients , says Santhosh , @ @ @ @ @ @ @ you ... and we are going to work on the mind and body together.
” Yet it ’ s currently impossible to predict who will have long-lasting symptoms from Covid-19 .
“ People who are older and frailer with more comorbidities are more likely to have longer physical recovery .
However , I ’ ve seen a lot of young people be really , really sick , ” Santhosh says .
“ They will have a long tail of recovery too.
” At the new OPTIMAL Clinic at UCSF , doctors are seeing @ @ @ @ @ @ @ the UCSF health system , as well as taking referrals of other patients with persistent pulmonary symptoms .
For ongoing cough and chest tightness , the clinic is providing inhalers , as well as pulmonary rehabilitation , including gradual aerobic exercise with oxygen monitoring .
They ’ re also connecting patients with mental health resources .
“ Normalizing those symptoms , as well as plugging people into mental health care , is really critical , ” says Santhosh , who is also the physician lead and founder of the clinic .
“ I @ @ @ @ @ @ @ .
It ’ s not ‘ in their heads.
’ ” Neeta Thakur , a pulmonary specialist at Zuckerberg San Francisco General Hospital and Trauma Center who has been providing care for Covid-19 patients in the ICU , just opened a similar outpatient clinic for post-Covid care .
Thakur has also arranged a multidisciplinary approach , including occupational and physical therapy , as well as expedited referrals to neurology colleagues for rehabilitation for the muscles and nerves that can often be compressed when patients are prone for long periods in the ICU .
@ @ @ @ @ @ @ the cognitive impairments she ’ s seeing , especially as she ’ s dealing with a lot of younger patients .
These California centers join new post-Covid-19 clinics in major cities across the country , including Mount Sinai in New York and National Jewish Health Hospital in Denver .
As more and more hospitals begin to focus on post-Covid care , Iwashyna suggests patients try to seek treatment where they were hospitalized , if possible , because of the difficulty in transferring sufficient medical records .
Santosh recommends that patients with persistent symptoms @ @ @ @ @ @ @ academic medical center ’ s pulmonary division , and ask if they can participate in any clinical trials .
Many of the new clinics are enrolling patients in studies to try to better understand the long-term consequences of the disease .
Fortunately , treatment associated with research is often free , and sometimes also offers financial incentives to participants .
But otherwise , one of the biggest challenges in post-Covid-19 treatment is — like so much of American health care — being able to pay for it .
Outside of clinical trials , @ @ @ @ @ @ @ .
It can be tricky to get insurance to cover long-term care , Iwashyna notes .
After being discharged from an ICU , he says , “ Recovery depends on [ patients ’ ] social support , and how broke they are afterward.
” Many struggle to cover the costs of treatment .
“ Our patient population is all underinsured , ” says Thakur , noting that her hospital works with patients to try to help cover costs .
Lasting health impacts can also affect a person ’ s ability to go back @ @ @ @ @ @ @ experience , many patients quickly run through their guaranteed 12 weeks of leave under the Family Medical and Leave Act , which isn ’ t required to be paid .
Eve Leckie , a 39-year-old ICU nurse in New Hampshire , came down with Covid-19 on March 15 .
Since then , Leckie has experienced symptom relapses and still can ’ t even get a drink of water without help .
“ I ’ m typing this to you from my bed , because I ’ m too short of breath today to @ @ @ @ @ @ @ “ This could disable me for the rest of my life , and I have no idea how much that would cost , or at what point I will lose my insurance , since it ’ s dependent on my employment , and I ’ m incapable of working.
” Leckie was the sole wage earner for their five children , and was facing eviction when their partner “ essentially rescued us , ” allowing them to move in .
These long-term burdens are not being felt equally .
At Thakur ’ s @ @ @ @ @ @ @ population [ admitted ] here is younger and Latinx , a disparity which reflects who gets exposed , ” she says .
She worries that during the pandemic , “ social and structural determinants of health will just widen disparities across the board.
” People of color have been disproportionately affected by the virus , in part because they are less likely to be able to work from home .
Black people are also more likely to be hospitalized if they get Covid-19 , both because of higher rates of preexisting conditions — @ @ @ @ @ @ @ — and because of lack of access to health care .
“ If you are more likely to be exposed because of your job , and likely to seek care later because of fear of cost , or needing to work , you ’ re more likely to have severe disease , ” Thakur says .
“ As a result , you ’ re more likely to have long-term consequences .
Depending on what that looks like , your ability to work and economic opportunities will be hindered .
It ’ s a @ @ @ @ @ @ @ of health can really impact someone over their lifetime.
” If policies don ’ t support people with persistent symptoms in getting the care they need , ongoing Covid-19 challenges will deepen what ’ s already a clear crisis of inequality .
Iwashyna explains that a lot of extended treatment for Covid-19 patients is “ going to be about interactions with health care systems that are not well-designed .
The correctable problems often involve helping people navigate a horribly fragmented health care system .
“ We can fix that , but we ’ @ @ @ @ @ @ @ .
These patients need help now.
” Lois Parshley is a freelance investigative journalist and the 2019-2020 Snedden Chair of Journalism at the University of Alaska Fairbanks .
Follow her Covid-19 reporting on Twitter @ loisparshley .
Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ @ @ @ @ @ @ @ ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

What happens if Covid-19 symptoms don’t go away? Doctors are trying to figure it out.
Share All sharing options for: What happens if Covid-19 symptoms don’t go away? Doctors are trying to figure it out.
In late March, when Covid-19 was first surging, Jake Suett, a doctor of anesthesiology and intensive care medicine with the National Health Service in Norfolk, England, had seen plenty of patients with the disease — and intubated a few of them.
Then one day, he started to feel unwell, tired, with a sore throat. He pushed through it, continuing to work for five days until he developed a dry cough and fever. “Eventually, I got to the point where I was gasping for air literally doing nothing, lying on my bed.”
At the hospital, his chest X-rays and oxygen levels were normal — except he was gasping for air. After he was sent home, he continued to experience trouble breathing and developed severe cardiac-type chest pain.
Because of a shortage of Covid-19 tests, Suett wasn’t immediately tested; when he was able to get a test, 24 days after he got sick, it came back negative. PCR tests, which are most commonly used, can only detect acute infections, and because of testing shortages, not everyone has been able to get a test when they need one.
It’s now been 14 weeks since Suett’s presumed infection and he still has symptoms, including trouble concentrating, known as brain fog. (One recent study in Spain found that a majority of 841 hospitalized Covid-19 patients had neurological symptoms, including headaches and seizures.) “I don’t know what my future holds anymore,” Suett says.
Some doctors have dismissed some of his ongoing symptoms. One doctor suggested his intense breathing difficulties might be related to anxiety. “I found that really surprising,” Suett says. “As a doctor, I wanted to tell people, ‘Maybe we’re missing something here.’” He’s concerned not just for himself, but that many Covid-19 survivors with long-term symptoms aren’t being acknowledged or treated.
Related My coronavirus survivor group is my most important medical support right now
Suett says that even if the proportion of people who don’t eventually fully recover is small, there’s still a significant population who will need long-term care — and they’re having trouble getting it. “It’s a huge, unreported problem, and it’s crazy no one is shouting this from rooftops.”
In the US, a number of specialized centers are popping up at hospitals to help treat — and study — ongoing Covid-19 symptoms. The most successful draw on existing post-ICU protocols and a wide range of experts, from pulmonologists to psychiatrists. Yet even as care improves, patients are also running into familiar challenges in finding treatment: accessing and being able to pay for it.
What’s causing these long-term symptoms?
Scientists are still learning about the many ways the virus that causes Covid-19 impacts the body — both during initial infection and as symptoms persist.
One of the researchers studying them is Michael Peluso, a clinical fellow in infectious diseases at the University of California San Francisco, who is currently enrolling Covid-19 patients in San Francisco in a two-year study to study the disease’s long-term effects. The goal is to better understand what symptoms people are developing, how long they last, and eventually, the mechanisms that cause them. This could help scientists answer questions like how antibodies and immune cells called T-cells respond to the virus, and how different individuals might have different immune responses, leading to longer or shorter recovery times.
At the beginning of the Covid-19 pandemic, “the assumption was that people would get better, and then it was over,” Peluso says. “But we know from lots of other viral infections that there is almost always a subset of people who experience longer-term consequences.” He explains these can be due to damage to the body during the initial illness, the result of lingering viral infection, or because of complex immunological responses that occur after the initial disease.
“People sick enough to be hospitalized are likely to experience prolonged recovery, but with Covid-19, we’re seeing tremendous variability,” he says. It’s not necessarily just the sickest patients who experience long-term symptoms, but often people who weren’t even initially hospitalized.
“We know from lots of other viral infections that there is almost always a subset of people who experience longer-term consequences”
That’s why long-term studies of large numbers of Covid-19 patients are so important, Peluso says. Once researchers can find what might be causing long-term symptoms, they can start targeting treatments to help people feel better. “I hope that a few months from now, we’ll have a sense if there is a biological target for managing some of these long-term symptoms.”
Lekshmi Santhosh, a physician lead and founder of the new post-Covid OPTIMAL Clinic at UCSF, says many of her patients are reporting the same kinds of problems. “The majority of patients have either persistent shortness of breath and/or fatigue for weeks to months,” she says.
Additionally, Timothy Henrich, a virologist and viral immunologist at UCSF who is also a principal investigator in the study, says that getting better at managing the initial illness may also help. “More effective acute treatments may also help reduce severity and duration of post-infectious symptoms.”
In the meantime, doctors can already help patients by treating some of their lingering symptoms. But the first step, Peluso explains, is not dismissing them. “It is important that patients know — and that doctors send the message — that they can help manage these symptoms, even if they are incompletely understood,” he says. “It sounds like many people may not be being told that.”
Long-term symptoms, long-term consequences
Even though we have a lot to learn about the specific damage Covid-19 can cause, doctors already know quite a bit about recovery from other viruses: namely, how complex and challenging a task long-term recovery from any serious infection can be for many patients.
Generally, it’s common for patients who have been hospitalized, intubated, or ventilated — as is common with severe Covid-19 — to have a long recovery. Being bed-bound can cause muscle weakness, known as deconditioning, which can result in prolonged shortness of breath. After a severe illness, many people also experience anxiety, depression, and PTSD.
A stay in the ICU not uncommonly leads to delirium, a serious mental disorder sometimes resulting in confused thinking, hallucinations, and reduced awareness of surroundings. But Covid-19 has created a “delirium factory,” says Santhosh at UCSF. This is because the illness has meant long hospital stays, interactions only with staff in full PPE, and the absence of family or other visitors.
Theodore Iwashyna, an ICU physician-scientist at the University of Michigan and VA Ann Arbor, is involved with the CAIRO Network, a group of 40 post-intensive care clinics on four continents. In general, after patients are discharged from ICUs, he says, “about half of people have some substantial new disability, and half will never get back to work. Maybe a third of people will have some degree of cognitive impairment. And a third have emotional problems.” And it’s common for them to have difficulty getting care for their ongoing symptoms after being discharged.
In working with Covid-19 patients, says Santhosh, she tells patients, “We believe you ... and we are going to work on the mind and body together.”
Yet it’s currently impossible to predict who will have long-lasting symptoms from Covid-19. “People who are older and frailer with more comorbidities are more likely to have longer physical recovery. However, I’ve seen a lot of young people be really, really sick,” Santhosh says. “They will have a long tail of recovery too.”
Who can access care?
At the new OPTIMAL Clinic at UCSF, doctors are seeing patients who were hospitalized for Covid-19 at the UCSF health system, as well as taking referrals of other patients with persistent pulmonary symptoms. For ongoing cough and chest tightness, the clinic is providing inhalers, as well as pulmonary rehabilitation, including gradual aerobic exercise with oxygen monitoring. They’re also connecting patients with mental health resources.
“Normalizing those symptoms, as well as plugging people into mental health care, is really critical,” says Santhosh, who is also the physician lead and founder of the clinic. “I want people to know this is real. It’s not ‘in their heads.’”
Neeta Thakur, a pulmonary specialist at Zuckerberg San Francisco General Hospital and Trauma Center who has been providing care for Covid-19 patients in the ICU, just opened a similar outpatient clinic for post-Covid care. Thakur has also arranged a multidisciplinary approach, including occupational and physical therapy, as well as expedited referrals to neurology colleagues for rehabilitation for the muscles and nerves that can often be compressed when patients are prone for long periods in the ICU. But she’s most concerned by the cognitive impairments she’s seeing, especially as she’s dealing with a lot of younger patients.
These California centers join new post-Covid-19 clinics in major cities across the country, including Mount Sinai in New York and National Jewish Health Hospital in Denver. As more and more hospitals begin to focus on post-Covid care, Iwashyna suggests patients try to seek treatment where they were hospitalized, if possible, because of the difficulty in transferring sufficient medical records.
Santosh recommends that patients with persistent symptoms call their closest hospital, or nearest academic medical center’s pulmonary division, and ask if they can participate in any clinical trials. Many of the new clinics are enrolling patients in studies to try to better understand the long-term consequences of the disease. Fortunately, treatment associated with research is often free, and sometimes also offers financial incentives to participants.
But otherwise, one of the biggest challenges in post-Covid-19 treatment is — like so much of American health care — being able to pay for it.
Outside of clinical trials, cost can be a barrier to treatment. It can be tricky to get insurance to cover long-term care, Iwashyna notes. After being discharged from an ICU, he says, “Recovery depends on [patients’] social support, and how broke they are afterward.” Many struggle to cover the costs of treatment. “Our patient population is all underinsured,” says Thakur, noting that her hospital works with patients to try to help cover costs.
Related 4 aftershocks of the coronavirus pandemic that will be felt for years
Lasting health impacts can also affect a person’s ability to go back to work. In Iwashyna’s experience, many patients quickly run through their guaranteed 12 weeks of leave under the Family Medical and Leave Act, which isn’t required to be paid. Eve Leckie, a 39-year-old ICU nurse in New Hampshire, came down with Covid-19 on March 15. Since then, Leckie has experienced symptom relapses and still can’t even get a drink of water without help.
“I’m typing this to you from my bed, because I’m too short of breath today to get out,” they say. “This could disable me for the rest of my life, and I have no idea how much that would cost, or at what point I will lose my insurance, since it’s dependent on my employment, and I’m incapable of working.” Leckie was the sole wage earner for their five children, and was facing eviction when their partner “essentially rescued us,” allowing them to move in.
These long-term burdens are not being felt equally. At Thakur’s hospital in San Francisco, “The population [admitted] here is younger and Latinx, a disparity which reflects who gets exposed,” she says. She worries that during the pandemic, “social and structural determinants of health will just widen disparities across the board.” People of color have been disproportionately affected by the virus, in part because they are less likely to be able to work from home.
Black people are also more likely to be hospitalized if they get Covid-19, both because of higher rates of preexisting conditions — which are the result of structural inequality — and because of lack of access to health care.
“If you are more likely to be exposed because of your job, and likely to seek care later because of fear of cost, or needing to work, you’re more likely to have severe disease,” Thakur says. “As a result, you’re more likely to have long-term consequences. Depending on what that looks like, your ability to work and economic opportunities will be hindered. It’s a very striking example of how social determinants of health can really impact someone over their lifetime.”
If policies don’t support people with persistent symptoms in getting the care they need, ongoing Covid-19 challenges will deepen what’s already a clear crisis of inequality.
Iwashyna explains that a lot of extended treatment for Covid-19 patients is “going to be about interactions with health care systems that are not well-designed. The correctable problems often involve helping people navigate a horribly fragmented health care system.
“We can fix that, but we’re not going to fix that tomorrow. These patients need help now.”
Lois Parshley is a freelance investigative journalist and the 2019-2020 Snedden Chair of Journalism at the University of Alaska Fairbanks. Follow her Covid-19 reporting on Twitter @loisparshley.