We’ve known since the beginning of the pandemic that the effects of the disease and response to the disease have different impacts on different groups of people. Healthcare workers have been among the most impacted by both the physical and psychological impacts of COVID. Futurity (US) reports new research shows, COVID-19 health care workers experienced high rates of potential ‘moral injury’ that are comparable to rates experienced by military veterans…. ‘Moral injuries can happen when health care workers’ values and beliefs conflict with their actions or the ways they witness others acting,’ says lead author Jason Nieuwsma…. Among the experiences that conflicted with their moral values, health care workers say they witnessed the public’s disregard for preventing COVID-19 transmission, saw people dying, endured staffing shortages, rationed care and personal protective equipment, and enforced policies disallowing visitors to see dying patients.” Beckers Hospital Review (US) quotes the study authors: "The potential for moral injury is relatively high among combat veterans and COVID-19 [healthcare workers], with deleterious consequences for mental health and burnout. Demographic characteristics suggestive of less social empowerment may increase risk for moral injury. Longitudinal research among COVID-19 [healthcare workers] is needed. Moral injury prevention and intervention efforts for [healthcare workers] may benefit from consulting models used with veterans."
 

If You Are in a Hurry

• Read Medscape on the impact of the US government’s lack of COVID funding on the global pandemic.
• Read MIT Technology Review on a Zambian study that reveals excess deaths from COVID.
• Then read WHO Africa on the estimated true toll of COVID in Africa.
• Read Vox on what the media got wrong about COVID and how to improve reporting on the next pandemic.
• Read The Guardian on risk perception among friends.
• Read Vox on the consequences of too few health workers to staff the pandemic.
• Read Nature on the consequences of WHO taking so long to declare SARS-CoV-2 airborne.
• Read Nature on what may trigger severe COVID.

 

Consequences of US Cut to Global COVID Aid

 
AP (US) reports health experts are criticizing US cuts to COVID aid. “They warn the suspension of COVID-19 aid for poorer countries could ultimately allow the kind of unchecked transmission needed for the next worrisome variant to emerge and unravel much of the progress achieved so far. The US has been the biggest contributor to the global pandemic response, delivering more than 500 million vaccines, and the lack of funding will be a major setback. The money has paid for numerous interventions, including a mass vaccination campaign in the Cameroonian capital that saw hundreds of thousands of people get their first dose, as well as the construction of a COVID-19 care facility in South Africa and the donation of 1,000 ventilators to that country.”
 
Medscape (US) reports, “Without global funding, [US HHS Secretary] Becerra said, the US Agency for International Development will not have resources ‘to get more shots in arms around the world. We will be forced to scale back our work providing oxygen and antiviral pills to others in need. We will lack the funding to provide rapid testing to countries in need at every turn.’ Helping all countries reach the WHO goal of vaccinating at least 70 percent of their populations ‘is in the interest of the United States itself,’ [WHO’s] Tedros said.”
 

COVID Impact in Africa

 
MIT Technology Review (US) reports in a study in a Zambian morgue: “it is here, among the cadavers at Zambia’s largest hospital, that researchers are finally close to solving one of the pandemic’s enduring mysteries: why Africa appeared to have been spared the brunt of the covid death toll experienced elsewhere. The truth, it increasingly appears, is that it wasn’t…. That’s the claim made by a new study, which has not yet been peer reviewed, based on tests of corpses carried out by staff equipped with nasal swabs and a heavy tolerance for the macabre. It constitutes perhaps the strongest clinical evidence yet that COVID-19 deaths in Lusaka, and likely much of Africa, have been vastly undercounted.”
 
WHO Africa says, “Up to 65 percent of Africans have been infected by SARS-CoV-2, the virus which causes COVID-19, a World Health Organization (WHO) analysis finds. The study finds that true infections on the continent were 97 times larger than reported confirmed cases. The analysis, which is available as a pre-print under peer review, synthesized 151 studies published on seroprevalence in Africa between January 2020 and December 2021. It found that exposure to SARS-CoV-2 skyrocketed from 3 percent (1.0-9.2 percent range) in June of 2020 to 65 percent (56.3-73 percent range) by September of 2021, or 800 million infections compared with 8.2 million cases reported at that time. The study showed that exposure to the virus rose sharply following the emergence of the Beta and the Delta variants. The analysis revealed that the true number of infections could be as much as 97 times higher than the number of confirmed reported cases. This compares to the global average where true number of infections is 16 times higher than the number of confirmed reported cases…. The continent differentiates itself from other regions by its high number of asymptomatic cases, with 67 percent of cases having no symptoms.”
 

Reinfections

 
US News (US) reports, “New research from the Centers for Disease Control and Prevention documented 10 cases of early coronavirus reinfection from the omicron variant shortly after infection from the delta variant, raising questions about the lasting power of natural immunity against new variants…. Due to rapid tests taken at home and limited capacity for strain testing in general, ‘most early reinfections are likely not identified,’ the CDC report stated.”
 

Immunity from Vaccination Plus Infection

 
Nature (UK) reports, “Even people who have had COVID-19 receive long-lasting benefits from a full course of vaccination, according to three recent studies. What's more, one of the studies found that the ‘hybrid’ immunity caused by vaccination and infection is long-lasting, conferring highly effective protection against symptomatic disease for at least six to eight months after vaccination…. Miguel Hernan, an epidemiologist at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, says the studies show the near-universal benefit of full vaccination. Some nations have issued guidelines that encourage people who have had COVID-19 to receive only a single vaccine dose: a move that ‘may be justified in a setting of vaccine scarcity, but not otherwise’…”
 

The Consequences of Eased COVID Restrictions

 
CBS News (US) reports some European “airlines are having to cancel hundreds of flights as they grapple with coronavirus-related staffing shortages weeks after they ditched rules requiring passengers and staff to mask up in the air…
 
AP (US) reports, The US is getting a first glimpse of what it's like to experience COVID-19 outbreaks during this new phase of living with the virus, and the roster of the newly infected is studded with stars. Cabinet members, House Speaker Nancy Pelosi, Broadway actors and the governors of New Jersey and Connecticut have all tested positive. Outbreaks at Georgetown University and Johns Hopkins University are bringing back mask requirements to those campuses as officials seek out quarantine space…. Across the nation, mask-wearing is at its lowest level since April 2020, said Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle. For every 100 infections, only seven are recorded in official tallies, according to his modeling group's latest estimate.”
 

COVID in China

 
Think Global Health (US) reports, “As transmission of the omicron variant speeds up in China, with the government imposing ever more aggressive lockdowns to halt its spread, the country is on the brink of a massive societal crisis…. It's still possible that China will succeed in stamping out this latest outbreak of omicron in Shanghai through lockdowns, as they did in Beijing earlier this year. But omicron's highly transmissible BA.2 mutation is a formidable enemy, and it could tear through communities like wildfire as it did recently in Hong Kong.”
 

India to Offer Boosters to All

 
Economic Times (India) reports, “India will make COVID-19 booster shots available to all adults for a fee…as the number of new virus cases in the country drops sharply. The nation of 1.3 billion has administered 1.85 billion shots so far, giving 96 percent of the population a single dose and 83 percent two jabs.”
 
AP (US) reports, “The doses, which India is calling a ‘precautionary’ shot instead of a booster, are available to people nine months after they receive their second jab, the Health Ministry said in a statement Friday. Those outside the two priority categories [healthcare workers and people over 60] will need to pay for the shots at privately run facilities, the ministry said.”
 

Reporting COVID

 
Vox (US) reports, “The media has come under harsh scrutiny for how it has covered COVID-19, for good and sometimes for unfair reasons. It is absolutely true that covering a fast-moving pandemic in an age when science is being done at a record cadence and under an unrelenting spotlight is a truly difficult job. But mistakes under duress are mistakes nonetheless, and the only way we get better at this job is to learn from them…. COVID-19 origins are far from the only story during the pandemic where there were efforts to put forward a ‘united front’ or an appearance of scientists all agreeing, when in fact the science was uncertain and the scientists did disagree. The attitudes that are lacking here — tolerance of uncertainty, a willingness to withhold reassuring but incomplete answers, and courage to admit past mistakes — are attitudes that we’ll need to adopt to do better in the next pandemic.”
 
Apoorva Mandavilli reports in The New York Times (US) on her personal experience of getting COVID after reporting on it through the pandemic, writing that “the experience nevertheless gave me perspective I would not have gained from reading scientific papers or interviewing experts….I’ve written about many diseases — HIV, tuberculosis, malaria, leprosy, polio — that I’ve never had. I could have done without this experience of getting COVID. I’m not worried about these symptoms persisting for too long — vaccination significantly cuts the risk of so-called long COVID — but I’m still inordinately fond of naps. I’m thankful to have gained a richer, broader immune defense to the virus. But mostly, I am glad to have a deeper understanding of what our readers have been experiencing.”
 

Staffing the Next Pandemic

 
Vox (US) reports, “When COVID-19 first hit the US health care system, the biggest concerns about responding to the crisis were about physical infrastructure: Would hospitals have enough ventilators or physical space to care for a surge of patients? But the shortfalls that limited the American response were ultimately about the country’s human infrastructure: There were not enough nurses in hospitals, not enough staff in long-term care facilities, not enough public health workers…[C]oming up with ways to temporarily expand the health care workforce — creating better protocols for relaxing medical regulations, calling in surge capacity staffing, and better allocating staff across the country in order to respond to the next emergency — is the first preparedness priority after our failures during the pandemic.”
 

Mixed News About 4^th Shots

 
Medpage Today (US) reports, “Rates of confirmed Omicron-related COVID infection and severe disease were lower after a fourth dose of the Pfizer-BioNTech vaccine, according to real-world data from Israel, although protection against confirmed infection seemed short-lived. Among adults ages 60 and up, the adjusted rate of confirmed infection 4 weeks after the fourth dose was twice as low compared to those who received three doses…. The authors concluded that a fourth dose provided ‘only short-term protection and a modest absolute benefit,’ for confirmed infection, but that it did increase protection against severe disease.”
 
Reuters (UK) reports, “EU health agencies said…there was no evidence to support the use of a fourth dose of COVID-19 vaccines developed by Pfizer and Moderna in the general population, but they recommend a second booster for people aged 80 and above. There is no clear evidence in the European Union that vaccine protection against severe disease is waning substantially in adults with normal immune systems aged 60-79, the European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC) said in a joint statement.”
 

Do We Need Better Boosters?

 
Bloomberg (US) reports, “While the COVID-19 vaccines have been very effective at stopping hospital admissions 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.”
 

Risk Perception

 
The Guardian (UK) reports, “The presence, or even the thought, of friends and family can lull people into a false sense of security when it comes to COVID, researchers have found. Marketing experts have revealed that those who believe they previously caught COVID from a friend or family member are less likely to think they would catch it again than those who were infected by an acquaintance or stranger…. ‘Limiting interactions to close friends and family members is a common protective measure to reduce COVID-19 transmission risk, but the study findings demonstrate that this practice also unintentionally creates other issues, in that people tend to perceive reduced health risks and engage in potentially hazardous health behaviours,’ the authors report.”
 

A Call for Clean Indoor Air

 
A commentary in Spotlight (South Africa) argues, “The COVID-19 pandemic has had a devastating impact on tuberculosis (TB) care in South Africa and globally, with TB-related deaths increasing for the first time in a decade. However, since COVID-19 and TB are both airborne infections, the attention surrounding mitigation measures could provide a glimmer of hope for the TB response…. Yet there has been inadequate prioritisation of the need to improve the safety of our shared air. This is particularly important in crowded indoor settings that pose the highest risk of transmission and requires dedicated efforts, resources, and policy changes to improve indoor ventilation.”
 

WHO’s Lag in Calling COVID Airborne

 
Nature (UK) reports, “Early in the pandemic, the World Health Organization stated that SARS-CoV-2 was not transmitted through the air. That mistake and the prolonged process of correcting it sowed confusion and raises questions about what will happen in the next pandemic.” The classification of SARS-CoV-2 as airborne, “places the virus among a select group of ‘airborne’ infections, a label long reserved for just a handful of the world’s most virulent pathogens, including measles, chickenpox and tuberculosis…. [One expert] says that there’s much greater recognition of airborne transmission because of the COVID-19 pandemic, and research over the next few years will probably show that most respiratory viruses can spread in this way. So the whole world will be more alert to the possibility of the airborne threat when old or new infectious diseases start spreading.”
 

Triggers for Severe COVID

 
Nature (UK) reports, “Immune cells infected with SARS-CoV-2 can trigger a massive inflammatory response that contributes to severe COVID-19, suggest two papers — one published…in Nature, and a preprint posted online…. Since the early days of the pandemic, research has suggested that inflammation leads to significant respiratory distress and other organ damage, hallmarks of severe COVID-19. But scientists have struggled to pinpoint what triggers the inflammation. The latest studies implicate two types of white blood cells — macrophages in the lungs, and monocytes in the blood — which, once infected with the virus, trigger the inflammation. The studies also provide conclusive evidence that the virus can infect and replicate in immune cells — and reveal how it enters those cells. Evidence of such infections has been mixed until now.”
 

New Waves of COVID

 
CBC (Canada) reports Ontario, Canada is facing a 6^th wave of COVID: “Estimates from the viral count in wastewater suggest about 100,000 people are now getting infected daily in Ontario, according to the COVID-19 Science Advisory Table. That is a faster infection rate than at any previous time in the pandemic. All of this leaves no doubt that Ontario is in a sixth wave…”
 
CNN (US) reports, “Dr. Anthony Fauci…said…that he thinks there will be an uptick in cases of COVID-19 over the next few weeks and that it is likely that there could be a surge in the fall. ‘I think we should expect…that over the next couple of weeks, we are going to see an uptick in cases—and hopefully there is enough background immunity so that we don't wind up with a lot of hospitalizations,’ Fauci said…. Fauci reiterated that the US often follows other countries, offering the UK, which also has the BA.2 variant, as an example. He said that as well as a pullback on many mask mandates and restrictions for indoor settings, there has been a waning of immunity.”

Exports of Indian Vaccine Halted

 
Science (US) reports, “The World Health Organization (WHO) has raised unspecified concerns about the manufacturing of Covaxin, one of India’s home-grown COVID-19 vaccines. On 2 April, WHO said it had found problems during a March inspection of the production facilities of Bharat Biotech, the vaccine’s producer. WHO did not disclose the nature of the problems at the plant, which is located in Hyderabad, in Telangana state. But it said Bharat Biotech has agreed to stop exports of Covaxin and is ‘developing a corrective and preventive action plan.’ WHO’s decision means UN procurement agencies such as UNICEF can no longer supply countries with the vaccine. The agency has also asked countries that have authorized Covaxin to switch to other products. Just how widely the vaccine is used outside India is unclear, however.”
 

COVID and Diabetes

 
The Daily Maverick (South Africa) reports, “Over the past two years COVID-19 has brought the heightened risks faced by people with diabetes into sharp relief. While diabetics are not at increased risk of getting infected with COVID-19, once they do contract it, they face a higher risk of severe disease and death—particularly if they have uncontrolled diabetes. Available data suggest that, if a diabetic’s blood sugar is not controlled, they are more likely to have poor outcomes on contracting COVID-19…”