As many in the media seem to be turning their attention to monkeypox (more on that below), WHO’s Tedros reminded the world that COVID is not over. Times of India (India) reports at the World Health Assembly, meeting for the first time in person in two years, Tedros said “‘declining testing and sequencing means we are blinding ourselves to the evolution of the virus.’ He also noted that almost 1 billion people in lower-income countries still haven't been vaccinated…. Reported deaths are rising in Africa, the continent with the vaccination coverage he said, and only 57 countries—almost all of them wealthy—have vaccinated 70 percent of their people.”
 
Speaking at the World Economic Forum in Davos, Switzerland UNAIDS’ Winnie Byanyima called out the “racism” of the policies that have led to 75 percent of people in high income countries which are predominately white to be fully vaccinated while only 13 percent of those in lower income countries, which are mostly brown and Black people, have been vaccinated. Watch her remarks here.
 

If You Are in a Hurry

• Read The South African on new South African guidelines that integrate COVID into routine care for mothers and babies.
• Read NBC News on the extraordinary disruptions that the US COVID response have caused to HIV services.
• Read Physician Dhruv Khullar in The New Yorker on when the pandemic might end.
• Read The New York Times on what we know about long COVID.
• Read John Nkengasong’s salute to Tulio de Oliveira and Sikhulile Moyo in Time magazine.
• Read virologist Hitoshi Oshitani in Nature on good public health messaging and COVID in Japan. 
• Read a fact sheet, watch a video and read Jon Cohen’s overview in Science for background on monkeypox.
• Read a UNAIDS statement on the dangers of homophobic and racist stereotypes in monkeypox coverage and commentary.

 

Messaging is Key to COVID Success

 
A commentary in Nature (UK) by virologist Hitoshi Oshitani looks at the success of public health messaging in Japan leading to much lower death rates than other G7 countries despite Japan having an older population and high density. “Other parts of the world have continued to flirt with ‘going back to normal’ by totally lifting restrictions, often in service of the economy, only to see cases soar again, with significant numbers of deaths. Simple solutions that help only the privileged and immunocompetent individuals cannot be accepted as a ‘new normal’ while vulnerable people bear the brunt of such policies…. Often, phrases such as ‘exit strategy’ or ‘back to normal’ are used by people longing for the days when we lived without the threat of this virus. But we are nowhere near back to normal. Nations must continue to seek the best balance between suppressing transmission and maintaining social and economic activities. How? By using all the tools at hand as they apply to cultures, traditions, legal frameworks and existing practices, to minimize suffering across the globe.”
 

Credit to African Researchers

 
John Nkengasong writes in Time magazine’s (US) The 100 Most Influential People of 2022 about the ground-breaking work of Tulio de Oliveira and Sikhulile Moyo who “identified and reported the emergence of the Omicron variant last November. It was a transformational moment and a shift in paradigm—one that for me symbolized that excellence in science can originate in Africa. The international response to news of this discovery—which included travel bans imposed on African countries by other nations—was complex. It made me reflect on what global cooperation and solidarity must look like when we fight a common threat like COVID-19.”
 

China’s Lockdowns Continue

 
Reuters (UK) reports lockdowns are continuing as the country pursues a “zero COVID” approach. “Beijing stepped up quarantine efforts to end its month-old COVID outbreak as fresh signs of frustration emerged in Shanghai, where some bemoaned unfair curbs with the city of 25 million preparing to lift a prolonged lockdown in just over a week.
 
AP (US) reports on the impact of China’s decision to try to develop its own mRNA vaccines. “Now health experts say that delay — a result of putting politics and national pride above public health — could lead to avoidable coronavirus deaths and deeper economic losses because whole cities would be locked down to insulate the country’s unprotected population.”
 

Calculating COVID’s Impact

 
More than two years into COVID researchers are looking to quantify the health burden brought by the pandemic so far – not just the millions of deaths, but the impact of illness and long COVID. Nature (UK) reports that researchers are attempting “for example, to discern how different populations are affected and to provide evidence about the effects of vaccine roll-outs and new variants of the virus…. Research groups are exploring a number of ways to calculate the burden of COVID-19, and many are starting to report their results. Early data suggest that the impact is significant and varies by country. One study found that COVID-19 took a heavy toll across 16 European countries, but that the impacts on different nations varied owing to factors ranging from the population’s age structure to political responses to the pandemic.” Nature notes that there are major data gaps for COVID that make it difficult to measure the full impact.
 

Long COVID

 
The Guardian (UK) reports “Damage to the body’s organs including the lungs and kidneys is common in people who were admitted to hospital with COVID, with one in eight found to have heart inflammation, researchers have revealed…. What’s more, they say the severity of ongoing symptoms appears to be linked to the severity of the COVID infection itself…. Writing in the journal Nature Medicine, the researchers describe how they tracked the outcomes of 159 people hospitalised with COVID between May 2020 and March 2021.” Read the Nature study.
 
The New York Times (US) looks at what we know so far about Long COVID. “[S]tudies estimate that 10 to 30 percent of people report persistent or new medical issues months after their initial coronavirus infections — a constellation of symptoms known as long Covid. People who experience mild or moderate illness, as well as those without any underlying medical conditions, can nonetheless experience some debilitating long-term symptoms, including fatigue, shortness of breath, an erratic heart rate, headaches, dizziness, depression and problems with memory and concentration. Such lingering medical issues are so varied that one study by a patient-led research group evaluated 203 symptoms that may fluctuate or even appear out of the blue after people seem to have recovered.”
 
A MMWR (US) study found “COVID-19 survivors have twice the risk for developing pulmonary embolism or respiratory conditions; one in five COVID-19 survivors aged 18–64 years and one in four survivors aged ≥65 years experienced at least one incident condition that might be attributable to previous COVID-19.”
 

Vaccine Acceptance

 
A systematic review and meta-analysis in PLoS One (US) of COVID vaccine acceptance among healthcare workers in Africa concluded “The data revealed generally low acceptance of the vaccine amongst HCWs across Africa. The side effects of the vaccine, vaccine’s safety, efficacy and effectiveness, short duration of the clinical trials, COVID-19 infections, limited information, and social trust were the major reasons for COVID-19 hesitancy in Africa. The misconceptions and barriers to COVID-19 vaccine acceptance amongst HCWs must be addressed as soon as possible in the continent to boost COVID-19 vaccination rates in Africa.
 
Reuters (UK) reports, “as doses finally arrive in force in the continent, inoculation rates are falling. The number of shots administered dropped 35 percent in March, World Health Organization data shows, erasing a 23 percent rise seen in February. People are less afraid now. Misinformation about vaccines has festered…. Misinformation is tough to unglue on a continent where big pharmaceutical companies have in the past run dubious clinical trials resulting in deaths. Health workers say they need funds to counter false rumours.”
 

Pregnancy and COVID

 
The South African (South Africa) reports, “Mitigating current COVID-19 risks, while minimising indirect harm, requires careful risk-benefit analysis and clear and practical guidance. It’s in this light that the National Department of Health has published new guidelines for the care of mothers and newborns in the context of the ever-present threat of COVID-19. The guidelines incorporate new scientific and operational evidence. The aim is to ensure that clinical care for mothers, babies and children during the pandemic remains relevant, practical and evidence-based…. South Africa, and the world at large, is starting to come to terms with the fact that COVID-19 will probably be around for a while. COVID-19 therefore needs to be managed as part of a comprehensive package of maternal and child health services.”
 

A Lost Year in the HIV Fight

 
NBC News (US) reports, “The Centers for Disease Control and Prevention’s annual HIV Surveillance Report, published Tuesday, provides the first major bird’s-eye view of the turn the nation’s four-decade-old epidemic took after the coronavirus upended society. The report, which includes 2020 data, follows worrisome previous findings that found HIV testing plunged as stay-at-home orders swept the nation in March of that year. CDC officials have expressed concern that the extraordinary disruptions the nation’s COVID response have caused to HIV-related services have inflicted collateral damage that could take years to undo. It even remains possible that, after decades of hard-fought declines, the national HIV transmission rate has crept up again.”
 

Will It Ever End?

 
Physician Dhruv Khullar writes in The New Yorker (US), “We often think that the COVID-19 pandemic is unique because scientists were so quick to influence its biological end, by developing vaccines and therapeutics at an unprecedented pace. But it is also unique in its social dimensions. Never before have we tracked a pathogen’s every mutation in real time, shared so much information and misinformation about it on social media, stalked its daily, even hourly, spread from one place to the next. The abundance of data has allowed different people to tell different stories about the pandemic. In the US, the pandemic is not the emergency it once was, but neither is it over. A subacute condition may be less dramatic, but no less damaging. It requires care, attention, and investment. If Americans decide too soon that the pandemic has come to a social end, we may risk pushing its biological end further away. Where we go from here depends on the narrative we construct next.”
 

Vaccine Decision for Little Kids Coming

 
Reuters (UK) reports, “The US Food and Drug Administration set June 14-15 as the new meeting date to review Moderna Inc's emergency authorization request for its COVID-19 vaccine for children aged 6 months to 5 years and Pfizer Inc's vaccine for those aged 6 months through 4 years.”
 

And Now to Monkeypox

 
There is a lot of confusing information coming through US and European media about a monkeypox outbreak in several countries. The disease has been endemic in parts of Africa for decades, but is just beginning to be seen outside of Africa. Photos circulating in the media of severe cases of the disease are not representative of what is being seen in these new outbreaks and while experts are concerned, there is no cause for panic. We’ve gathered a few good media articles and resources below to help you find the most important and accurate information.
 
An explainer video from STAT (US) looks at monkeypox’s symptoms and how the disease spreads.
 
A fact sheet from Johns Hopkins University provides background on the disease.
 
Science (US) says, “The sudden appearance of monkeypox in 13 countries on four continents has jolted the public health community into action. A much milder cousin of smallpox that sporadically causes small outbreaks in Africa, monkeypox is thought to spread slowly and is unlikely to be a pandemic in the making. But scientists worry about the spread among men who have sex with men (MSM), who make up a disproportionate number of the cases so far. The outbreak is a strange and unsettling return to the spotlight for poxviruses, a largely forgotten threat since the World Health Organization (WHO) declared smallpox eradicated in 1980…. Most people recover within a few weeks. The Congo Basin strain kills up to 10 percent of those infected, but the recent outbreak appears to only involve the West African strain, which in past outbreaks had a fatality rate of about 1 percent.”
 
The Washington Post (US) quotes Oyewale Tomori, a Nigerian virologist. “The virus — discovered five decades ago in the Democratic Republic of Congo — causes mild illness in most people, he said, along with blisters that usually clear up in weeks. It’s much less transmissible than the coronavirus and much less deadly than Ebola. There’s already an effective vaccine.” The Post notes that monkeypox has spread in parts of Africa for decades. “What bothers infectious-disease experts across the continent is the double standard that has emerged since monkeypox grabbed the world’s attention: Few seemed to care, or even notice, until people in the West started getting sick.”
 
The New York Times (US) reports, “As more than a dozen countries grapple with outbreaks of monkeypox, health officials worldwide are rushing to assess reserves of vaccines and treatments that may be needed to contain the spread.” Few cases have been confirmed in the US, but “As of Monday, there were more than 100 confirmed cases in 14 countries outside Africa, and dozens more under investigation. That day, the European Center for Disease Prevention and Control urged health officials in Europe to assess the availability of smallpox vaccines, antivirals and personal protective equipment. The World Health Organization is holding stockpiles of about 31 million smallpox vaccine doses, but they may have lost some potency in the decades since they were made.”
 
A UNAIDS statement says, “UNAIDS has expressed concern that some public reporting and commentary on monkeypox has used language and imagery, particularly portrayals of LGBTI and African people, that reinforce homophobic and racist stereotypes and exacerbate stigma. Lessons from the AIDS response show that stigma and blame directed at certain groups of people can rapidly undermine outbreak response.”