Is This What Endemic Disease Looks Like?
For months, some American and European leaders have foretold that the coronavirus pandemic would soon become endemic. Covid-19 would resolve into a disease that we learn to live with. According to several governors, it nearly has.
But we are still in the acute phase of the pandemic, and what endemic Covid might look like remains a mystery. Endemic diseases can take many forms, and we do not know yet where this two-year-old disease will fall among them.
At its most basic, an endemic disease is one with a constant, predictable or expected presence. It’s a disease that persists. Beyond that, there is no fixed definition.
Endemic diseases infect millions of people around the world each year, and some endemic diseases kill hundreds of thousands. Some we can treat and vaccinate against. Yet they can also cause unexpected outbreaks and significant suffering.
Interviews with two dozen scientists, public health experts and medical historians suggest the rush to recast Covid as endemic may be missing the point.
“There’s been a political reframing of the idea of endemic as something that is harmless or normal,” said Lukas Engelmann, a historian of medicine and epidemiology at the University of Edinburgh. But epidemiologists use endemic to mean something we should watch carefully, he said, because an endemic disease can become epidemic again.
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https://www.nytimes.com/interactive/202 ... 778d3e6de3
Post Pandemic Thinking/Issues
Bill Gates: How to Develop Life-Saving Drugs Much Faster
By Bill Gates
Mr. Gates is an American businessman, software developer and philanthropist.
The Covid-19 pandemic would look very different if scientists had been able to develop a treatment sooner. The death rates are likely to have been far lower, and it may have been harder for myths and misinformation to spread the way they did.
In the early days of the pandemic, I expected a treatment to come along well before any vaccines were available. I wasn’t alone: Most people I know in the public health community felt the same way. Unfortunately, that’s not what happened. Safe, effective Covid vaccines were available within a year — a historic feat — but treatments that could keep large numbers of people out of the hospital were surprisingly slow out of the gate.
It wasn’t for lack of trying. As soon as the coronavirus was identified, researchers started looking for the holy grail of treatments: an antiviral drug that’s cheap, easy to administer, effective for different variants and capable of helping people before they get too sick. Scientists explored dozens of potential treatments, including hydroxychloroquine, dexamethasone, remdesivir and convalescent plasma. Some showed promise, but all had drawbacks.
In late 2021, a few of their efforts paid off — not as soon as would have been ideal, but still in time to have a big impact. Merck and its partners developed an antiviral called molnupiravir, which was shown to significantly reduce the risk of hospitalization or death for people at high risk. Soon after, another oral antiviral, Paxlovid, made by Pfizer, also proved to be very effective, reducing the risk of severe illness or death by nearly 90 percent among high-risk, unvaccinated adults. These drugs are useful tools for combating the pandemic, but they arrived much later than they should have and, for many, they are still difficult to access.
By the time these treatments were available, a large share of the world’s population had received at least one dose of a vaccine. But just because there is a vaccine doesn’t mean therapeutics aren’t important, in Covid or any other outbreak. It’s a mistake to think of vaccines as the star of the show and therapeutics as the opening act you would just as soon skip.
We’re lucky that scientists made Covid vaccines as quickly as they did — if they hadn’t, the death toll would be far worse. But in the event of another pandemic, even if the world is able to develop a vaccine for a new pathogen in 100 days, it will still take a long time to get the vaccine to most of the population. This is especially true if you need two or more doses for full and continued protection. If the pathogen is especially transmissible and deadly, a therapeutic drug could save tens of thousands or more.
Even once there is a vaccine, we’ll still need good therapeutics. As we’ve seen with Covid, not everyone who can take a vaccine will choose to do so. And, along with non-pharmaceutical interventions, therapeutics can reduce the strain on hospitals, which would prevent the overcrowding that ultimately means that some patients die who otherwise wouldn’t.
With good therapeutics, the risk of severe illness and death could drop significantly, and countries could decide to loosen restrictions on schools and businesses, reducing the disruption to education and the economy. What’s more, imagine how people’s lives would change if we’re able to take the next step by linking testing and treatment. Anyone with early symptoms that might indicate Covid (or any other viral disease) could walk into a pharmacy or clinic anywhere in the world, get tested and, if positive for the virus, walk out with antivirals to take at home.
All of which is to say: Therapeutics are fundamentally important in an outbreak. To understand what caused the delay in drugs and how we can avoid such delays in the future, we need to take a tour through the world of therapeutics: what they are, how they get from the lab to the market, why they didn’t fare better early in this pandemic and how innovation can set the stage for a better response in the future.
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https://www.nytimes.com/2022/04/15/opin ... iversified
India Is Stalling the W.H.O.’s Efforts to Make Global Covid Death Toll Public
The agency has calculated that 15 million people have died as a result of the pandemic, far more than earlier estimates, but has yet to release those numbers.
An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has found that vastly more people died than previously believed — a total of about 15 million by the end of 2021, more than double the official total of six million reported by countries individually.
But the release of the staggering estimate — the result of more than a year of research and analysis by experts around the world and the most comprehensive look at the lethality of the pandemic to date — has been delayed for months because of objections from India, which disputes the calculation of how many of its citizens died and has tried to keep it from becoming public.
More than a third of the additional nine million deaths are estimated to have occurred in India, where the government of Prime Minister Narendra Modi has stood by its own count of about 520,000. The W.H.O. will show the country’s toll is at least four million, according to people familiar with the numbers who were not authorized to disclose them, which would give India the highest tally in the world, they said. The Times was unable to learn the estimates for other countries.
The W.H.O. calculation combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aim to account for deaths that were missed. Most of the difference in the new global estimate represents previously uncounted deaths, the bulk of which were directly from Covid; the new number also includes indirect deaths, like those of people unable to access care for other ailments because of the pandemic.
The delay in releasing the figures is significant because the global data is essential for understanding how the pandemic has played out and what steps could mitigate a similar crisis in the future. It has created turmoil in the normally staid world of health statistics — a feud cloaked in anodyne language is playing out at the United Nations Statistical Commission, the world body that gathers health data, spurred by India’s refusal to cooperate.
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https://www.nytimes.com/2022/04/16/heal ... iversified
An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has found that vastly more people died than previously believed — a total of about 15 million by the end of 2021, more than double the official total of six million reported by countries individually.
But the release of the staggering estimate — the result of more than a year of research and analysis by experts around the world and the most comprehensive look at the lethality of the pandemic to date — has been delayed for months because of objections from India, which disputes the calculation of how many of its citizens died and has tried to keep it from becoming public.
More than a third of the additional nine million deaths are estimated to have occurred in India, where the government of Prime Minister Narendra Modi has stood by its own count of about 520,000. The W.H.O. will show the country’s toll is at least four million, according to people familiar with the numbers who were not authorized to disclose them, which would give India the highest tally in the world, they said. The Times was unable to learn the estimates for other countries.
The W.H.O. calculation combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aim to account for deaths that were missed. Most of the difference in the new global estimate represents previously uncounted deaths, the bulk of which were directly from Covid; the new number also includes indirect deaths, like those of people unable to access care for other ailments because of the pandemic.
The delay in releasing the figures is significant because the global data is essential for understanding how the pandemic has played out and what steps could mitigate a similar crisis in the future. It has created turmoil in the normally staid world of health statistics — a feud cloaked in anodyne language is playing out at the United Nations Statistical Commission, the world body that gathers health data, spurred by India’s refusal to cooperate.
More...
https://www.nytimes.com/2022/04/16/heal ... iversified
The Drive to Vaccinate the World Against Covid Is Losing Steam
Rates are stalling in most low-income countries well short of the W.H.O.’s goal to immunize 70 percent of people in every nation. Some public health experts believe the momentum is gone forever.
In the middle of last year, the World Health Organization began promoting an ambitious goal, one it said was essential for ending the pandemic: fully vaccinate 70 percent of the population in every country against Covid-19 by June 2022.
Now, it is clear that the world will fall far short of that target by the deadline. And there is a growing sense of resignation among public health experts that high Covid vaccination coverage may never be achieved in most lower-income countries, as badly needed funding from the United States dries up and both governments and donors turn to other priorities.
“The reality is that there is a loss of momentum,” said Dr. Isaac Adewole, a former health minister of Nigeria who now serves as a consultant for the Africa Centers for Disease Control and Prevention.
Only a few of the world’s 82 poorest countries — including Bangladesh, Bhutan, Cambodia and Nepal — have reached the 70 percent vaccination threshold. Many are under 20 percent, according to data compiled from government sources by the Our World in Data project at the University of Oxford.
By comparison, about two-thirds of the world’s richest countries have reached 70 percent. (The United States is at 66 percent.)
The consequences of giving up on achieving high vaccination coverage worldwide could prove severe. Public health experts say that abandoning the global effort could lead to the emergence of dangerous new variants that would threaten the world’s precarious efforts to live with the virus.
“This pandemic is not over yet — far from it — and it’s imperative that countries use the doses available to them to protect as much of their population as possible,” said Dr. Seth Berkeley, chief executive of Gavi, the nonprofit that runs the global vaccine clearinghouse Covax.
Countries in different parts of the world, including some in Eastern Europe and the Middle East, have seen their vaccination rates stagnate in recent months at a third or less of their populations. But Africa’s vaccination rate remain the most dismal.
Fewer than 17 percent of Africans have received a primary Covid immunization. Nearly half of the vaccine doses delivered to the continent thus far have gone unused. Last month, the number of doses injected on the continent fell by 35 percent compared to February. W.H.O. officials attributed the drop to mass vaccination pushes being replaced by smaller-scale campaigns in several countries.
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https://www.nytimes.com/2022/04/23/heal ... 778d3e6de3
In the middle of last year, the World Health Organization began promoting an ambitious goal, one it said was essential for ending the pandemic: fully vaccinate 70 percent of the population in every country against Covid-19 by June 2022.
Now, it is clear that the world will fall far short of that target by the deadline. And there is a growing sense of resignation among public health experts that high Covid vaccination coverage may never be achieved in most lower-income countries, as badly needed funding from the United States dries up and both governments and donors turn to other priorities.
“The reality is that there is a loss of momentum,” said Dr. Isaac Adewole, a former health minister of Nigeria who now serves as a consultant for the Africa Centers for Disease Control and Prevention.
Only a few of the world’s 82 poorest countries — including Bangladesh, Bhutan, Cambodia and Nepal — have reached the 70 percent vaccination threshold. Many are under 20 percent, according to data compiled from government sources by the Our World in Data project at the University of Oxford.
By comparison, about two-thirds of the world’s richest countries have reached 70 percent. (The United States is at 66 percent.)
The consequences of giving up on achieving high vaccination coverage worldwide could prove severe. Public health experts say that abandoning the global effort could lead to the emergence of dangerous new variants that would threaten the world’s precarious efforts to live with the virus.
“This pandemic is not over yet — far from it — and it’s imperative that countries use the doses available to them to protect as much of their population as possible,” said Dr. Seth Berkeley, chief executive of Gavi, the nonprofit that runs the global vaccine clearinghouse Covax.
Countries in different parts of the world, including some in Eastern Europe and the Middle East, have seen their vaccination rates stagnate in recent months at a third or less of their populations. But Africa’s vaccination rate remain the most dismal.
Fewer than 17 percent of Africans have received a primary Covid immunization. Nearly half of the vaccine doses delivered to the continent thus far have gone unused. Last month, the number of doses injected on the continent fell by 35 percent compared to February. W.H.O. officials attributed the drop to mass vaccination pushes being replaced by smaller-scale campaigns in several countries.
More...
https://www.nytimes.com/2022/04/23/heal ... 778d3e6de3
Death Toll During Pandemic Far Exceeds Totals Reported by Countries, W.H.O. Says
Nearly 15 million more people died during the first two years of the pandemic than would have been expected during normal times, the organization found. The previous count of virus deaths, from countries’ reporting, was six million.
Nearly 15 million more people died during the pandemic than would have in normal times, the World Health Organization said on Thursday, a staggering measure of Covid’s true toll that laid bare how vastly country after country has undercounted victims.
In Mexico, the excess death toll during the first two years of the pandemic was twice as high as the government’s official tally of Covid deaths, the W.H.O. found.
In Egypt, excess deaths were roughly 12 times as great as the official Covid toll.
In Pakistan, the figure was eight times as high.
Those estimates, calculated by a global panel of experts assembled by the W.H.O., represent what many scientists see as the most reliable gauge of the total impact of the pandemic. Faced with large gaps in global death data, the expert team set out to calculate excess mortality: the difference between the number of people who died in 2020 and 2021 and the number who would have been expected to die during that time if the pandemic had not happened.
Their calculations combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aimed to account for deaths that were missed.
Most of the excess deaths were victims of Covid itself, the experts said, but some died because the pandemic made it more difficult to get medical care for ailments such as heart attacks. The previous toll, based solely on death counts reported by countries, was six million.
Much of the loss of life from the pandemic was concentrated in 2021, when more contagious variants tore through even countries that had fended off earlier outbreaks. Overall deaths that year were roughly 18 percent higher — an extra 10 million people — than they would have been without the pandemic, the W.H.O.-assembled experts estimated.
Developing nations bore the brunt of the devastation, with nearly eight million more people than expected dying in lower-middle-income nations during the pandemic.
“It’s absolutely staggering what has happened with this pandemic, including our inability to accurately monitor it,” said Dr. Prabhat Jha, an epidemiologist at St. Michael’s Hospital and the University of Toronto, who was a member of the expert working group that made the calculations. “It shouldn’t happen in the 21st century.”
The figures had been ready since January, but their release was stalled by objections from India, which disputes the methodology for calculating how many of its citizens died.
Nearly a third of the excess deaths globally — 4.7 million — took place in India, according to the W.H.O. estimates. The Indian government’s own figure through the end of 2021 is 481,080 deaths.
But India was far from the only country where deaths were substantially underreported. Where excess deaths far outstripped the number of reported Covid fatalities, experts said the gap could reflect countries’ struggles to collect mortality data or their efforts to intentionally obscure the toll of the pandemic.
In some countries, flaws in government reports were widely known. Russia, for example, had reported roughly 310,000 Covid deaths by the end of 2021, but the W.H.O. experts indicated that the excess death toll was nearly 1.1 million. That mirrored earlier estimates from a Russian national statistics agency that is fairly independent of the government.
Aleksei Raksha, an independent demographer who quit the Russian state statistics service after complaining of the failure to count Covid deaths properly, said that informal orders had been given to local authorities to ensure that in many cases, Covid was not registered as the primary cause of death.
“Excess deaths have established the true picture,” Mr. Raksha said. “Russia demonstrated a dismal performance in fighting the pandemic.”
In other nations, W.H.O. experts used what limited data was available to arrive at estimates jarringly at odds with previous counts, though they cautioned that some of those calculations remained highly uncertain. In Indonesia, for example, the experts leaned heavily on monthly death data from Jakarta, the capital, to estimate that the country had experienced over a million more deaths than normal. That figure would be seven times as high as the reported Covid death toll.
Siti Nadia Tarmizi, a spokeswoman for the government’s Covid-19 vaccination program, acknowledged that Indonesia had suffered more deaths than the government had reported. She said the problem stemmed in part from people not reporting relatives’ deaths to avoid complying with government rules for Covid victims’ funerals. But she said that the W.H.O. estimates were far too high.
In Pakistan, Dr. Faisal Sultan, a former health minister, defended the government’s death reports, saying that studies of the number of graveyard burials in major cities did not reveal large numbers of uncounted victims of the pandemic.
For still other countries that suffered grievously during the pandemic, the W.H.O. estimates illuminated even more startling figures hiding inside already devastating death counts. In Peru, for instance, the expert estimate of 290,000 excess deaths by the end of 2021 was only 1.4 times as high as the reported Covid death toll. But the W.H.O. estimate of 437 excess deaths for every 100,000 Peruvians left the country with among the world’s highest per capita tolls.
“When a health care system isn’t prepared to receive patients who are seriously ill with pneumonia, when it can’t provide the oxygen they need to live, or even provide beds for them to lay in so they can have some peace, you get what you’ve gotten,” said Dr. Elmer Huerta, an oncologist and public health specialist who hosts a popular radio show in Peru.
In the United States, the W.H.O. estimated that roughly 930,000 more people than expected had died by the end of 2021, compared with the 820,000 Covid deaths that had been officially recorded over the same period.
In Mexico, the government has itself kept a tally of excess deaths during the pandemic that appears roughly in line with the W.H.O.’s. Those estimates — about double the country’s reported Covid death toll — reflected what analysts there described as difficulties counting the dead.
“We responded badly, we reacted slowly. But I think the most serious of all was to not communicate the urgency, the wanting to minimize, minimize,” said Xavier Tello, a public health analyst based in Mexico City. “Because Mexico wasn’t or isn’t testing for Covid, a lot of people died and we don’t know if they had Covid.”
The W.H.O.’s calculations include people who died directly from Covid, from medical conditions complicated by Covid, or because they had ailments other than Covid but could not get needed treatment because of the pandemic. The excess death estimates also take into account expected deaths that did not occur because of Covid restrictions, such as reductions in traffic accidents or isolation that prevented deaths from the flu and other infectious diseases.
Calculating excess deaths is complex, the W.H.O. experts said. About half of countries globally do not regularly report the number of deaths from all causes. Others supply only partial data. In the W.H.O.’s African region, the experts said that they had data from only six of 47 countries.
Scientists also noted that excess death rates were not necessarily indicative of a country’s pandemic response: Older and younger populations will fare differently in a pandemic, regardless of the response. And the W.H.O. experts said that they did not account for the effects of heat waves or conflicts.
Where death figures were missing, the statisticians had to rely on modeling. In those cases, they made predictions based on country-specific information like containment measures, historical rates of disease, temperature and demographics to assemble national figures and, from there, regional and global estimates.
W.H.O. officials used the release of their calculations to plead for greater investment in death reporting.
“When we underestimate, we may underinvest,” said Dr. Samira Asma, the W.H.O.’s assistant director general for data, analytics and delivery for impact. “And when we undercount, we may miss targeting the interventions where they are needed most.”
Image
In the U.S., the W.H.O. estimated that roughly 930,000 more people than normal had died by the end of 2021, compared with the 820,000 officially reported Covid deaths over the same period.
In the U.S., the W.H.O. estimated that roughly 930,000 more people than normal had died by the end of 2021, compared with the 820,000 officially reported Covid deaths over the same period.Credit...Kirsten Luce for The New York Times
W.H.O. officials cited Britain as an example of a country that had accurately recorded Covid deaths: Their analysis found that about 149,000 more people than normal had died during the pandemic, nearly identical to the number of Covid deaths Britain reported.
The disagreement over India’s Covid deaths spilled into public this week when the Indian government on Tuesday abruptly released mortality data from 2020, reporting an 11 percent increase in registered deaths in 2020 compared with average annual deaths registered over the two prior years.
Analysts saw the release as an attempt to force the W.H.O. to reconsider its calculations on the eve of publication. Indian health officials said their figures showed that the country had lost fewer people to Covid than outside estimates suggested.
But scientists believe that most of the country’s excess mortality occurred in 2021, during a grievous wave caused by the Delta variant. And even India’s 2020 figures gave additional credence to the W.H.O. estimates, said Dr. Jha, who has also studied excess deaths in India.
“The Indian government wanted to deflect the news,” he said, “but they’re confirming, at least for 2020, the W.H.O. numbers.”
Other experts said that India’s refusal to cooperate with the W.H.O. analysis was rooted in the country’s history of ignoring how data can inform policymaking.
“It’s natural to miss some of the Covid deaths,” said Dr. Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who has been working with the W.H.O. to review the data. But, she added, “Nobody’s been this resistant.”
The Ministry of Health in New Delhi did not respond to requests for comment. W.H.O. officials said that India’s 2020 death figures were released too late to be incorporated into their calculations but that they would “carefully review” the data.
Nations that report Covid deaths more accurately have also been at the center of disputes over the reliability of excess death estimates. In Germany, for example, the W.H.O. experts estimated that 195,000 more people than normal had died during the pandemic, a significantly higher toll than the 112,000 Covid deaths recorded there.
But Giacomo De Nicola, a statistician at Ludwig Maximilian University of Munich, who has studied excess deaths in Germany, said that the country’s rapidly aging population meant that the W.H.O. analysis might have underestimated the number of people who would have been expected to die in a normal year. That, in turn, could have produced overestimates of excess deaths.
He said that the W.H.O.-assembled experts had accounted for trends in mortality, but not directly for changes in the age structure of the population. While Germany experienced excess deaths, he said, the W.H.O. estimate for the country “seems very high.”
Overall, the W.H.O. calculations were more conservative than separate analyses released earlier by The Economist and the Institute for Health Metrics and Evaluation.
Some experts said that the W.H.O. analysis benefited from relying more heavily than other estimates on actual data, even where it was incomplete, as opposed to statistical modeling.
Oscar Lopez, Karan Deep Singh, Sofía Villamil, Christopher F. Schuetze, Ivan Nechepurenko, Richard C. Paddock, Muktita Suhartono, Mitra Taj, Julie Turkewitz, Merna Thomas and Salman Masood contributed reporting.
https://www.nytimes.com/2022/05/05/heal ... 778d3e6de3
Nearly 15 million more people died during the pandemic than would have in normal times, the World Health Organization said on Thursday, a staggering measure of Covid’s true toll that laid bare how vastly country after country has undercounted victims.
In Mexico, the excess death toll during the first two years of the pandemic was twice as high as the government’s official tally of Covid deaths, the W.H.O. found.
In Egypt, excess deaths were roughly 12 times as great as the official Covid toll.
In Pakistan, the figure was eight times as high.
Those estimates, calculated by a global panel of experts assembled by the W.H.O., represent what many scientists see as the most reliable gauge of the total impact of the pandemic. Faced with large gaps in global death data, the expert team set out to calculate excess mortality: the difference between the number of people who died in 2020 and 2021 and the number who would have been expected to die during that time if the pandemic had not happened.
Their calculations combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aimed to account for deaths that were missed.
Most of the excess deaths were victims of Covid itself, the experts said, but some died because the pandemic made it more difficult to get medical care for ailments such as heart attacks. The previous toll, based solely on death counts reported by countries, was six million.
Much of the loss of life from the pandemic was concentrated in 2021, when more contagious variants tore through even countries that had fended off earlier outbreaks. Overall deaths that year were roughly 18 percent higher — an extra 10 million people — than they would have been without the pandemic, the W.H.O.-assembled experts estimated.
Developing nations bore the brunt of the devastation, with nearly eight million more people than expected dying in lower-middle-income nations during the pandemic.
“It’s absolutely staggering what has happened with this pandemic, including our inability to accurately monitor it,” said Dr. Prabhat Jha, an epidemiologist at St. Michael’s Hospital and the University of Toronto, who was a member of the expert working group that made the calculations. “It shouldn’t happen in the 21st century.”
The figures had been ready since January, but their release was stalled by objections from India, which disputes the methodology for calculating how many of its citizens died.
Nearly a third of the excess deaths globally — 4.7 million — took place in India, according to the W.H.O. estimates. The Indian government’s own figure through the end of 2021 is 481,080 deaths.
But India was far from the only country where deaths were substantially underreported. Where excess deaths far outstripped the number of reported Covid fatalities, experts said the gap could reflect countries’ struggles to collect mortality data or their efforts to intentionally obscure the toll of the pandemic.
In some countries, flaws in government reports were widely known. Russia, for example, had reported roughly 310,000 Covid deaths by the end of 2021, but the W.H.O. experts indicated that the excess death toll was nearly 1.1 million. That mirrored earlier estimates from a Russian national statistics agency that is fairly independent of the government.
Aleksei Raksha, an independent demographer who quit the Russian state statistics service after complaining of the failure to count Covid deaths properly, said that informal orders had been given to local authorities to ensure that in many cases, Covid was not registered as the primary cause of death.
“Excess deaths have established the true picture,” Mr. Raksha said. “Russia demonstrated a dismal performance in fighting the pandemic.”
In other nations, W.H.O. experts used what limited data was available to arrive at estimates jarringly at odds with previous counts, though they cautioned that some of those calculations remained highly uncertain. In Indonesia, for example, the experts leaned heavily on monthly death data from Jakarta, the capital, to estimate that the country had experienced over a million more deaths than normal. That figure would be seven times as high as the reported Covid death toll.
Siti Nadia Tarmizi, a spokeswoman for the government’s Covid-19 vaccination program, acknowledged that Indonesia had suffered more deaths than the government had reported. She said the problem stemmed in part from people not reporting relatives’ deaths to avoid complying with government rules for Covid victims’ funerals. But she said that the W.H.O. estimates were far too high.
In Pakistan, Dr. Faisal Sultan, a former health minister, defended the government’s death reports, saying that studies of the number of graveyard burials in major cities did not reveal large numbers of uncounted victims of the pandemic.
For still other countries that suffered grievously during the pandemic, the W.H.O. estimates illuminated even more startling figures hiding inside already devastating death counts. In Peru, for instance, the expert estimate of 290,000 excess deaths by the end of 2021 was only 1.4 times as high as the reported Covid death toll. But the W.H.O. estimate of 437 excess deaths for every 100,000 Peruvians left the country with among the world’s highest per capita tolls.
“When a health care system isn’t prepared to receive patients who are seriously ill with pneumonia, when it can’t provide the oxygen they need to live, or even provide beds for them to lay in so they can have some peace, you get what you’ve gotten,” said Dr. Elmer Huerta, an oncologist and public health specialist who hosts a popular radio show in Peru.
In the United States, the W.H.O. estimated that roughly 930,000 more people than expected had died by the end of 2021, compared with the 820,000 Covid deaths that had been officially recorded over the same period.
In Mexico, the government has itself kept a tally of excess deaths during the pandemic that appears roughly in line with the W.H.O.’s. Those estimates — about double the country’s reported Covid death toll — reflected what analysts there described as difficulties counting the dead.
“We responded badly, we reacted slowly. But I think the most serious of all was to not communicate the urgency, the wanting to minimize, minimize,” said Xavier Tello, a public health analyst based in Mexico City. “Because Mexico wasn’t or isn’t testing for Covid, a lot of people died and we don’t know if they had Covid.”
The W.H.O.’s calculations include people who died directly from Covid, from medical conditions complicated by Covid, or because they had ailments other than Covid but could not get needed treatment because of the pandemic. The excess death estimates also take into account expected deaths that did not occur because of Covid restrictions, such as reductions in traffic accidents or isolation that prevented deaths from the flu and other infectious diseases.
Calculating excess deaths is complex, the W.H.O. experts said. About half of countries globally do not regularly report the number of deaths from all causes. Others supply only partial data. In the W.H.O.’s African region, the experts said that they had data from only six of 47 countries.
Scientists also noted that excess death rates were not necessarily indicative of a country’s pandemic response: Older and younger populations will fare differently in a pandemic, regardless of the response. And the W.H.O. experts said that they did not account for the effects of heat waves or conflicts.
Where death figures were missing, the statisticians had to rely on modeling. In those cases, they made predictions based on country-specific information like containment measures, historical rates of disease, temperature and demographics to assemble national figures and, from there, regional and global estimates.
W.H.O. officials used the release of their calculations to plead for greater investment in death reporting.
“When we underestimate, we may underinvest,” said Dr. Samira Asma, the W.H.O.’s assistant director general for data, analytics and delivery for impact. “And when we undercount, we may miss targeting the interventions where they are needed most.”
Image
In the U.S., the W.H.O. estimated that roughly 930,000 more people than normal had died by the end of 2021, compared with the 820,000 officially reported Covid deaths over the same period.
In the U.S., the W.H.O. estimated that roughly 930,000 more people than normal had died by the end of 2021, compared with the 820,000 officially reported Covid deaths over the same period.Credit...Kirsten Luce for The New York Times
W.H.O. officials cited Britain as an example of a country that had accurately recorded Covid deaths: Their analysis found that about 149,000 more people than normal had died during the pandemic, nearly identical to the number of Covid deaths Britain reported.
The disagreement over India’s Covid deaths spilled into public this week when the Indian government on Tuesday abruptly released mortality data from 2020, reporting an 11 percent increase in registered deaths in 2020 compared with average annual deaths registered over the two prior years.
Analysts saw the release as an attempt to force the W.H.O. to reconsider its calculations on the eve of publication. Indian health officials said their figures showed that the country had lost fewer people to Covid than outside estimates suggested.
But scientists believe that most of the country’s excess mortality occurred in 2021, during a grievous wave caused by the Delta variant. And even India’s 2020 figures gave additional credence to the W.H.O. estimates, said Dr. Jha, who has also studied excess deaths in India.
“The Indian government wanted to deflect the news,” he said, “but they’re confirming, at least for 2020, the W.H.O. numbers.”
Other experts said that India’s refusal to cooperate with the W.H.O. analysis was rooted in the country’s history of ignoring how data can inform policymaking.
“It’s natural to miss some of the Covid deaths,” said Dr. Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who has been working with the W.H.O. to review the data. But, she added, “Nobody’s been this resistant.”
The Ministry of Health in New Delhi did not respond to requests for comment. W.H.O. officials said that India’s 2020 death figures were released too late to be incorporated into their calculations but that they would “carefully review” the data.
Nations that report Covid deaths more accurately have also been at the center of disputes over the reliability of excess death estimates. In Germany, for example, the W.H.O. experts estimated that 195,000 more people than normal had died during the pandemic, a significantly higher toll than the 112,000 Covid deaths recorded there.
But Giacomo De Nicola, a statistician at Ludwig Maximilian University of Munich, who has studied excess deaths in Germany, said that the country’s rapidly aging population meant that the W.H.O. analysis might have underestimated the number of people who would have been expected to die in a normal year. That, in turn, could have produced overestimates of excess deaths.
He said that the W.H.O.-assembled experts had accounted for trends in mortality, but not directly for changes in the age structure of the population. While Germany experienced excess deaths, he said, the W.H.O. estimate for the country “seems very high.”
Overall, the W.H.O. calculations were more conservative than separate analyses released earlier by The Economist and the Institute for Health Metrics and Evaluation.
Some experts said that the W.H.O. analysis benefited from relying more heavily than other estimates on actual data, even where it was incomplete, as opposed to statistical modeling.
Oscar Lopez, Karan Deep Singh, Sofía Villamil, Christopher F. Schuetze, Ivan Nechepurenko, Richard C. Paddock, Muktita Suhartono, Mitra Taj, Julie Turkewitz, Merna Thomas and Salman Masood contributed reporting.
https://www.nytimes.com/2022/05/05/heal ... 778d3e6de3
In Grief Is How We Live Now
We are grieving the loss of the familiar.
By Gary Greenberg
Dr. Greenberg is a psychotherapist and the first selectman of Scotland, Conn.
Leer en español
I’m no stranger to grief. After all, I’ve been alive for nearly 65 years. And I’ve spent almost 40 of them as a psychotherapist, midwifing people’s grief: the couple who split after their child dies because they remind each other of the loss, the woman who swears her dead husband talks to her every night, the man who can’t clean out his deceased wife’s closet even after three years.
Any therapist will tell you that death is not the only occasion for grief. We can mourn the loss of anything to which we have become attached: a pet, a job, a home, a way of life. In bereavement, what is best about us — our ability to love — becomes the source of our suffering. It’s a wonder that all grief isn’t prolonged and that anyone is able to love again rather than wander through life stunned by its cruelty. And it’s surprising that anyone actually believes that there are stages and time limits to grief or that we know enough about how it works to know what to expect of it.
I figured my job had acquainted me with all the varieties of grief. But then I took on an additional one. Since November 2019, I’ve been the first selectman of a small New England town (population: about 1,575). It means I’m its chief executive officer, as well as its chief of police, tree warden and cemetery sexton, and I wind the clock in the Scotland Congregational Church.
The new job has a lot more in common with the old one than you’d think, or at least more than I would have thought. In both cases, unhappy people tell me what is bothering them and often expect (or even demand) that I do something about it. Responding to concerns about high taxes or flooded storm drains does not, however, usually require an excavation of a complainant’s past trauma; when I can fix the problem with a phone call, I am gratified in a way I would not have expected.
When the American Psychiatric Association added prolonged grief disorder to its Diagnostic and Statistical Manual of Mental Disorders last fall, the organization’s president, Vivian B. Pender, explained that “the circumstances in which we are living” have made people more susceptible to prolonged bouts of grief. The association noted that in addition to Covid deaths, Americans faced many ongoing disasters, including, at the time, “the wind-down in Afghanistan, floods, fires, hurricanes and gun violence.”
“Check in with yourself” if you’ve lost someone, Dr. Pender recommended. “Grief in these circumstances is normal, but not at certain levels and not most of the day, nearly every day for months. Help is available.”
Dr. Pender’s comments marked the culmination of a process that began about a decade ago, when the association identified prolonged grief as a possible mental disorder, a designation that encouraged researchers and the pharmaceutical industry to fund studies into such matters as the brain chemistry of protracted mourning, the difference between prolonged grief disorder and depression and the merits of various talk and drug therapies. They have identified neural circuits, sharpened diagnostic criteria and developed treatment regimens. There’s even an app for it under study called My Grief.
Critics, including me, have called this yet another intrusion of psychiatry into normal life, pointing out that there are no biological markers to distinguish prolonged grief disorder from normal grieving, whatever that is, and that no one has yet come close to figuring out how neural circuits give rise to any experience, let alone one as complex as grief.
But we must acknowledge that the new diagnosis is already doing exactly what a diagnosis is supposed to do — garnering resources for suffering people and attention to their suffering. The occasions for grief, prolonged or otherwise, do seem to be multiplying, and there is more to mourn than the loved ones lost to Covid or war or climate change. Coupled with our polarized, paralyzed politics, these calamities seem to threaten the foundations of our cultural, political and natural worlds. Turning grief into a mental disorder at least draws notice to the enormousness of the losses we face and to the bereavement that underlies all of them: the loss of the familiar.
I am confronted frequently by the derangements of loss. Sometimes it’s obvious, like when a couple are furious about the location of the cemetery plot they are purchasing for their son who died from an overdose. Other times, it’s not quite so on the nose, such as when an applicant for a fishing license likens the masks we’ve mandated at Town Hall to Nazism or when a young couple, baby in arms, tell me the pistol permits I just signed for them are so they can defend themselves but can’t say exactly against what or when a woman calls to ask if anything can be done about her neighbor’s flag with an obscenity aimed at people who voted for President Biden.
But even if you have to squint a little to see it, the loss is always there, lurking behind the anger: loss of control, of certainty, of the confidence that hard work and persistence will pay off with a life that is predictable and secure.
You may have guessed that my town is a Donald Trump town, and you would be correct: He beat Hillary Clinton and Mr. Biden handily here, and MAGA hats seem as common here as caps advertising trucks or construction equipment. You don’t have to squint to see the loss written on those caps. What is nostalgia but a yearning for what once was, at least in imagination, and a wish to have it again — the truck that you can fix yourself, the world before the pandemic, the reliably upward trajectory of an American life? Isn’t anger a way to stave off the helplessness that accompanies the recognition that something precious is gone forever?
I am also nostalgic for the time, probably also imagined, when the Enlightenment dream prevailed. That tolerance would bring forward our differences so that reason could sort them out, with facts as our common ground. That fairness and liberty might pull in different directions but would not pull us apart. At the very least, that we could unite to fight a virus. I am also bereft, heartsick over the incipient loss of a shared world so total that we can’t even agree on what has been lost, let alone mourn it in unison. Or, for that matter, pick up the pieces and see if we can fashion something better out of them.
Perhaps the American Psychiatric Association is correct to turn prolonged grief into an illness and to cite the multiplicity of world-historical calamities to support this claim. Not because the diagnosis will lead to finding errant brain circuits to treat but because, as the links in the supply chain of our familiar world weaken and snap, we may need to be reminded that behind the outrage and blame is bereavement, that we may be entering a long age of grief and we have no one to console us for our losses or to build something new with, except one another.
https://www.nytimes.com/2022/05/07/opin ... 778d3e6de3
By Gary Greenberg
Dr. Greenberg is a psychotherapist and the first selectman of Scotland, Conn.
Leer en español
I’m no stranger to grief. After all, I’ve been alive for nearly 65 years. And I’ve spent almost 40 of them as a psychotherapist, midwifing people’s grief: the couple who split after their child dies because they remind each other of the loss, the woman who swears her dead husband talks to her every night, the man who can’t clean out his deceased wife’s closet even after three years.
Any therapist will tell you that death is not the only occasion for grief. We can mourn the loss of anything to which we have become attached: a pet, a job, a home, a way of life. In bereavement, what is best about us — our ability to love — becomes the source of our suffering. It’s a wonder that all grief isn’t prolonged and that anyone is able to love again rather than wander through life stunned by its cruelty. And it’s surprising that anyone actually believes that there are stages and time limits to grief or that we know enough about how it works to know what to expect of it.
I figured my job had acquainted me with all the varieties of grief. But then I took on an additional one. Since November 2019, I’ve been the first selectman of a small New England town (population: about 1,575). It means I’m its chief executive officer, as well as its chief of police, tree warden and cemetery sexton, and I wind the clock in the Scotland Congregational Church.
The new job has a lot more in common with the old one than you’d think, or at least more than I would have thought. In both cases, unhappy people tell me what is bothering them and often expect (or even demand) that I do something about it. Responding to concerns about high taxes or flooded storm drains does not, however, usually require an excavation of a complainant’s past trauma; when I can fix the problem with a phone call, I am gratified in a way I would not have expected.
When the American Psychiatric Association added prolonged grief disorder to its Diagnostic and Statistical Manual of Mental Disorders last fall, the organization’s president, Vivian B. Pender, explained that “the circumstances in which we are living” have made people more susceptible to prolonged bouts of grief. The association noted that in addition to Covid deaths, Americans faced many ongoing disasters, including, at the time, “the wind-down in Afghanistan, floods, fires, hurricanes and gun violence.”
“Check in with yourself” if you’ve lost someone, Dr. Pender recommended. “Grief in these circumstances is normal, but not at certain levels and not most of the day, nearly every day for months. Help is available.”
Dr. Pender’s comments marked the culmination of a process that began about a decade ago, when the association identified prolonged grief as a possible mental disorder, a designation that encouraged researchers and the pharmaceutical industry to fund studies into such matters as the brain chemistry of protracted mourning, the difference between prolonged grief disorder and depression and the merits of various talk and drug therapies. They have identified neural circuits, sharpened diagnostic criteria and developed treatment regimens. There’s even an app for it under study called My Grief.
Critics, including me, have called this yet another intrusion of psychiatry into normal life, pointing out that there are no biological markers to distinguish prolonged grief disorder from normal grieving, whatever that is, and that no one has yet come close to figuring out how neural circuits give rise to any experience, let alone one as complex as grief.
But we must acknowledge that the new diagnosis is already doing exactly what a diagnosis is supposed to do — garnering resources for suffering people and attention to their suffering. The occasions for grief, prolonged or otherwise, do seem to be multiplying, and there is more to mourn than the loved ones lost to Covid or war or climate change. Coupled with our polarized, paralyzed politics, these calamities seem to threaten the foundations of our cultural, political and natural worlds. Turning grief into a mental disorder at least draws notice to the enormousness of the losses we face and to the bereavement that underlies all of them: the loss of the familiar.
I am confronted frequently by the derangements of loss. Sometimes it’s obvious, like when a couple are furious about the location of the cemetery plot they are purchasing for their son who died from an overdose. Other times, it’s not quite so on the nose, such as when an applicant for a fishing license likens the masks we’ve mandated at Town Hall to Nazism or when a young couple, baby in arms, tell me the pistol permits I just signed for them are so they can defend themselves but can’t say exactly against what or when a woman calls to ask if anything can be done about her neighbor’s flag with an obscenity aimed at people who voted for President Biden.
But even if you have to squint a little to see it, the loss is always there, lurking behind the anger: loss of control, of certainty, of the confidence that hard work and persistence will pay off with a life that is predictable and secure.
You may have guessed that my town is a Donald Trump town, and you would be correct: He beat Hillary Clinton and Mr. Biden handily here, and MAGA hats seem as common here as caps advertising trucks or construction equipment. You don’t have to squint to see the loss written on those caps. What is nostalgia but a yearning for what once was, at least in imagination, and a wish to have it again — the truck that you can fix yourself, the world before the pandemic, the reliably upward trajectory of an American life? Isn’t anger a way to stave off the helplessness that accompanies the recognition that something precious is gone forever?
I am also nostalgic for the time, probably also imagined, when the Enlightenment dream prevailed. That tolerance would bring forward our differences so that reason could sort them out, with facts as our common ground. That fairness and liberty might pull in different directions but would not pull us apart. At the very least, that we could unite to fight a virus. I am also bereft, heartsick over the incipient loss of a shared world so total that we can’t even agree on what has been lost, let alone mourn it in unison. Or, for that matter, pick up the pieces and see if we can fashion something better out of them.
Perhaps the American Psychiatric Association is correct to turn prolonged grief into an illness and to cite the multiplicity of world-historical calamities to support this claim. Not because the diagnosis will lead to finding errant brain circuits to treat but because, as the links in the supply chain of our familiar world weaken and snap, we may need to be reminded that behind the outrage and blame is bereavement, that we may be entering a long age of grief and we have no one to console us for our losses or to build something new with, except one another.
https://www.nytimes.com/2022/05/07/opin ... 778d3e6de3
My College Students Are Not OK
By Jonathan Malesic
Mr. Malesic is the author of “The End of Burnout.” He teaches first-year writing at Southern Methodist University and lives in Dallas.
In my classes last fall, a third of the students were missing nearly every time, and usually not the same third. Students buried their faces in their laptop screens and let my questions hang in the air unanswered. My classes were small, with nowhere to hide, yet some students openly slept through them.
I was teaching writing at two very different universities: one private and wealthy, its lush lawns surrounded by towering fraternity and sorority houses; the other public, with a diverse array of strivers milling about its largely brutalist campus. The problems in my classrooms, though, were the same. Students just weren’t doing what it takes to learn.
By several measures — attendance, late assignments, quality of in-class discussion — they performed worse than any students I had encountered in two decades of teaching. They didn’t even seem to be trying. At the private school, I required individual meetings to discuss their research paper drafts; only six of 14 showed up. Usually, they all do.
I wondered if it was me, if I was washed up. But when I posted about this on Facebook, more than a dozen friends teaching at institutions across the country gave similar reports. Last month, The Chronicle of Higher Education received comments from more than 100 college instructors about their classes. They, too, reported poor attendance, little discussion, missing homework and failed exams.
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The pandemic certainly made college more challenging for students, and over the past two years, compassionate faculty members have loosened course structures in response: They have introduced recorded lectures, flexible attendance and deadline policies, and lenient grading. In light of the widely reported mental health crisis on campuses, some students and faculty members are calling for those looser standards and remote options to persist indefinitely, even as vaccines and Covid therapies have made it relatively safe to return to prepandemic norms.
I also feel compassion for my students, but the learning breakdown has convinced me that continuing to relax standards would be a mistake. Looser standards are contributing to the problem, because they make it too easy for students to disengage from classes.
Student disengagement is a problem for everyone, because everyone depends on well-educated people. College prepares students for socially essential careers — including as engineers and nurses — and to be citizens who bring high-level intellectual habits to bear on big societal problems, from climate change to the next political crisis. On a more fundamental level it also prepares many students to be responsible adults: to set goals and figure out what help they need to attain them.
Higher education is now at a turning point. The accommodations for the pandemic can either end or be made permanent. The task won’t be easy, but universities need to help students rebuild their ability to learn. And to do that, everyone involved — students, faculties, administrators and the public at large — must insist on in-person classes and high expectations for fall 2022 and beyond.
In March 2020, essentially all of U.S. higher education went remote overnight. Faculties, course designers and educational technology staffs scrambled to move classes online, developing new techniques on the fly. The changes often entailed a loosening of requirements. A study by Canadian researchers found that nearly half of U.S. faculty members reduced their expectations for the quantity of work in their classes in spring 2020, and nearly a third lowered quality expectations. That made sense in those emergency conditions; it seemed to me that students and faculties just needed to make it through.
That fall, most students were learning at least partly online. Simultaneously, colleges gave undergraduate students more autonomy and flexibility over how they learned, with options to go remote or asynchronous.
Faculty members and students across the Dallas-Fort Worth area, where I live, described a widespread breakdown in learning that year. Matthew Fujita, a biology professor at the University of Texas at Arlington, said the results of the first exam in his fall 2020 genetics class, a large lecture course, reflected “the worst performance I’d ever seen on a test.”
Amy Austin, who teaches Spanish at U.T.A., began calling her students her “divine little silent circles” — a reference to Dante Alighieri’s “Divine Comedy” — because she would typically see only their initials in a circle on her computer screen, none of them speaking.
Students’ self-reports track with these observations. A June 2021 survey by Inside Higher Ed found that more than half of students said they learned less that academic year than they did before the pandemic.
There is much evidence that students learn less online than they do in person, in part because online courses demand considerable self-discipline and motivation. And some lessons just don’t translate to a remote format. “You can’t learn how to use a microscope online,” said Melissa Walsh, who teaches biology and environmental science at U.T.A. “You just can’t.”
It’s no surprise, then, that in one of the first studies to examine broad-scale learning outcomes during the pandemic, researchers found that the switch to online learning resulted in more course failures and withdrawals in the Virginia community-college system, even despite more lenient grading. Students nationwide reported a greater willingness to cheat, too.
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https://www.nytimes.com/2022/05/13/opin ... 778d3e6de3
The Answer to Stopping the Coronavirus May Be Up the Nose
By Akiko Iwasaki
Dr. Iwasaki is a professor of immunobiology at Yale School of Medicine. She studies Covid-19 vaccines and immunity.
The Covid-19 vaccines authorized for use today were developed at unprecedented speed and surpassed expectations in how well they worked. The billions of people who are protected by them have avoided severe symptoms, hospitalization and deaths. These vaccines are a scientific success beyond measure.
And yet they could be even better.
The enemy has evolved, and the world needs next-generation vaccines to respond. This includes vaccines that prevent coronavirus infections altogether.
When the early mRNA vaccines were first authorized in December 2020, the world was dealing with a different kind of pandemic. The dominant strain circulating had a relatively low capacity to spread between people. At that time, not only did the mRNA vaccines provide strong protection against severe disease and death, but they were also highly protective against infections and the virus’s spread as well.
But SARS-CoV-2 continued mutating, and in doing so it has given rise to variants that are more contagious and highly capable at skirting around protective antibodies, causing widespread infections, despite ever growing levels of immunity from vaccines and prior infections. Thankfully, after the booster shot, the mRNA vaccines are still very effective at preventing hospitalizations and deaths, including against the highly contagious Omicron variant.
So, one may ask, if we can eliminate much of the severe disease and fatality risk through a combination of existing vaccines and treatments, why should we worry about infections?
Even mild infections can develop into long Covid, with people suffering long-lasting, debilitating symptoms. Data also suggests that groups like older adults who have been vaccinated but haven’t received their boosters may continue to be at a higher risk for the worst outcomes of Covid-19. Regular infections can pose substantial disruptions to people’s lives, affecting their ability to work and keep their children in school. There’s also no guarantee that people infected with Omicron will remain protected against infections with future variants.
One change that could make vaccines more effective is if they can stop the virus in its tracks, right when it enters the body. This could cut down on infections altogether, as well as the spread of the virus.
The currently available Covid-19 vaccines are injected into people’s arm muscles and are highly capable at combating the virus once people are infected. But they are not as successful at preventing people from getting infected to begin with. To do that, you ideally want to stop a virus from spreading right at the site where people get infected: the nasal cavity.
Groups of scientists, including myself, are working on nasal Covid vaccines for this very reason. Ideally, a nasal vaccine could enter the mucus layer inside the nose and help the body make antibodies that capture the virus before it even has a chance to attach to people’s cells. This type of immunity is known as sterilizing immunity.
By catching viruses right at the site of infection, antibodies induced by nasal vaccines can give the body a head start at combating the virus before it causes symptoms. Not only could nasal vaccines be better positioned to prevent infections, but they can also develop the same kind of immune system protection as other vaccines, and even stronger because this immune memory is at the portal of virus entry. These vaccines can establish highly protective memory B cells, which make faster and better antibodies to future infections, and memory T cells, which help kill infected cells and support the production of antibodies.
These kinds of vaccines have traditionally been considered more difficult to make. The mucus layer is a formidable barrier. The body also doesn’t generate a robust immune response by simply spraying any conventional vaccine up the nose. The approved nasal vaccine for the flu, called FluMist, uses weakened viruses to get into cells in the nose and spur an immune system response. But this approach is not safe for use in immunocompromised people.
The good news is that scientists like myself believe we have found a way around this problem for SARS-CoV-2. We have shown in animal studies that we can spray the virus’s so-called spike proteins into the nose in a previously vaccinated host and significantly reduce infection in the nose and lungs as well as provide protection against disease and death. Combining this approach with efforts underway to develop a single vaccine for a broader range of coronaviruses could potentially offer people protection against future variants, too.
One big question is how long immunity from a nasal vaccine would last. So far, in animal studies, antibodies and memory immune cells persist in the nose for months. Should this immunity wane over time, like with the other vaccines, using the nasal spray as a booster — potentially over the counter — every four to six months may make the most sense for this pandemic. This presents similar challenges as do other boosters, where uptake could be much higher, especially for high-risk groups. Encouraging people to get their boosters is critical. But the barrier for a nasal spray booster may be lower for many people than for a needle shot.
The world desperately needs a vaccine strategy that places immunological guards outside the gates to prevent viral invaders from infecting us. There are several other nasal vaccine approaches in various phases of clinical trials. And any successes we have in developing a nasal vaccine for Covid-19 will not be limited to this one virus. Nasal spray vaccine strategies can be applied to other respiratory pathogens, too.
While there are some remaining obstacles, the potential immunological and public health benefits of nasal spray vaccines are worth focusing on now and for years to come.
https://www.nytimes.com/2022/05/16/opin ... 778d3e6de3
It’s Still Covid’s World. We’re Just Living in It.
There are days, now, when you can almost forget about the virus. Hundreds of thousands of people around the world are still being infected with Covid-19 daily — an average of about 361 Americans died from it every day in the last week — but after more than two years and millions of lost lives, the pandemic has given way in headlines and breaking-news crawls to older and more familiar atrocities.
Across much of the United States the rhythms of life have returned to something like their prepandemic tempo. Bars and restaurants are packed, there’s a wedding boom, and Memorial Day weekend looks likely to kick off a busy summer travel season.
But remember how giddy we all were for a virus-free summer last year? It was in May 2021 that officials at the Centers for Disease Control and Prevention advised that Americans who had been vaccinated could take off their masks and forget about social distancing in most settings. Then, during a successful campaign to vaccinate millions of Americans, the White House began preparing a Fourth of July bash to declare a “summer of freedom” from the virus.
You know how that turned out. America’s vaccination rate was too low, and just when we thought we’d licked it, Covid wriggled free. First the Delta variant spread widely, then Omicron and its many subvariants. Masks were ordered back on. Boosters were soon recommended for people over 12. And in the year since what was once billed “hot vax summer,” about 400,000 more Americans died from Covid-19.
This is not a column about the dangers of prematurely declaring victory against the pandemic. Few American health officials are urging anything but caution and vigilance now.
But last summer’s rapid Covid turnabout does illustrate a dynamic that I worry we have yet to internalize: Any peace we’ve reached with the virus may be only a temporary, uneasy one. It seems likely that, at least for the foreseeable future, our lives may continue to be upended by the whims of this wily, unpredictable virus, until we can advance against it.
And it isn’t just our health that’s at stake. I worry that Covid’s very unpredictability could inject volatility into global affairs. It’s been remarkable to watch how the zigs and zags of the pandemic era have confounded not just public health officials and the Biden administration, but also the Federal Reserve, the Chinese government, hedge funds and some of the world’s largest businesses.
How can humanity effectively plan for the future if the virus keeps pulling the rug out from under us? From the beginning of the pandemic we’ve heard about adjusting to a “new normal,” but Covid’s malleability suggests it may not be just one new normal we’ll have to get used to. And as long as the virus keeps swerving in unpredictable directions, it may continue to rock our politics, shock our economy and hinder our ability to work collectively to address every other major problem humanity faces, especially global threats like climate change.
The basic problem is that especially since the emergence of the Omicron variant, it has become painfully clear that while vaccines prevent severe illness and death, research shows that even vaccinated people can keep getting sick from Covid-19. The elderly, unvaccinated, immunocompromised and others at high risk may continue to face greater danger.
Even though far fewer people are becoming seriously ill from the virus than at its peak, consider the level of disruption to daily life that we may continue to face — the labor shortages brought on by sickness, burnout and overwork, the toll of stress and psychological fatigue on a population that has had little respite from the ever-present danger of disease.
And because the effects of the virus will play out in different ways in different parts of the world, the disruptions could ripple erratically across the globe. China’s troubled zero-tolerance approach to fighting Covid has snarled ports in Europe and the United States and forced some carmakers to suspend production.
Of course, it isn’t just the virus that has undermined global stability. Russia’s invasion of Ukraine and extreme weather exacerbated by climate change are also roiling the world’s economy.
But look at just about any economic story these days and you’ll see the pandemic playing some mischief. Robert Califf, the commissioner of the Food and Drug Administration, told a House panel this week that a Covid-19 outbreak caused a delay in the agency’s inspection of the Abbott Nutrition plant implicated in the national shortage of baby formula. Another lapse was “likely due to Covid-19 staffing issues” in the F.D.A. mailroom, Califf wrote.
Eventually the world will adapt to Covid’s tricks. Nasal vaccines that are now in clinical trials may be able to curb transmission of the virus, which could deal a blow to Covid’s many variants. Wider access to therapeutic drugs could make catching Covid less risky and disruptive. And after a few years perhaps the virus’s waves may settle into a seasonal pattern that we could adapt to living with.
Over the next few years, though, we may be in for a bumpy Covid ride. New variants have proven more contagious. People are burned out on doing much to avoid it. And we have no idea what the next variant may unleash upon a world already thoroughly pummeled by the disease.
Happy summer!
https://www.nytimes.com/2022/05/26/opin ... 778d3e6de3
New Tools Can Make Our Covid Immunity Even Stronger
By Deepta Bhattacharya
Dr. Bhattacharya is a professor of immunology at the University of Arizona.
Leer en español
The Covid-19 pandemic has been a protracted battle between a generation-defining virus and scientists working at a breakneck pace to fight it. Following the development of the remarkably effective first-generation Covid-19 vaccines, the virus made its response: More infectious variants have emerged, capable of infecting people who have been vaccinated or were previously infected. This is by no means a failure of the vaccines, which continue to keep millions of people protected from the most devastating consequences of the virus. But science should be ready to make its next move.
Initially, people who received the mRNA vaccines from Pfizer or Moderna were around 95 percent less likely to get Covid-19 than those who had no prior immunity. Protection against severe disease was strong. Countries with high vaccine uptake saw coronavirus cases, hospitalizations and death rates plummet.
Given these powerful tools, it seemed that the worst of the pandemic would rapidly be put behind us. And it likely has been. Despite an astonishingly large fraction of the country becoming infected during this winter’s Omicron wave, deaths from Covid-19 were lower than or not far surpassing those of previous waves that caused far fewer infections. These deaths were much less likely to occur in those who were vaccinated compared to those who weren’t. Beyond the vaccines, antiviral medications have been developed that are of particular benefit to those who are unvaccinated or immunocompromised. There are many tools now that make Covid-19 less of a threat than it was in 2020.
It’s also true that the road out of the pandemic has been bumpier than many had hoped. Over half of the U.S. population has been infected, and some more than once. Importantly, post-vaccination infections and re-infections only rarely land people in the hospital, but the experience can nonetheless be miserable and disruptive.
The Covid situation, in terms of hospitalizations and deaths, is in a much better place now, but it is not the best science can do, and we must continue to advance against it. There are several ways to improve the state of immunity.
Following vaccination or recovery from an infection, the immune system leaves behind several layers of defense to counter any future virus exposures. One component of durable immunity is made of memory cells that patrol the body, looking for any signs of the virus. If such evidence is found, memory T cells can kill the infected cells while memory B cells rapidly produce antibodies, which are proteins that can stick to viruses and prevent them from infecting more cells.
Memory cells used to have enough time to find and shut down the virus before a coronavirus infection led to noticeable symptoms. But as rapidly replicating variants such as Delta and Omicron have emerged, the window of time before a person develops symptoms has shrunk, making it harder for them to clear the infection before they feel sick. Memory cells still usually catch up to the virus before it can spread through the lungs and cause severe disease, but one can feel pretty awful in the meantime.
The Covid vaccines do a good job of inducing all kinds of memory cells. These cells remain stable over time and are relatively impervious to mutations in variants like Omicron. This is good news, and helps explain why the available vaccines continue to sharply reduce severe illness even from variants that have changed substantially from the original strain of the coronavirus. Still, it’s clear that to prevent people from getting sick, scientists need to find ways to shorten the response time of these cells even further.
A second layer of immunity is composed of specialized soldiers of the immune system called plasma cells. Each plasma cell makes antibodies at an astronomical clip — several thousand every second, whether the virus is around or not. Because antibodies themselves only stick around for a few weeks, the persistence of plasma cells is the key to replenishing and maintaining protective antibodies over time.
The Covid vaccines behave very differently from one another in terms of how many plasma cells are made and how long they live. This can be estimated by measuring the concentrations of antibodies in the blood over time. Both the Moderna and Pfizer mRNA vaccines lead to very high initial levels of protective antibodies. These antibodies then decline precipitously for six to nine months before stabilizing between 10 to 20 percent of their peak levels. Because the peak levels of plasma cells and antibodies after mRNA vaccination are so high, even a 90 percent loss would probably still leave one highly protected against symptomatic infection had the virus not evolved into new variants.
In contrast, the single-dose Johnson & Johnson vaccine induces far fewer plasma cells and antibodies initially, and its effectiveness against Covid-19 is lower than that of the mRNA vaccines. The Food and Drug Administration has understandably limited its use because of risk for a rare but serious blood-clotting side effect. However, the Johnson & Johnson vaccine maintains and may even slowly increase protective antibodies over time. In an ideal world, people would get high levels of protection from an mRNA vaccination and then maintain it as seen with a single-dose vaccine such as Johnson & Johnson’s.
So, given this state of affairs, what are actionable things that can be done to improve the duration of immunity? There are several possibilities, ranging from options that are available now to what I expect will be coming in the next few years.
First, there are boosters. Because antibodies are maintained at high levels when the Johnson & Johnson vaccine is given as a booster after the mRNA vaccines, it’s worth considering whether there are ways to safely resurrect this vaccine for boosters, perhaps by better defining the groups at risk for the rare blood clotting side effect.
Second, the vaccines and boosters we have, currently aimed at a strain that has been gone for over a year, will be updated to match variants like Omicron. The matching of the vaccines to the virus will likely help antibodies work better, potentially providing some buffer room for them to decline. Getting a booster with an Omicron-specific vaccine could help protect people from infections or getting the virus again.
While frequent boosters could restore some portion of the original vaccines’ levels of protection against the virus, given the lower uptake of boosters so far, scientists and stakeholders must also pursue longer-lasting solutions and new tools to stop infections.
Vaccines that are received up the nose or in the mouth position memory cells and antibodies near the sites of infection and offer potential ways to prevent symptoms and perhaps even infections altogether. Some of these types of vaccines are now in clinical trials and could become available soon.
Groups of researchers are also studying single vaccines that could work against all versions of the novel coronavirus. These vaccines, which aim to be variant-proof, make it difficult for the virus to outmatch the immune system. They have shown great promise in animal experiments. Some are entering clinical trials and could be available in the next few years.
These kinds of vaccines could buy us long-lasting protection against infections and disease. When combined together, our armamentarium for fighting Covid-19 is growing. This is not the end of the chess match. Our next moves are coming soon.
https://www.nytimes.com/2022/06/13/opin ... 778d3e6de3
When Will the Pandemic End? And Other Pressing Questions, Answered
While the risks of deaths and hospitalizations from Covid-19 are substantially lower now, navigating this phase of the pandemic can be frustrating and confusing. The coronavirus is less deadly but more transmissible. There’s no set guide to personal behavior. For some, it may continue to be a season of sweaty masks and calculated indoor dining. For others, life is back to normal. Still, questions remain, and making informed choices can help.
So we asked three experts — two immunologists and an epidemiologist — to weigh in on some of the hundreds of questions we’ve gathered from readers over the past few weeks, based on their expertise and opinion. A selection of those questions followed by responses from the experts are below. They have been lightly edited for clarity and length.
‘Keeping up with vaccines and boosters is so important.’
I feel Covid is now like our annual flu strains. Is there a new type of vaccine coming this fall or winter to help with future variants? — Gerry Moss, Naples, Fla.
Akiko Iwasaki: Although it may feel like Covid is now like annual flu, data show it is still causing more hospitalizations and deaths than the flu does. This is why keeping up with vaccines and boosters is so important. There will likely be an Omicron-matched booster in the fall or winter to help protect against the current variant. Myself and others are also working on nasal booster vaccines and universal coronavirus vaccines designed to reduce infection and spread from future variants. Nasal vaccines will not be available this winter, but if there is government support and coordination, they can be available in the near future, potentially in a couple of years.
‘The Omicron-focused vaccine will contain new targets for the immune system.’
I’m 64, in good health, haven’t had Covid and have a family wedding coming up, so I went ahead and got a second booster in July. Now I’m afraid that if an Omicron-focused vaccine arrives in the fall, I won’t be eligible. Did I make a mistake? — Mary Murphy, Kansas City, Mo.
Marion Pepper: Getting a booster in July before a big family wedding was a good idea and certainly not a mistake, even with Omicron-focused vaccines likely arriving this fall. The C.D.C. recommends that non-immunocompromised individuals 18 years and older wait for at least five months after their primary Pfizer or Moderna vaccine doses, and people 50 and older wait for at least four months after receiving a first booster prior to getting a subsequent one. These delays are suggested for several reasons, including the fact that immunity wanes over time, so more frequent boosting with the same vaccine is not needed, and because the immune response also evolves over time and getting an additional vaccine within a shorter time period may impact that response and reduce protection.
However, the Omicron-focused vaccine will contain new targets for the immune system, so these concerns may not be as important as the added breadth of protection introduced by the new vaccine. Most important, if an Omicron-focused vaccine provides better protection against Omicron variants due to these new targets in the vaccine, that would be the most important consideration.
‘Getting infected is not inevitable, but ultimately it does come down to a trade-off.’
I do not get close to people and am very cautious, even outside. My friend who is equally cautious, maybe more so than I am, just came down with it. Is it just inevitable? — Carol Kushner, Fire Island, N.Y.
Nuzzo: It’s important to realize that the virus is not going away and will remain a risk for the foreseeable future. Getting infected is not inevitable, but ultimately it does come down to a trade-off: How much are you willing to give up to lower your risks of infection and for how long? We all have different answers to those questions and will choose to take on risks based on how much we value certain activities. We know that tools like masks and tests help lower our risks and outdoor gatherings are safest. But we also know that many very cautious people have gotten infected nonetheless. This suggests it will be hard to dodge the virus forever unless we continue to faithfully avoid indoor gatherings, social events and other activities that enrich our lives. My advice to anyone who is looking to reduce their risk of infection is to mask when you are going to a crowded indoor space, particularly when case counts are increasing. But I don’t recommend forgoing important life events or not seeing friends and family, as it doesn’t seem like a sustainable or happy way to live.
‘A test represents a snapshot in time.’
Are the current at-home tests reliable for BA.5? — Gayle DeRose, Victor, N.Y.
Nuzzo: Yes, the home tests continue to be reliable for detecting when you have a contagious infection. With the emergence of Omicron, there were reports of patients developing symptoms before their rapid tests turned positive. This is likely because our immune system may respond to the virus, causing symptoms before the virus grows to levels that are high enough to be contagious and detectable by the rapid tests. It has always been the case that a rapid test represents a snapshot in time. If you test negative, it does not mean that you are free of infection. You may subsequently turn positive if you have symptoms or were exposed to someone who had Covid-19. Rapid tests work best when they are repeated.
‘Additional vaccination will help to protect your 4-year-old.’
My 4-year-old got Covid for the first time this week, as did the rest of our family. He is the only one not vaccinated yet and had the worst symptoms, but it was much like other childhood illnesses. Will he really benefit much from a vaccine now? — Morgan Morris, Kansas City, Kan.
Pepper: Studies from our lab and others have demonstrated that while a prior infection provides you with some immune protection, getting an additional vaccine enhances that immune response significantly and creates even greater immune protection. So yes, additional vaccination will help to protect your 4-year-old by boosting that protection and potentially prolonging his immune protection.
Nuzzo: Several studies have demonstrated that hybrid immunity (vaccine plus infection) may be more protective than infection alone. So vaccination would likely add additional protection, as Marion suggested. The C.D.C. recommends delaying vaccination for three months after infection (measured from the date his symptoms started or date of positive test if he didn’t have symptoms). By that timing, your 4-year-old would enter the winter and holiday months with some additional protection, which is a benefit given that we tend to see large case increases that time of year.
‘The risk of long Covid is likely to be reduced with every new exposure.’
If you’ve been vaccinated and boosted and still get Covid, are your odds of having long Covid the same as someone who is unvaccinated? Or do vaccines help reduce the chance of developing long Covid too? If there is a benefit, how large is it? — Mark Hurwich, Chicago
Iwasaki: The reported impacts of vaccines in preventing long Covid vary between studies. Some say vaccines halve the odds of long Covid, while others find around a 15 percent reduction. Vaccines are very likely to reduce the risk of developing long Covid, and boosters help this even more.
Pepper: There are also some interesting preliminary studies in animal models suggesting that treatment with antiviral medications may help to prevent some clinical symptoms associated with long Covid, so it will be important to see if that is the case in humans treated with antiviral medications as well.
If we’re going to see the virus 10 or 15 times over the next five years, does the risk of long Covid increase with every exposure? It’s impossible to know what to do with our kids. — Carmen McAlister, South Lyon, Mich.
Iwasaki: Based on immune responses that fortify with every exposure, the risk of long Covid is likely to be reduced with every new exposure. However, in certain populations, the risk may be cumulative. Of course, it’s not possible to say for certain what will happen over the next five years, but most of what we know suggests that multiple exposures will lead to milder outcomes.
Nuzzo: So far, the more rigorous studies show that the risks for long Covid in children seems to be low, occurring much less frequently than among adults who are infected. This along with Dr. Iwasaki’s explanation of why we may generally expect the risk of long Covid to decrease with subsequent exposures and vaccination may provide some reassurance. But there is some uncertainty here and people will navigate that uncertainty differently.
When it comes to my kids, I am not as worried about long Covid, especially now that they are fully vaccinated. I am more worried about being too restrictive with their childhoods. They missed out on a lot of socialization already, and now that the worst threat is over, we’ve resumed most of our usual activities. I feel this is important for their growth and development.
‘Covid-19 has strengthened the world’s preparedness in important ways.’
To what extent is the world now better prepared for a whole new pandemic? — Helen Kara, Uttoxeter, England
Nuzzo: Covid-19 has strengthened the world’s preparedness in important ways. We have seen that with enough political will and scientific determination, we can develop multiple safe and effective vaccines, rapid tests we can use in the privacy and convenience of our own home and new medicines for treating infections. The path taken to develop these tools has the potential to help alleviate human suffering from other serious diseases, including future pandemic threats.
But in watching our continued response to Covid-19 and now monkeypox, I do continue to see deeply concerning gaps in readiness for future pandemics. The biggest one in the United States is that we don’t fund and staff our public health departments to be able to meet the demands of infectious disease emergencies like the continuing hazards they are. Instead of letting emergency funding lapse every time political attention to an event wanes, we need to permanently equip every health department with enough staff and modern data systems to effectively respond to infectious disease emergencies, including the possibility of multiple emergencies at the same time.
Pepper: I feel that there is generally a greater understanding and appreciation of the biology of infection and the immune response. My hope is that this heightened awareness of these topics and how scientists and biomedical researchers have been consistently working in the background to create new vaccine technologies and drugs will lead to enhanced funding. Additional funding would speed up drug and vaccine development and ensure that we have the tools in place to respond to the next pandemic when it emerges. The will seems to be there, but we will see if that translates to better funding and preparedness.
‘We will reach a point where we move on from having the virus be a daily concern in our lives.’
Will the pandemic end and if so, how soon? — Gary McCormick, Searcy, Ariz.
Nuzzo: There is no defined state that constitutes the “end” of a pandemic. The virus that caused our last pandemic, 2009 H1N1 influenza, continues to sicken people every year as a seasonal flu virus. But we don’t talk about that virus much because it no longer upends our lives as it once did.
Like the H1N1 virus, it is clear that the virus that causes Covid-19 will not disappear. But how it will play out in the coming months and years is uncertain, particularly as the virus continues to evolve. I do think we will reach a point where we move on from having the virus be a daily concern in our lives. In my view, that happens when we no longer worry about hospitals becoming overwhelmed with surges of patients.
Vaccines and treatments help us get there by lessening the virus’s ability to severely sicken people or kill them. But not enough of us benefit from the protection that these tools offer. About half of people age 18 and older have received a booster shot. Getting people up-to-date on their vaccinations and ensuring that people who are at high risk for severe illness can access treatments if they get infected is key to ending Covid’s ability to disrupt our lives, which in my view is what defines a pandemic.
https://www.nytimes.com/2022/08/12/opin ... 778d3e6de3
Philippines Returns to School, Ending One of World’s Longest Shutdowns
More than two years after Covid emptied their classrooms, students are resuming in-person learning. The lost time will be hard to make up.
Watch video at:
https://www.nytimes.com/2022/08/22/worl ... 778d3e6de3
MANILA — Millions of students throughout the Philippines headed to school on Monday as in-person classes began to fully restart for the first time in more than two years, ending one of the world’s longest pandemic-related shutdowns in a school system already plagued by severe underinvestment.
“We could no longer afford to delay the education of young Filipinos,” said Vice President Sara Duterte, who is also the education secretary, as she toured schools in the town of Dinalupihan, about 40 miles northwest of Manila.
Even before the pandemic, the Philippines had among the world’s largest education gaps, with more than 90 percent of students unable to read and comprehend simple texts by age 10, according to the World Bank.
Schools in the Philippines have long suffered from shortages of classrooms and teachers, whose pay is low, leaving the vast numbers of poor children who cannot afford private schools and rely on the public system with inadequate teaching.
Now, after losing more than two years of in-person instruction, schools face the monumental challenge of educating many students who have fallen even further behind.
Though the Philippines offered online instruction during the pandemic, many students lacked access to computers or internet connections, and overburdened parents often found it hard to keep tabs on their children’s remote learning.
A boy cried outside his classroom on Monday, the first day of in-person classes at a public school in San Juan City.Credit...Eloisa Lopez/Reuters
“As we welcome children back into the classrooms today, let’s remember that this is the first of many steps in our learning recovery journey,” said Oyunsaikhan Dendevnorov, the Unicef representative in the Philippines.
In many countries, as the shortcomings of online learning became increasingly well documented — especially for more disadvantaged students — governments elected to send children back to classrooms even as the coronavirus continued to circulate widely.
A World Bank report that examined 35 studies from 20 countries concluded that the longer schools remained closed, the more ground students lost, with potentially far-reaching consequences. “The inequality in learning between advantaged and disadvantaged groups is likely to grow,” the report said, “posing a significant challenge to ending extreme poverty and promoting shared prosperity.”
Many children simply dropped out. In Uganda, for example, one in 10 students did not report back for classes when they resumed in January after what was one of the world’s longest shutdowns, according to UNICEF.
In the Philippines, government officials and parents were hesitant to reopen classrooms, fearing that schoolchildren could bring the virus back to homes crowded with multiple generations of family members and overtax an already creaky health care system.
Starting in late 2021, the government began to experiment with conducting in-person classes in about 300 schools, but has now begun expanding it to cover all primary and secondary schools. Currently only some schools are in-person all five weekdays; by November, all of the country’s roughly 47,000 schools will be.
Students and their parents lined up on Monday in front of the school gate in Quezon City.Credit...Ted Aljibe/Agence France-Presse — Getty Images
Ms. Duterte said the number of those enrolled in the country has hit nearly 28 million children, both in the public and private schools.
Maria Rogas, a mother of three in suburban Bacoor City, south of Manila, said she had mixed feelings about sending her children back to school.
On the one hand, she welcomes the return to normalcy, but on the other, “Covid remains a scary problem.”
Data from the Department of Health shows that only roughly 27 percent of children aged 5 to 11, and about 76 percent of those between 12 and 17, have been fully vaccinated.
To make it easier for children to get their shots, local health officials were encouraged to set up satellite vaccination sites at schools. However, this was not mandated by the government at the national level. Vaccinations remain purely voluntary, and widespread hesitancy is a problem.
A boy received a Covid vaccine on Monday at San Juan Elementary School in Manila.Credit...Aaron Favila/Associated Press
President Ferdinand Marcos Jr., who last month ruled out more economically crippling lockdowns amid the pandemic, on Monday stressed that learning was more effective if classes were done physically in schools, but also called on the public to observe proper health protocols.
Ms. Rogas, 43, said her children had been vaccinated, but she still worried. “You never know about this virus, which mutates every so often,” she said.
For now, she said, they were just happy to return to school. “For two years, they only saw their friends and classmates on small screens, so they are excited to interact with them.”
https://www.nytimes.com/2022/08/22/worl ... 778d3e6de3
Watch video at:
https://www.nytimes.com/2022/08/22/worl ... 778d3e6de3
MANILA — Millions of students throughout the Philippines headed to school on Monday as in-person classes began to fully restart for the first time in more than two years, ending one of the world’s longest pandemic-related shutdowns in a school system already plagued by severe underinvestment.
“We could no longer afford to delay the education of young Filipinos,” said Vice President Sara Duterte, who is also the education secretary, as she toured schools in the town of Dinalupihan, about 40 miles northwest of Manila.
Even before the pandemic, the Philippines had among the world’s largest education gaps, with more than 90 percent of students unable to read and comprehend simple texts by age 10, according to the World Bank.
Schools in the Philippines have long suffered from shortages of classrooms and teachers, whose pay is low, leaving the vast numbers of poor children who cannot afford private schools and rely on the public system with inadequate teaching.
Now, after losing more than two years of in-person instruction, schools face the monumental challenge of educating many students who have fallen even further behind.
Though the Philippines offered online instruction during the pandemic, many students lacked access to computers or internet connections, and overburdened parents often found it hard to keep tabs on their children’s remote learning.
A boy cried outside his classroom on Monday, the first day of in-person classes at a public school in San Juan City.Credit...Eloisa Lopez/Reuters
“As we welcome children back into the classrooms today, let’s remember that this is the first of many steps in our learning recovery journey,” said Oyunsaikhan Dendevnorov, the Unicef representative in the Philippines.
In many countries, as the shortcomings of online learning became increasingly well documented — especially for more disadvantaged students — governments elected to send children back to classrooms even as the coronavirus continued to circulate widely.
A World Bank report that examined 35 studies from 20 countries concluded that the longer schools remained closed, the more ground students lost, with potentially far-reaching consequences. “The inequality in learning between advantaged and disadvantaged groups is likely to grow,” the report said, “posing a significant challenge to ending extreme poverty and promoting shared prosperity.”
Many children simply dropped out. In Uganda, for example, one in 10 students did not report back for classes when they resumed in January after what was one of the world’s longest shutdowns, according to UNICEF.
In the Philippines, government officials and parents were hesitant to reopen classrooms, fearing that schoolchildren could bring the virus back to homes crowded with multiple generations of family members and overtax an already creaky health care system.
Starting in late 2021, the government began to experiment with conducting in-person classes in about 300 schools, but has now begun expanding it to cover all primary and secondary schools. Currently only some schools are in-person all five weekdays; by November, all of the country’s roughly 47,000 schools will be.
Students and their parents lined up on Monday in front of the school gate in Quezon City.Credit...Ted Aljibe/Agence France-Presse — Getty Images
Ms. Duterte said the number of those enrolled in the country has hit nearly 28 million children, both in the public and private schools.
Maria Rogas, a mother of three in suburban Bacoor City, south of Manila, said she had mixed feelings about sending her children back to school.
On the one hand, she welcomes the return to normalcy, but on the other, “Covid remains a scary problem.”
Data from the Department of Health shows that only roughly 27 percent of children aged 5 to 11, and about 76 percent of those between 12 and 17, have been fully vaccinated.
To make it easier for children to get their shots, local health officials were encouraged to set up satellite vaccination sites at schools. However, this was not mandated by the government at the national level. Vaccinations remain purely voluntary, and widespread hesitancy is a problem.
A boy received a Covid vaccine on Monday at San Juan Elementary School in Manila.Credit...Aaron Favila/Associated Press
President Ferdinand Marcos Jr., who last month ruled out more economically crippling lockdowns amid the pandemic, on Monday stressed that learning was more effective if classes were done physically in schools, but also called on the public to observe proper health protocols.
Ms. Rogas, 43, said her children had been vaccinated, but she still worried. “You never know about this virus, which mutates every so often,” she said.
For now, she said, they were just happy to return to school. “For two years, they only saw their friends and classmates on small screens, so they are excited to interact with them.”
https://www.nytimes.com/2022/08/22/worl ... 778d3e6de3