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It's a question everyone wants answered: Who is more likely to develop long COVID-19, the debilitating symptoms that can linger for weeks, months or even longer, after an infection?
A new unpublished study from 23andMe is part of a growing body of research shedding light on who experiences post-COVID conditions and why. The survey, which was voluntary and relied on people self-reporting symptoms, had several major findings, including that women were far more likely to experience long-term symptoms, as were people with a prior diagnosis of depression or anxiety. More than half of people who reported a diagnosis of long COVID had a history of cardiometabolic disease, such as heart attacks or diabetes.
The 23andMe survey included 100,000 people who reported a diagnosis of COVID. Of those, 26,000 described experiencing symptoms of COVID at least a month after being infected. In addition, more than 7,000 participants reported an official diagnosis of long COVID. Survey participants were asked about their symptoms at 3, 6 and 12 months. According to Centers for Disease Control and Prevention estimates, about 13.3% of people with COVID will experience symptoms for at least a month, and 2.5% of people will experience symptoms for longer than three months.
Dr. Stella Aslibekyan, a genetic epidemiologist for the consumer genetics company, which is based in South San Francisco, told SFGATE that the 23andMe study is unique because it's so large and directly surveyed people about their symptoms. Many other studies into long-term symptoms are smaller, and based on data from medical records, as opposed to self-reported experiences.
"We're able to paint a more complete picture of the COVID experience than would be possible from just using medical records," Aslibekyan said.
There are limitations to this approach, too. Participating in the study was voluntary, as opposed to a random sample of patients in a health system. The demographics and characteristics of people represented in these kinds of “self-selecting” studies are often skewed, based on who has enough time and interest to fill out the surveys.
The study, which has not been peer-reviewed or published in a medical journal, is part of an effort to solve the mystery of why so many people experience symptoms such as shortness of breath, cough, fever, fatigue, brain fog or chest pain for weeks to months after a COVID infection. Many of these symptoms align with the symptoms of chronic fatigue syndrome, a poorly understood condition that has often been linked to other viral infections, including flu and Epstein-Barr.
"One hypothesis positions long COVID as an autoimmune condition, in which the immune system is attacking the body's own tissues," Aslibekyan said.
Many studies have found that long-term symptoms are much more likely to occur in the most severe COVID cases, but the U.S. Centers for Disease Control and Prevention says that "anyone who was infected with the virus can experience post-COVID conditions, even people who had mild illness or no symptoms from COVID-19."
"Researchers found that individuals with COVID who required hospitalization had a more than ten-fold risk of being diagnosed with long COVID compared to those who were not hospitalized when controlling for age, sex, and ethnicity," 23andMe said.
Depression and anxiety also seem to be risk factors.
To Aslibekyan, one of the most illuminating findings in the survey was that people diagnosed with long COVID were twice as likely to report experiencing depression or anxiety before they were infected.
There is extensive research into the relationship between depression and the immune system. People with diseases that cause over-activation of the immune system are more likely to be diagnosed with depression, and vice versa.
"When [depressed people] are hit with that acute COVID-19 infection, those long term symptoms also represent inappropriate malfunction of the immune system, so it makes sense that they're more vulnerable to those long-term dysfunctions of the immune system," Aslibekyan said.
Researchers also found that people with two X chromosomes in each cell were more than twice as likely to report a long COVID diagnosis than those with only one. This finding is consistent with other studies that have found women are less likely to die from COVID, but more likely to develop long-term symptoms.
The X chromosome is home to many genes that control immune responses. While most men inherit just one copy from their mothers, women generally inherit two — one from each parent — and, therefore, two sets of those important immune-related genes. (In every individual cell, one or the other X chromosome is switched “on” at random.) That genetic diversity is often a good thing; women are better able to fight off many illnesses than men, for instance. But it’s also linked to a higher rate of autoimmune diseases among women, including multiple sclerosis and Sjogren’s syndrome, Aslibekyan said.
The symptom most commonly reported by people responding to the survey was brain fog, a term for sluggish thinking, followed by fatigue, shortness of breath and loss of smell. Among people who received long COVID diagnoses, about 19% reported brain fog a year after infection.
Among participants who received vaccines after catching COVID, more than half (55%) reported no change in their symptoms, 25% reported an improvement in symptoms, and about 13% reported that their symptoms got worse. The rest did not know, weren't sure or didn't answer.
23andMe began collecting data in April 2020. That means many of the people in the survey contracted COVID-19 before the vaccine was available.
“So what does that tell us?” Aslibekyan said. “The vaccine may not be a cure for long COVID. Now what we do know is that the vaccine is very good at preventing both initial infection and hospitalization, yes. And hospitalization was associated with a tenfold increase in risk of long COVID. So the vaccine is great for prevention.”
Editor’s note: This story was updated on May 31 at 12:30 p.m. to clarify the circumstances around women’s immune systems.
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The U.S. Justice Department on Tuesday asked a federal appeals court to overturn a U.S. District Court judge’s order that declared a government mandate requiring masks on public transportation unlawful, according to a report.
A federal judge in April voided the Biden administration’s mask mandate for travelers using public transportation such as trains and airplanes. The mandate from the Centers for Disease Control and Prevention (CDC) applied to people as young as 2-years-old.
FILE: A United Airlines worker assists travelers after the Biden administration announced it would no longer enforce a U.S. coronavirus disease (COVID-19) mask mandate on public transportation, at Ronald Reagan Washington National Airport in Arlington, Virginia, U.S. (REUTERS/Kevin Lamarque/File Photo)
After the judge’s ruling the DOJ said it would appeal the judge’s ruling if the CDC deemed it necessary. The DOJ has told the federal appeals court that the CDC order, issued in January 2021, was "within" the agency’s legal authority, Reuters reported.
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The ruling from U.S. District Court Judge Kathryn Kimball Mizelle, came in a case brought in Florida federal court by Health Freedom Defense Fund, Inc. and frequent air travelers Ana Daza and Sarah Pope against the administration. Judge Mizelle determined that the mandate violated the Administrative Procedure Act by being outside the scope of the CDC's authority, was "arbitrary" and "capricious," and for not going through the required notice and comment period for federal rulemaking.
This is a developing story. Check back for updates.
GUANGZHOU, China — Adding a spoonful of sugar to a cup of coffee could be the key to a longer life, according to a new study. Scientists have found coffee-drinkers are at a lower risk of death than non-coffee drinkers, but those who like the drink sweet are even less likely to die.
Researchers in China who followed a group of British adults for an average of seven years found people who drank between one and a half to three and a half cups of caffeinated coffee were less likely to die during that time in comparison to those who did not take sugar or those who do did drink coffee at all.
People who drank any amount of unsweetened coffee were up to 21 percent less likely to die than those who did not drink coffee.
Those who like their coffee sweet were up to 31 percent less likely to die than non-coffee drinkers during the follow-up period — if they kept their coffee consumption between one and a half and three and a half cups a day. Adults who took sugar only added one spoonful on average.
Drinking coffee displayed a connection to a lower risk of dying from any cause, dying from cancer, and dying from heart disease. It didn’t matter whether people drank decaffeinated, instant, or ground coffee — the results held up for all of them.
The team notes that their results were inconclusive for participants adding artificial sweeteners to their coffee. Earlier research has shown the beverage puts coffee-drinkers at a lower risk of dying, but those studies did not distinguish between sweetened and unsweetened coffee.
During the new study, researchers looked at data on more than 171,000 adults participating in the UK Biobank study health behavior questionnaire. The healthy volunteers, who did not have a known case of heart disease or cancer, answered dietary and health questions to determine the effect of their coffee-drinking habits. Scientists followed up with each person from 2009 to 2018.
While the results, published in the journal Annals of Internal Medicine, adjusted for each person’s lifestyle, demographics, and clinical factors, they do not prove drinking coffee is the only reason participants were less likely to die.
The average amount of sugar participants took was much lower than the amount typically added to a drink in coffee chain restaurants. However, the study authors say that, based on their findings alone, doctors do not need to tell coffee-drinking patients to kick the habit.
“Our study found that adults who drank moderate amounts of coffee sweetened with sugar every day were about 30 percent less likely to die from any cause during the average of seven year follow up period compared to non-coffee drinkers,” study author Dan Liu from Southern Medical University says in a statement, according to SWNS. “These novel findings are of clinical and public health relevance.”
“Drinking coffee was associated with a lower risk of dying whether or not you added sugar,” adds Annals of Internal Medicine deputy editor Dr. Christina Wee.
“The relationship between drinking coffee with artificial sweeteners and your risk of dying was less clear in the study,” Dr. Wee tells SWNS. “The authors found that drinking moderate levels of coffee regularly was associated with a lower risk of dying from any cause, dying from cancer and dying from heart disease. The lower risk of dying associated with moderate levels of coffee-drinking was true regardless of whether you drank decaffeinated coffee, instant coffee or ground coffee.”
South West News Service writer Gwyn Wright contributed to this report.
Researchers aren’t totally sure when or how long individuals with Covid-19 might be contagious and shedding virus.
Photo: David Paul Morris/Bloomberg News
Seeing that bright red line appear on an at-home Covid-19 test can feel inevitable during a surge like the one under way now. What can be surprising is how many days later that line keeps popping up.
The Centers for Disease Control and Prevention recommends five days from first symptoms or diagnosis as a minimum isolation period before infected people can return to public activities while maintaining certain precautions. Yet some people continue to test positive for the Covid-19 virus on rapid tests beyond those five days. Some even test positive after 10 days and after symptoms have resolved.
The question then becomes: How long are people infectious? Into the pandemic’s third year, as new, more infectious variants continue to circulate widely and more people have built-up immune defenses, researchers aren’t totally sure when or how long individuals with Covid-19 might be contagious and shedding virus, particularly at the end of an infection.
“It’s still up for debate,” said Nathaniel Hafer, director of operations for the University of Massachusetts Center for Clinical and Translational Science.
The isolation guidance that the CDC updated amid Omicron’s rapid spread is likely leading some people to leave isolation while they are contagious, some health experts and clinicians said, particularly if people don’t wait for a negative rapid test and aren’t wearing high-quality masks for a full 10 days.
“We know that people will be returning to work while they’re still infectious, even if they feel better,” said Carina Marquez, an associate professor and infectious-disease doctor at the University of California, San Francisco.
Dr. Marquez said she tested positive on an at-home test for 13 days recently, a period when she decided to work remotely. For those without that option, Dr. Marquez said that they should stop isolating after getting a negative rapid test, or they should stop isolating after 10 days and wear a mask, whichever comes first.
No test can perfectly tell whether someone with Covid-19 is contagious.
Photo: Justin Sullivan/Getty Images
Most people with Covid-19 will still test positive on a rapid test at five days, and a “fairly large percentage” test positive after 10 days, CDC spokeswoman Jasmine Reed said. Infectiousness drops significantly at eight days, with few people remaining contagious at 10 days, she said.
The CDC guidance also takes symptoms into account as a factor to gauge contagiousness, she said, noting that people should only leave isolation after five days if their symptoms are improving. The CDC recommends that everyone wear a well-fitted mask and avoid travel and being around high-risk people for 10 days, no matter when the person leaves isolation.
No test can perfectly tell whether someone with Covid-19 is contagious, infectious-disease experts and laboratorians said. A more accurate indicator is culturable virus, a test of whether a virus sample taken from a patient can infect cells in a lab. But such tests are complex and can only be run in labs with certain safety protocols.
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Several studies suggest that positive results on rapid antigen tests such as the iHealth, QuickVue and BinaxNow often match with culturable virus results. Some public-health experts have encouraged people to use at-home tests as a gauge for infectiousness, especially since they have become more widely available.
The tests often only turn positive when a person is carrying large amounts of virus. At the beginning of an infection, when a person’s viral load is rising, it might take a few days before tests turn positive. That is why health authorities recommend that people with symptoms and negative rapid-test results wait and retest or get a more sensitive lab-based PCR test.
As a person’s viral load drops, rapid tests are a better indicator of who is no longer infectious, public-health experts said. The University of Chicago started deploying the tests in December to figure out which healthcare workers could safely come back to work and help alleviate staffing shortages before 10 days of isolation, said Emily Landon, UChicago Medicine’s executive medical director of infection prevention and control.
More than 40% of 260 healthcare workers who felt well enough to work were positive the first time they took a rapid test between days five and 10 of an infection, Dr. Landon and her colleagues found, according to a preprint study that isn’t peer-reviewed.
“We didn’t feel comfortable having them come back,” Dr. Landon said.
Other recent studies have also demonstrated that a significant portion of people test positive on rapid tests after five days, including one published by the CDC in February that found 54% of people had positive rapid-test results between days five and nine after symptoms or diagnosis. The percentage of positive results declined over time.
Studies have found that a negative rapid test after an initial diagnosis is a solid sign that a person is likely no longer contagious.
Photo: John Tully/Bloomberg News
The authors wrote that rapid tests might be a useful tool to help guide whether someone is infectious, even if it isn’t a guarantee. The findings support the CDC’s recommendations that people take precautions until day 10 even if they leave isolation earlier, Ms. Reed said.
One recent study found that only 17% of vaccinated college students had culturable virus beyond day five, while a separate study of people with mild Covid-19 cases found more than 50% had culturable virus at day five and 25% did at day eight. Neither study has been peer-reviewed.
“It does make us concerned that people are still able to transmit at day five or day eight,” said Amy Barczak, an infectious-disease doctor at Massachusetts General Hospital in Boston and senior author of one of the studies.
Both studies found that a negative rapid test after an initial diagnosis is a good indicator that a person no longer has culturable virus and a solid sign they are likely no longer contagious. With a positive rapid-test result toward the tail end of the 10 days, however, it can be more difficult to tell how infectious that person might be, especially if they are feeling better and the line is growing fainter.
Dr. Barczak said that there appears to be a subset of people who can continue to test positive on rapid tests and who have negative viral culture. But for people testing at home, the only information they have is a positive result.
“You should consider yourself potentially having transmissible virus,” said Tara Bouton, an assistant professor of medicine at Boston University School of Medicine and lead author on another one of the studies.
Immunocompromised people and those who get severely ill can be contagious even longer than 10 days, studies suggest, and patients who experience rebounding symptoms or who test positive again after taking Pfizer Inc.’s Paxlovid pill should also assume that they are contagious, infectious-disease experts said.
Generally, studies suggest it is rare for virus to be culturable after 10 days. Infectious-disease experts disagree about whether most people should continue to test beyond that point.
“These tests aren’t perfect,” UChicago’s Dr. Landon said. “They underestimate contagiousness in the beginning of illness and overestimate at the end…but not by that much.”
Write to Brianna Abbott at brianna.abbott@wsj.com
LONDON (AP) — The World Health Organization’s top monkeypox expert said she doesn’t expect the hundreds of cases reported to date to turn into another pandemic, but acknowledged there are still many unknowns about the disease, including how exactly it’s spreading and whether the suspension of mass smallpox immunization decades ago may somehow be speeding its transmission.
In a public session on Monday, WHO’s Dr. Rosamund Lewis said it was critical to emphasize that the vast majority of cases being seen in dozens of countries globally are in gay, bisexual or men who have sex with men, so that scientists can further study the issue. She urged those at risk to be careful.
“It’s very important to describe this because it appears to be an increase in a mode of transmission that may have been under-recognized in the past,” said Lewis.
“At the moment, we are not concerned about a global pandemic,” she said. “We are concerned that individuals may acquire this infection through high-risk exposure if they don’t have the information they need to protect themselves.”
She warned that anyone is at potential risk for the disease, regardless of their sexual orientation. Other experts have pointed out that it may be accidental that the disease was first picked up in gay and bisexual men, saying it could quickly spill over into other groups if it is not curbed.
Last week, WHO said 23 countries that haven’t previously had monkeypox have now reported more than 250 cases. On Monday, the U.K. announced another 71 monkeypox cases.
Lewis said it’s unknown whether monkeypox is being transmitted by sex or just the close contact between people engaging in sexual activity and described the threat to the general population as “low.”
Monkeypox is known to spread when there is close physical contact with an infected person, their clothing or bedsheets.
She also warned that among the current cases, there is a higher proportion of people with lesions that are more concentrated in the genital region and sometimes nearly impossible to see.
“You may have these lesions for two to four weeks (and) they may not be visible to others, but you may still be infectious,” she said.
Last week, a top adviser to WHO said the monkeypox outbreak in Europe, U.S., Israel, Australia and beyond was likely linked to sex at two recent raves in Spain and Belgium. That marks a significant departure from the disease’s typical pattern of spread in central and western Africa, where people are mainly infected by animals like wild rodents and primates.
Scientists haven’t yet determined whether the monkeypox outbreak in rich countries can be traced to Africa, but the disease continues to sicken people on the continent.
On Monday, authorities in Congo said nine people have died of monkeypox in 2022. Dr. Aime Alongo, chief of the Sankuru health division in Congo, also said 465 cases have been confirmed, making it one of the worst-hit nations in West and Central Africa.
Nigerian authorities confirmed the country’s first monkeypox death this year, in addition to six more cases. WHO says thousands of cases are reported from Nigeria and Congo every year.
Most monkeypox patients experience only fever, body aches, chills and fatigue. People with more serious illness may develop a rash and lesions on the face and hands that can spread to other parts of the body. No deaths have been reported in the current outbreak beyond Africa.
WHO’s Lewis also said while previous cases of monkeypox in central and western Africa have been relatively contained, it was not clear if people could spread monkeypox without symptoms or if the disease might be airborne, like measles or COVID-19.
Monkeypox is related to smallpox, but has milder symptoms. After smallpox was declared eradicated in 1980, countries suspended their mass immunization programs, a move that some experts believe may be helping monkeypox spread now, since there is now little widespread immunity to related diseases. Smallpox vaccines are also protective against monkeypox.
Lewis said it was also uncertain how much immunity people who were previously vaccinated against smallpox might still have, since that was at least more than four decades ago. She said WHO’s priority was to stop the current spread of monkeypox before the disease became entrenched in new regions.
“If we all react quickly and we all work together, we will be able to stop this,” she predicted. “We will be able to stop it before it reaches more vulnerable people and before it establishes itself as a replacement for smallpox.”
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Chinedu Asadu in Abuja, Nigeria, contributed to this report.
Michelle Fishman calls it the “worst-case scenario that you don’t really think through.”
After a three-week vacation in Greece, the 52-year-old hotel art consultant from Miami and her husband took pre-departure coronavirus tests required to fly home from overseas. She tested positive, he did not.
Instead, she took advantage of a quirk in the rules to head home after five days (the mandatory self-isolation period required by the Greek government) via a “backdoor” — crossing into the United States by land, which does not require a coronavirus test, rather than by air. Because Canada does not require a test for entry, the couple first flew to Toronto and, after spending a night there, Ms. Fishman and her husband drove across the border into Buffalo and caught a flight home. (There is no testing requirement for flying domestically.)
“I had zero symptoms, no fever, nothing. I felt fine and when you’re stateside, the C.D.C. says you can end isolation five days after testing positive, so the same rules should apply when I’m traveling,” Ms. Fishman said. “It makes no sense that I can go to a wedding five days after a positive test in Miami, but if I catch the virus when I’m on vacation I can’t fly home. That should be illegal.”
It is not clear how many infected people are using backdoor routes to get home, which can also include flying to Mexico and using a land crossing there, because airlines do not require passengers to provide reasons for canceling or changing flights. But strong anecdotal evidence indicates that some travelers — and travel advisers — are sharing suggestions for how to avoid getting stuck.
In flying to Toronto, Ms. Fishman said she was following the guidance of a family friend who used a similar backdoor route to get home to Boston when he tested positive in France in April.
Asked if she was worried about infecting other passengers on her long journey home from Greece (she tested positive again, on her fifth day), Ms. Fishman pointed to the C.D.C.’s guidance for people who catch the virus in the United States, which says that asymptomatic people or those with symptoms that have resolved within the five-day isolation period can leave their homes. The recommendation is based on the science that the majority of coronavirus transmission occurs early in the course of the illness, the C.D.C. said.
“I slept in the same bed as my husband for five nights and he didn’t catch it, so I don’t think I was contagious by the time I took the flight home,” Ms. Fishman said. “I wore a mask the whole time.”
The C.D.C. did not say why it has different policies in place for Americans who test positive at home and abroad, but a spokeswoman for the agency reiterated that travelers should follow the 10-day guidance to not travel before boarding a flight to the United States, even if they test negative. The Department of Homeland Security declined to comment on the possibility of travelers using land borders to circumvent the testing requirement for air travel.
The United States introduced the testing requirement in January 2021, when fewer than 10 percent of Americans were vaccinated and cases of new infections and hospitalizations were reaching record levels. Now, with higher vaccination rates and less severe cases of the virus, many American travelers, as well as industry representatives, are calling for the requirement to be lifted, arguing that it does little to prevent new variants of the virus from spreading in the United States.
“The existence of these workarounds highlights the absurdity of the current inbound testing policy that is nothing short of ineffective,” said Erika Richter, vice president of communications at the American Society of Travel Advisors, a trade organization. “We’re not following the science.”
David Freedman, president-elect of the American Society of Tropical Medicine and Hygiene, is concerned by travelers using this method, warning that infectious people taking a flight or public transportation to a border crossing will put a lot of people who are not up-to-date on their vaccinations at risk, including at airport eateries and other places along the way.
“From a public health point of view, the infectious person may be carrying in one of the new variants BA.4 or BA.5 which is more infectious and is not so common yet in the U.S.,” he said. “There may be new enhanced vaccines by the fall and introducing these variants sooner rather than later may be bad.”
After testing positive in Stockholm in early April, one American traveler and her wife decided to return to Seattle via Vancouver, because a U.S.-Canada border crossing was relatively close to their home. If she was required to take a test upon arrival at the Vancouver airport, she said, she planned to drive home and isolate there. The woman asked to speak anonymously, because she was afraid of negative repercussions.
“We had symptoms for about two weeks before testing positive. By the time we actually tested positive we felt great, with barely any symptoms, so we felt confident to travel,” she said. “Vancouver airport is pretty chill and low-key. If you look healthy, determined and at ease, no one is going to pull you out of a crowd.”
Upon arrival, Canadian officials often ask passengers health questions, and some airports, like those in Toronto and Vancouver, may randomly select some passengers to take coronavirus tests before being cleared to leave the airport.
The Canadian authorities warn infected people against attempting to transit through Canada, saying that they are not permitted to board flights into the country if they have Covid-19 symptoms or have been infected within 10 days of their departure. Before arriving in Canada, travelers have to fill out a health and travel form on the ArriveCAN app. The form contains a number of questions, including vaccination status and whether a passenger has coronavirus symptoms.
“All travelers arriving in Canada are obligated by Canadian law to respond truthfully to all questions,” said Rebecca Purdy, a senior spokeswoman for the Canada Border Services Agency.
“Travelers who knowingly travel to Canada with an active Covid-19 infection and who do not disclose this information may face penalties and/or criminal charges and foreign nationals may also be denied entry and/or banned from returning to Canada,” Ms. Purdy said.
Mexican authorities did not return requests for comment. U.S. travelers may enter Mexico without testing or quarantine, though they may be subject to health screenings on arrival.
Despite the expense of last-minute bookings, the backdoor routes are also being used by people preemptively, to ensure they can travel home on time.
Hilary Aranda, 39, a user-experience designer, had just finished a two-week dance tour in Italy when 12 Americans in her group tested positive. To avoid a positive result and the possible headaches involved, she never took a test, instead canceling her flight home to Los Angeles for a flight to Tijuana, Mexico, with layovers in London and Mexico City. She then crossed the land border into San Diego and drove home. The changes to her itinerary set her back more than $2,000.
“Everyone around me had Covid and I knew with my luck that if I took the test, it would come out positive and I didn’t want to risk it,” said Ms. Aranda, who wore a mask on her flights. “Looking back, it was kind of a crazy decision and a big schlep, but I had to get back to my life and kids.”
Some travelers who are more risk-averse, but still determined to avoid isolation in another country, have been using telemedicine services like Quick MD to obtain “documentation of recovery” that allows people to travel to the United States without having to show a negative test. The option is available to travelers who continue to test positive 10 days after their initial positive test or onset of symptoms, as it can take weeks or even months before some people test negative.
During the video or phone consultation with a medical professional authorized to give travel clearance, some travelers have been lying about the date their symptoms started so that they can return home without having to complete the 10-day isolation period.
“It was a three-minute consultation, and I just told the doctor that my symptoms started earlier than they did,” said one traveler, who asked to speak anonymously out of fear of getting into trouble with authorities. He had tested positive in London a day before his scheduled flight home to New York, he said, but returned home three days later.
“I got my clearance document within an hour it was so easy,” he said.
Quick MD did not respond to multiple requests for comment.
Ms. Fishman made it back home in time for the wedding and never developed Covid-19 symptoms, although she said she felt exhausted, which she blamed on the stress caused by the ordeal of trying to get back in time.
“My chances of catching Covid in Miami are just as high as catching it while I travel so the testing requirement is useless in my opinion,” she said.
Travelers contemplating a similar route should be warned that they can be caught out. Ms. Purdy, of the Canadian border services, noted that violating instructions upon entering Canada could lead to up to six months in prison, 750,000 Canadian dollars in fines (around $586,000) or both.
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A Beijing man has landed thousands of his neighbors in quarantine after he ignored an order to stay at home and later tested positive for COVID-19, prompting a police investigation.
The Chinese capital has ordered hundreds of thousands of residents to stay home over the last five weeks to curb its largest coronavirus outbreak since the start of the pandemic.
Officials said Sunday a man in his 40s surnamed Sun had failed to follow a requirement to isolate that he was given after he visited a shopping center considered "high risk".
"During the home isolation period he ... went out many times and walked in the neighborhood," said Beijing public security official Pan Xuhong.
Sun and his wife later tested positive, prompting authorities to lock down 5,000 of their neighbors at home and send 250 to a government quarantine center.
It comes as virus restrictions began to be eased in Beijing on Monday, with authorities re-opening parks, museums and cinemas and declaring the outbreak under control.
China is wedded to a zero-COVID strategy of hard lockdowns, mass testing and long quarantine periods to wipe out clusters as they emerge.
There are tough penalties for breaking the rules and Sun is now under police investigation.
Beijing's Omicron-fueled cluster has seen more than 1,700 infections since late April -- a tiny number by global standards but troubling for China's rigid approach to the virus.
Case numbers have dropped sharply in the past week.
"There have been no new cases found in society (outside quarantine centers) for two days," Xu Hejian, a spokesman for the Beijing government, said Sunday. "The situation is stable and improving... but the risk of a rebound still exists."
Most bus, subway and taxi services in three of the capital's most populous districts were running again Monday and millions were told to return to work.
A handful of tai chi practitioners and locals were enjoying balmy weather in a re-opened downtown park.
"I think people are waiting to see whether there will be new cases before coming out in large numbers," said Zhi Ruo, a government employee who had brought his five-year-old child out to play.
Schools remain closed and Beijing still requires a negative COVID test to enter public facilities, including supermarkets.
China's commercial hub, Shanghai, has announced plans to re-open businesses from June 1 -- nearly two months after all economic activity ground to a halt in a citywide lockdown.
The city will "eliminate unreasonable restrictions ... and abandon the approval system for work and production by enterprises", Vice Mayor Wu Qing told a news briefing Sunday.
Wu announced a slew of measures to shore up Shanghai's virus-battered economy, including cutting property taxes, subsidizing gas and electricity for businesses and ordering banks to lend more to small and medium-sized enterprises.
Residents allowed to leave home for a few hours were seen getting haircuts and massages on sidewalks over the weekend as Shanghai slowly started to re-open.
The city reported 66 infections Monday, while Beijing reported 12.
(CNN)Paris Saint-Germain and Argentina superstar Lionel Messi has revealed the difficulties he faced after contracting Covid-19. The 34-year-old contracted the virus in early January, as reported by CNN.
(CNN)North Korea says its Covid-19 outbreak is improving and it is considering revising its anti-epidemic regulations.
On May 19, a group of Bay Area doctors and scientists published a preprint study looking at how symptoms of COVID-19 have changed over the course of the three most recent surges. It’s an interesting report, and I wrote about it a week later — while isolating at home after finally getting COVID myself.
I tested positive the day before that study came out. I was too sick to work that day, or the next, but when I finally caught up with the paper I was fascinated by how well it reflected my own experiences. Omicron, they found (among other results), causes more upper respiratory symptoms among the vaccinated than earlier variants. As I read I checked off my own boxes: Cough? Yes. Congestion? Yes. Fever? A little. Body aches? Nope.
After more than two years writing about this virus it was bizarre finally to be up close and personal with it. I’ve written before about the pandemic feeling more like a haunting to many people, especially in the early months when we were all locked down and few people had actually been infected, even as the coronavirus was dominating our daily lives. But as more people became infected in my social circles — the delta summer, when it first snuck up on the vaccinated, and omicron, when catching it seemed almost inevitable — I still somehow avoided it.
I’ve been cautious throughout the pandemic, but not remarkably so. I put myself in the slightly more liberal end of COVID-careful, by Bay Area standards: Since getting vaccinated, I’ve masked and unmasked as cases surged and dropped, I’ve gone to some very crowded bars and eaten indoors, and I’ve hugged my nephew lots even when he was runny-nosed (I did that pre-vaccines, too). I haven’t been overly worried for myself, being an otherwise healthy 40-something, but I didn’t want to give COVID to the vulnerable people in my life.
I don’t know where exactly I finally became infected, but I suspect it was during Sunday brunch at a restaurant, two days before I started feeling ill. It came on fast — I felt off Tuesday night, tested positive Wednesday morning (very positive — the home test lit up on contact with my sample). I’ve been telling friends that I feel like I got to tick the last box on my pandemic Bingo card: writing about COVID while having COVID.
Health reporters very often write about topics we are not personally familiar with. That’s true for journalists in general. This pandemic has been a unique experience for me in part because I was so directly impacted, as everyone was, by the fallout. I’ve written hundreds of pandemic stories by now, some of which very much affected me — about testing and vaccination and public health responses like mask mandates. Having COVID makes it even more personal, but also reminds me that my experience remains atypical in many ways.
When I first felt sick, my editors immediately told me to take time off. I ended up having to write one story while I wasn’t feeling well, but then I lounged around a lot for two days. When I was ready to work again, I was lucky to be able to work from home, and to have the resources to have supplies delivered to me, and friends checking in to make sure I had what I needed. There was no pressure to return to in-person work while I was ill — in fact, I’m pretty sure I would have been ordered home if I’d tried to show up in the newsroom.
And unlike most people who get COVID, I had easy access to infectious disease and public health experts. Throughout the pandemic I’ve been constantly impressed by the patience these experts have shown and the care they have provided to journalists like me — taking calls early in the morning and very late at night, walking me through complex science and challenging, nuanced public health discourse.
Obviously I haven’t been calling them up for advice on my own illness. But if, in the course of reporting that study on changing COVID symptoms, I happened to drop in a few personal questions? They were happy to entertain them. When I told Dr. Diane Havlir — an HIV expert I’ve interviewed dozens of times over the years and who led the most recent COVID study — that I was frustrated to still be testing positive on day 10 of my illness, she was sympathetic.
She confirmed I was probably safe to resume some normal activities, like going to the grocery store with a mask or hiking with a friend, but she agreed I might want to stay away from people who are vulnerable to severe disease until I’m negative. Which is to say: She agreed I probably shouldn’t visit my parents over the long Memorial Day weekend.
That’s a bummer. I was looking forward to getting out of town after being cooped up for a week and a half. But I’m fully aware and appreciative of my good fortune — even, or maybe especially, after two-plus years of covering this disaster.
Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday
When Covid-19 cases were exploding across the United States in early 2020, public health officials remained in the dark, in large part because of major errors in developing a test for the illness.
The Centers for Disease Control and Prevention was the manufacturer of the only Covid-19 test then available in the United States, and there were blunders in the design and manufacture of the test that the agency mailed out in February 2020. This, coupled with the Food and Drug Administration’s initial refusal to allow qualified laboratories to develop or use their own Covid-19 tests, meant that testing was all but impossible to access in the United States in the early weeks of the pandemic.
As the world confronts monkeypox, we must not make similar mistakes in disease surveillance and public communication. While monkeypox and the coronavirus are not the same, there are lessons to be learned from Covid-19 and prior pandemics: We cannot stop transmission of a disease we can’t see, and we can’t help people if we don’t let them know what they’re up against.
As public health experts and advocates, we are concerned about how far monkeypox has spread around the world. The lack of easy testing and surveillance makes the size of the outbreak difficult to estimate. As queer men from the United States and South Africa, we are also concerned for our communities. Much, though not all, of the spread outside the regions where monkeypox is more common has been among men who have sex with men.
Monkeypox is a type of orthopoxvirus that usually spreads from animals to humans. This new outbreak marks the first time extensive human-to-human spread has occurred outside of the places where the virus has been known to spread, like central and western Africa. So far, nearly 400 cases of monkeypox have been confirmed in more than 20 countries, including around 12 cases in the United States.
Testing for monkeypox in the United States remains cumbersome. Currently, if a person is suspected to have monkeypox, their physician must contact a state or local public health department to test for the disease. Then, a C.D.C. laboratory partner runs a generic orthopoxvirus test on the sample. If that test is positive, the sample is sent to the C.D.C. headquarters in Atlanta so a monkeypox-specific test can be performed to confirm.
There are 66 public health labs that can test for orthopoxvirus. The C.D.C. estimates the partner labs have the capacity to test 6,500 orthopoxvirus tests per week, which the C.D.C. says is more than current demand. Between May 17 and 24, the labs were sent fewer than 60 samples for orthopoxvirus testing. Given that some of the cases detected so far appear to not be linked to travel, we remain concerned about efforts to identify and test ongoing community spread.
We worry the centralization of testing wastes precious time and would limit capacity if more testing is needed. Monkeypox tests, like Covid-19 tests, are based on P.C.R. technology that is available in hospitals and clinical labs across the country. Many labs at major hospitals, commercial sites, and city and state health departments have capacity to develop, manufacture and run tests for monkeypox rapidly if they are given guidance and samples to use to validate their tests.
Even if widespread testing is ultimately not needed, the cost of being prepared is low and the risk of being caught off guard is high. Increasing the nation’s monkeypox testing capacity will allow health leaders to intervene and slow the possible spread of the outbreak.
The C.D.C. should widely release the details of its monkeypox testing protocols so that more labs around the country can develop and run their own tests for monkeypox. The F.D.A. should also issue guidance to all labs with credentials to perform complex laboratory tests and clarify what regulatory authority, if any, they will exercise over monkeypox tests developed elsewhere.
The C.D.C. says that any state health department that confirms a patient has orthopoxvirus should behave as if the person has monkeypox and immediately begin containment efforts like contact tracing. The agency says it is monitoring its testing kit availability should it need to be expanded.
Thankfully, there are monkeypox vaccines and an F.D.A. approved antiviral at the ready in the Strategic National Stockpile. Prioritizing people at immediate monkeypox risk, such as those with a recent close contact, is essential. Vaccinating those who have been exposed, also called ring vaccination, can prevent further spread. Proactive vaccination of those most at risk should also be considered. These efforts and the effective deployment of antivirals require a rapid diagnosis of cases, which is why testing must be a priority, alongside vaccination.
Even if cases among men who have sex with men continue, we will certainly not be the only ones falling ill. Infectious disease epidemics are shaped by the pattern and frequency of contact among people, the pathogen and population immunity and susceptibility. As we learned from Covid-19, epidemics are unpredictable, and human health is globally connected: Variants and viruses that occur in one country can easily cross borders into another.
Our own community of queer people can increase awareness of a novel disease that may present like many other common infections. In the past, we have often been able to lead our physicians and communities by sharing knowledge about our health and ways to intervene with stigma-free care. When bacterial meningitis outbreaks began spreading among gay communities, health officials provided vaccines at nightlife spots and places where men meet for sex. As summer and pride festivities approach, we need similar approaches to help keep one another safe.
Public health officials must develop and implement a testing and vaccination strategy focusing on all communities that are likely to be impacted. Testing and community education focused only in major cities, for example, could increase health disparities along racial, class and geographical lines. We cannot let monkeypox become a disease of those disconnected from health care access.
As experts provide preventive care to those at higher risk, researchers must also initiate studies to answer essential questions about monkeypox transmission. For example, is the virus in saliva and semen, or is it just on skin lesions? The lack of accurate scientific information is now a global problem, and it’s one that could have been addressed much earlier. The first human case was reported in 1970, and human-to-human transmission has been reported in recent years. This is yet another example of the importance of taking neglected diseases seriously in the scientific community even when they don’t appear to be a threat to white people living in the global north.
People who expect to be in close contact with others should monitor for skin lesions or symptoms that are consistent with this virus or many other sexually and skin-contact transmitted diseases like syphilis or herpes. If monkeypox is being transmitted in part via similar social networks as H.I.V., then H.I.V. and sexually transmitted infection experts will be key stakeholders in preventing a public health emergency. These clinicians and professionals have spent decades building relationships with the queer community, and the trust they have developed is critical for a successful response to an emergent threat.
We are not currently in a public health emergency because of monkeypox, and monkeypox is not a gay disease. By taking this moment seriously, and by acting with care and immediacy but without stigma, the United States may well avert an emergency entirely and ensure that we won’t be dealing with yet another pandemic this summer and fall.
James Krellenstein is a co-founder and a managing director of PrEP4All, an advocacy group dedicated to increasing access to H.I.V. and Covid-19 prevention technology. Joseph Osmundson is a molecular microbiologist at New York University and author of the upcoming book “Virology.” Keletso Makofane is a social network epidemiologist at FXB Center for Health and Human Rights at Harvard University, and a member of the Governing Council of the International AIDS Society.
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On May 19, a group of Bay Area doctors and scientists published a preprint study looking at how symptoms of COVID-19 have changed over the course of the three most recent surges. It’s an interesting report, and I wrote about it a week later — while isolating at home after finally getting COVID myself.
I tested positive the day before that study came out. I was too sick to work that day, or the next, but when I finally caught up with the paper I was fascinated by how well it reflected my own experiences. Omicron, they found (among other results), causes more upper respiratory symptoms among the vaccinated than earlier variants. As I read I checked off my own boxes: Cough? Yes. Congestion? Yes. Fever? A little. Body aches? Nope.
After more than two years writing about this virus it was bizarre finally to be up close and personal with it. I’ve written before about the pandemic feeling more like a haunting to many people, especially in the early months when we were all locked down and few people had actually been infected, even as the coronavirus was dominating our daily lives. But as more people became infected in my social circles — the delta summer, when it first snuck up on the vaccinated, and omicron, when catching it seemed almost inevitable — I still somehow avoided it.
I’ve been cautious throughout the pandemic, but not remarkably so. I put myself in the slightly more liberal end of COVID-careful, by Bay Area standards: Since getting vaccinated, I’ve masked and unmasked as cases surged and dropped, I’ve gone to some very crowded bars and eaten indoors, and I’ve hugged my nephew lots even when he was runny-nosed (I did that pre-vaccines, too). I haven’t been overly worried for myself, being an otherwise healthy 40-something, but I didn’t want to give COVID to the vulnerable people in my life.
I don’t know where exactly I finally became infected, but I suspect it was during Sunday brunch at a restaurant, two days before I started feeling ill. It came on fast — I felt off Tuesday night, tested positive Wednesday morning (very positive — the home test lit up on contact with my sample). I’ve been telling friends that I feel like I got to tick the last box on my pandemic Bingo card: writing about COVID while having COVID.
Health reporters very often write about topics we are not personally familiar with. That’s true for journalists in general. This pandemic has been a unique experience for me in part because I was so directly impacted, as everyone was, by the fallout. I’ve written hundreds of pandemic stories by now, some of which very much affected me — about testing and vaccination and public health responses like mask mandates. Having COVID makes it even more personal, but also reminds me that my experience remains atypical in many ways.
When I first felt sick, my editors immediately told me to take time off. I ended up having to write one story while I wasn’t feeling well, but then I lounged around a lot for two days. When I was ready to work again, I was lucky to be able to work from home, and to have the resources to have supplies delivered to me, and friends checking in to make sure I had what I needed. There was no pressure to return to in-person work while I was ill — in fact, I’m pretty sure I would have been ordered home if I’d tried to show up in the newsroom.
And unlike most people who get COVID, I had easy access to infectious disease and public health experts. Throughout the pandemic I’ve been constantly impressed by the patience these experts have shown and the care they have provided to journalists like me — taking calls early in the morning and very late at night, walking me through complex science and challenging, nuanced public health discourse.
Obviously I haven’t been calling them up for advice on my own illness. But if, in the course of reporting that study on changing COVID symptoms, I happened to drop in a few personal questions? They were happy to entertain them. When I told Dr. Diane Havlir — an HIV expert I’ve interviewed dozens of times over the years and who led the most recent COVID study — that I was frustrated to still be testing positive on day 10 of my illness, she was sympathetic.
She confirmed I was probably safe to resume some normal activities, like going to the grocery store with a mask or hiking with a friend, but she agreed I might want to stay away from people who are vulnerable to severe disease until I’m negative. Which is to say: She agreed I probably shouldn’t visit my parents over the long Memorial Day weekend.
That’s a bummer. I was looking forward to getting out of town after being cooped up for a week and a half. But I’m fully aware and appreciative of my good fortune — even, or maybe especially, after two-plus years of covering this disaster.
Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday
Enlarge / A baby with measles. CDC The Centers for Disease Control and Prevention is putting clinicians on alert about the growing r...
