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<h1 data-aos="fade-down" id="covid-19-sentry">Covid-19 Sentry</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-preprints">From Preprints</a></li>
<li><a href="#from-clinical-trials">From Clinical Trials</a></li>
<li><a href="#from-pubmed">From PubMed</a></li>
<li><a href="#from-patent-search">From Patent Search</a></li>
</ul>
<h1 data-aos="fade-right" id="from-preprints">From Preprints</h1>
<ul>
<li><strong>LRR protein RNH1 dampens the inflammasome activation and is associated with adverse clinical outcomes in COVID-19 patients</strong> -
<div>
Inflammasomes are cytosolic innate immune sensors of pathogen infection and cellular damage that induce caspase-1 mediated inflammation upon activation. Although inflammation is protective, uncontrolled excessive inflammation can cause inflammatory diseases and can be detrimental, such as in COVID-19. However, the underlying mechanisms that control inflammasome activation are incompletely understood. Here we report that the leucine rich repeat (LRR) protein Ribonuclease inhibitor (RNH1), which shares homology with LRRs of NLRP proteins, attenuates inflammasome activation. Deletion of RNH1 in macrophages increases IL-1b production and caspase-1 activation for inflammasome stimuli. Mechanistically, RNH1 decreases pro-IL-1b expression and induces proteasome-mediated caspase-1 degradation. Corroborating this, mouse models of monosodium urate (MSU)-induced peritonitis and LPS-induced endotoxemia, which are dependent on caspase-1, respectively show increased neutrophil infiltration and lethality in Rnh1-/- mice compared to WT mice. Furthermore, RNH1 protein levels are negatively correlated with inflammation and disease severity in hospitalized COVID-19 patients. We propose that RNH1 is a new inflammasome regulator with relevance to COVID-19 severity.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2021.04.12.438219v2" target="_blank">LRR protein RNH1 dampens the inflammasome activation and is associated with adverse clinical outcomes in COVID-19 patients</a>
</div></li>
<li><strong>Filthy Animals: Integrating the Behavioral Immune System and Disgust into A Model of Prophylactic Dehumanization</strong> -
<div>
The behavioral immune system (BIS) is an evolved psychological mechanism that motivates prophylactic avoidance of disease vectors by eliciting disgust. When felt toward social groups, disgust can dampen empathy and promote dehumanization. Therefore, we investigated whether the BIS facilitates the dehumanization of groups associated with disease by inspiring disgust toward them. An initial content analysis found that Nazi propaganda predominantly dehumanized Jews by portraying them as disease vectors or contaminants. This inspired three correlational studies supporting a Prophylactic Dehumanization Model in which the BIS predicted disgust toward disease-relevant outgroups, and this disgust in turn accounted for the dehumanization of these groups. In a final study, we found this process of prophylactic dehumanization had a downstream effect on increasing anti-immigrant attitudes during the COVID-19 pandemic. However, consistent with the evolutionary logic of a functionally-flexible BIS, this effect only occurred when the threat of COVID-19 was salient. The implications of these results for the study of dehumanization and evolutionary theories of xenophobia are discussed.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://psyarxiv.com/egxt6/" target="_blank">Filthy Animals: Integrating the Behavioral Immune System and Disgust into A Model of Prophylactic Dehumanization</a>
</div></li>
<li><strong>Staying home so you can keep going out: A multiplayer self-isolation game modelling pandemic behaviour</strong> -
<div>
The effectiveness of a nation’s COVID-19 response in limiting transmission depends on people complying with unfamiliar restrictions. The immediate cost of abiding by these restrictions (e.g., by staying home) to the individual is relatively clear, yet other outcomes are delayed and noisy. It is difficult to infer whether others have fallen ill because of one’s own actions, or whether one has played a part in causing a ‘lockdown’. This uncertainty leads people to take cues from their dynamic environment and social norms on the right course of action. This preregistered study investigates how people cooperate, and how the social context influences their decisions using an iterated multiplayer game (akin to a public goods game), wherein they encounter various levels of compliance of others, variations in disease prevalence, and differences in the costliness of a lockdown. Participants indicate how much they would hypothetically isolate themselves for each level of average self-isolation by others in the group, they predict how much others will self-isolate, and make a decision about their own self-isolation. We show that participants tend to self-isolate more when they predict others will self-isolate more, and when there are more infected players in the group; we show that participants suffer from illusory superiority, underestimating others’ self-isolation compared to their own, and we show that higher perceived cost of lockdown leads to more compliance, but that this effect is stronger when players predict that others will be compliant too.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://psyarxiv.com/mh69r/" target="_blank">Staying home so you can keep going out: A multiplayer self-isolation game modelling pandemic behaviour</a>
</div></li>
<li><strong>Yeast-expressed Recombinant SARS-CoV-2 Receptor Binding Domain, RBD203-N1 as a COVID-19 Protein Vaccine Candidate</strong> -
<div>
Background: SARS-CoV-2 protein subunit vaccines are being evaluated by multiple manufacturers to fill the need for low-cost, easy to scale, safe, and effective COVID-19 vaccines for global access. Vaccine candidates relying on the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein have been the focus of our development program. In this paper, we report on the generation of the RBD203-N1 yeast expression construct, which produces a recombinant protein that when formulated with alum and the TLR-9 agonist, CpG1826 elicits a robust immune response and protection in mice. Method: The RBD203-N1 antigen was expressed in the yeast Pichia pastoris X33. After fermentation at the 5 L scale, the protein was purified by hydrophobic interaction chromatography followed by anion exchange chromatography. The purified protein was characterized biophysically and biochemically, and after its formulation, the immunogenicity and efficacy were evaluated in mice. Results, Conclusions, and Significance: The RBD203-N1 production process yielded 492.9 {+/-} 3.0 mg/L of protein in the fermentation supernatant. A two-step purification process produced a &gt;96% pure protein with a recovery rate of 55 {+/-} 3% (total yield of purified protein: 270.5 {+/-} 13.2 mg/L fermentation supernatant). The protein was characterized as a homogeneous monomer with well-defined secondary structure, thermally stable, antigenic, and when adjuvanted on alum and CpG, it was immunogenic and induced robust levels of neutralizing antibodies against SARS-CoV-2 pseudovirus. These characteristics show that this vaccine candidate is well suited for technology transfer with feasibility of its transition into the clinic to evaluate its immunogenicity and safety in humans.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2021.08.24.457518v1" target="_blank">Yeast-expressed Recombinant SARS- CoV-2 Receptor Binding Domain, RBD203-N1 as a COVID-19 Protein Vaccine Candidate</a>
</div></li>
<li><strong>Woodsmoke particulates alter expression of antiviral host response genes in human nasal epithelial cells infected with SARS-CoV-2 in a sex-dependent manner</strong> -
<div>
We have previously shown that exposure to particulate air pollution, both from natural and anthropogenic sources, alters gene expression in the airways and increases susceptibility to respiratory viral infection. Additionally, we have shown that woodsmoke particulates (WSP) affect responses to influenza in a sex-dependent manner. In the present study, we used human nasal epithelial cells (hNECs) from both sexes to investigate how particulate exposure could modulate gene expression in the context of SARS-CoV-2 infection. We used diesel exhaust particulate (DEP) as well as WSP derived from eucalyptus or red oak wood. HNECs were exposed to particulates at a concentration of 22 g/cm2 for 2 h then immediately infected with SARS-CoV-2 at a MOI (multiplicity of infection) of 0.5. Exposure to particulates had no significant effects on viral load recovered from infected cells. Without particulate exposure, hNECs from both sexes displayed a robust upregulation of antiviral host response genes, though the response was greater in males. However, WSP exposure before infection dampened expression of genes related to the antiviral host response by 72 h post infection. Specifically, red oak WSP downregulated IFIT1, IFITM3, IFNB1, MX1, CCL3, CCL5, CXCL11, CXCL10, and DDX58, among others. After sex stratification of these results, we found that exposure to WSP prior to SARS-CoV-2 infection downregulated anti-viral gene expression in hNECs from females more so than males. These data indicate that WSP, specifically from red oak, alter virus-induced gene expression in a sex-dependent manner and potentially suppress antiviral host defense responses following SARS-CoV-2 infection.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2021.08.23.457411v1" target="_blank">Woodsmoke particulates alter expression of antiviral host response genes in human nasal epithelial cells infected with SARS-CoV-2 in a sex-dependent manner</a>
</div></li>
<li><strong>Direct RNA sequencing reveals SARS-CoV-2 m6A sites and possible differential DRACH motif methylation among variants</strong> -
<div>
The causative agent of COVID-19 pandemic, the SARS-CoV-2 coronavirus, has a 29,903 bases positive-sense single- stranded RNA genome. RNAs exhibit about 100 modified bases that are essential for proper function. Among internal modified bases, the N6-methyladenosine, or m6A, is the most frequent, and is implicated in SARS-CoV-2 immune response evasion. Although the SARS-CoV-2 genome is RNA, almost all genomes sequenced so far are in fact, reverse transcribed complementary DNAs. This process reduces the true complexity of these viral genomes because incorporation of dNTPs hides RNA base modifications. Here, in this perspective paper, we present an initial exploration on Nanopore direct RNA sequencing to assess the m6A residues in the SARS-CoV-2 sequences of ORF3a, E, M, ORF6, ORF7a, ORF7b, ORF8, N, ORF10 and the 3’-untranslated region. We identified 15 m6A methylated positions, of which, 6 are in ORF N. Also, because m6A is associated with the DRACH motif, we compared its distribution in major SARS-CoV-2 variants. Although DRACH is highly conserved among variants we show that variants Beta and Eta have a fourth position C&gt;T mutation in DRACH at 28,884b that could affect methylation. The Nanopore technology offers a unique opportunity for the study of viral epitranscriptomics. This technique is PCR-free and is not sequencing-by-synthesis, therefore, no PCR bias and synthesis errors are introduced. The modified bases are preserved and assessed directly with no need for chemical treatments or antibodies. This is the first report of direct RNA sequencing of a Brazilian SARS-CoV-2 sample coupled with identification of modified bases.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2021.08.24.457397v1" target="_blank">Direct RNA sequencing reveals SARS- CoV-2 m6A sites and possible differential DRACH motif methylation among variants</a>
</div></li>
<li><strong>Directing an mRNA-LNP vaccine toward lymph nodes improves humoral and cellular immunity against SARS-CoV-2</strong> -
<div>
The exploration and identification of safe and effective vaccines for the SARS-CoV-2 pandemic has captured the worlds attention and remains an ongoing issue in order to protect against emerging variants of concern (VoCs) while generating long lasting immunity. Here, we report the synthesis of a novel messenger ribonucleic acid (mRNA) encoding the spike protein in a lipid nanoparticle formulation (LNP) (STI-7264) that generates robust humoral and cellular immunity following immunization of C57Bl6 mice. In efforts to continually improve immunity, a lymphatic drug delivery device (MuVaxx) was engineered and tested to immunize the immune cells at the injection site (epidermis and dermis) and draining lymph node (LN) for adaptive immunity. Using MuVaxx, immune responses were elicited and maintained at a 10-fold dose reduction compared to traditional intramuscular (IM) administration as measured by anti-spike antibodies, cytokine producing CD8 T cells, and neutralizing antibodies against the Washington (Wild Type, WT) and South African (beta) variants. Remarkably, a 4-fold elevated T cell response was observed in MuVaxx administered vaccination as compared to that of IM administered vaccination. Thus, these data support further investigation into STI-7264 and lymphatic mediated delivery using MuVaxx for SARS-CoV-2 and VoCs vaccines.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2021.08.25.457699v1" target="_blank">Directing an mRNA-LNP vaccine toward lymph nodes improves humoral and cellular immunity against SARS-CoV-2</a>
</div></li>
<li><strong>Structure-based screening of drug candidates targeting the SARS-CoV-2 envelope protein</strong> -
<div>
The COVID-19 (coronavirus disease 2019) pandemic is caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). SARS-CoV-2 produces a small hydrophobic envelope (E) protein which shares high homology with SARS-CoV E protein. By patch-clamp recording, the E protein is demonstrated to be a cation-selective ion channel. Furthermore, the SARS-CoV-2 E protein can be blocked by a SARS-CoV E protein inhibitor hexamethylene amiloride. Using structural model and virtual screening, another E protein inhibitor AZD5153 is discovered. AZD5153 is a bromodomain protein 4 inhibitor against hematologic malignancies in clinical trial. The E protein amino acids Phe23 and Val29 are key determinants for AZD5153 sensitivity. This study provides two promising lead compounds and a functional assay of SARS-CoV-2 E protein for the future drug candidate discovery.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2021.08.25.457645v1" target="_blank">Structure-based screening of drug candidates targeting the SARS-CoV-2 envelope protein</a>
</div></li>
<li><strong>How COVID-19 has Impacted American Attitudes Toward China: A Study on Twitter</strong> -
<div>
Past research has studied social determinants of attitudes toward foreign countries. Confounded by potential endogeneity biases due to unobserved factors or reverse causality, the causal impact of these factors on public opinion is usually difficult to establish. Using social media data, we leverage the suddenness of the COVID-19 pandemic to examine whether a major global event has causally changed American views of another country. We collate a database of more than 297 million posts on the social media platform Twitter about China or COVID-19 up to June 2020, and we treat tweeting about COVID-19 as a proxy for individual awareness of COVID-19. Using regression discontinuity and difference- in-difference estimation, we find that awareness of COVID-19 causes a sharp rise in anti-China attitudes. Our work has implications for understanding how self-interest affects policy preference and how Americans view migrant communities.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/socarxiv/h3r5u/" target="_blank">How COVID-19 has Impacted American Attitudes Toward China: A Study on Twitter</a>
</div></li>
<li><strong>Understanding experiences of changing socioeconomic and psychosocial adversities during COVID-19 for freelancers working in the UK cultural sector: A rapid approach</strong> -
<div>
There is a dearth of qualitative research exploring how freelancers working in the cultural industries have been affected during COVID-19. In particular, there is a lack of research exploring how socioeconomic and psychosocial adversities may have changed or evolved, and how these changes have been experienced. This study builds on qualitative interviews carried out in July-November 2020 (n=20) by exploring findings from follow-up interviews conducted in May-July 2021 (n=16). It presents a diversity of experiences, showing how some freelancers experienced small changes (e.g., to the kind of work carried out), with others experiencing major changes (e.g., leaving the sector completely). The study also explores experiences of ongoing or increased mental health impact, as well as changing attitudes to cultural work. It concludes with a call for highly bespoke support in the future that can address the huge disparity of experiences during this time.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/socarxiv/bu4af/" target="_blank">Understanding experiences of changing socioeconomic and psychosocial adversities during COVID-19 for freelancers working in the UK cultural sector: A rapid approach</a>
</div></li>
<li><strong>Viral dynamics of SARS-CoV-2 variants in vaccinated and unvaccinated individuals</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background. The alpha and delta SARS-CoV-2 variants have been responsible for major recent waves of COVID-19 despite increasing vaccination rates. The reasons for the increased transmissibility of these variants and for the reduced transmissibility of vaccine breakthrough infections are unclear. Methods. We quantified the course of viral proliferation and clearance for 173 individuals with acute SARS-CoV-2 infections using longitudinal quantitative RT-PCR tests conducted using anterior nares/oropharyngeal samples (n = 199,941) as part of the National Basketball Association9s (NBA) occupational health program between November 28th, 2020, and August 11th, 2021. We measured the duration of viral proliferation and clearance and the peak viral concentration separately for individuals infected with alpha, delta, and non-variants of interest/variants of concern (non-VOI/VOC), and for vaccinated and unvaccinated individuals. Results. The mean viral trajectories of alpha and delta infections resembled those of non-VOI/VOC infections. Vaccine breakthrough infections exhibited similar proliferation dynamics as infections in unvaccinated individuals (mean peak Ct: 20.5, 95% credible interval [19.0, 21.0] vs. 20.7 [19.8, 20.2], and mean proliferation time 3.2 days [2.5, 4.0] vs. 3.5 days [3.0, 4.0]); however, vaccinated individuals exhibited faster clearance (mean clearance time: 5.5 days [4.6, 6.6] vs. 7.5 days [6.8, 8.2]). Conclusions. Alpha, delta, and non-VOI/VOC infections feature similar viral trajectories. Acute infections in vaccinated and unvaccinated people feature similar proliferation and peak Ct, but vaccinated individuals cleared the infection more quickly. Viral concentrations do not fully explain the differences in infectiousness between SARS-CoV-2 variants, and mitigation measures are needed to limit transmission from vaccinated individuals.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.02.16.21251535v3" target="_blank">Viral dynamics of SARS-CoV-2 variants in vaccinated and unvaccinated individuals</a>
</div></li>
<li><strong>Hydroxychloroquine for pre-exposure prophylaxis of COVID-19 in health care workers: a randomized, multicenter, placebo-controlled trial (HERO-HCQ)</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Objective: To determine whether hydroxychloroquine (HCQ) is safe and effective at preventing COVID-19 infections among health care workers (HCW). Design: Multicenter, 1:1 randomized, placebo-controlled, double-blind, parallel-group, superiority trial. Setting: 34 clinical centers in the United States. Participants: 1360 HCW at risk for COVID-19 infection enrolled between April and November 2020. Interventions: A loading dose of HCQ 600 mg twice on Day 1 followed by 400 mg daily for 29 days or matching placebo taken orally. Main Outcome Measure: Composite of confirmed or suspected COVID-19 clinical infection by Day 30 defined as new onset fever, cough, or dyspnea and either a positive SARS-CoV-2 PCR test (confirmed) or a lack of confirmatory testing due to local restrictions (suspected). Results: Enrollment for the study was closed before full accrual due to difficulties recruiting additional participants. The primary composite endpoint occurred in 41 (6.0%) participants receiving HCQ and 53 (7.8%) participants receiving placebo. No statistically significant difference in the proportion of participants experiencing clinical infection (estimated difference of -1.8%, 95% confidence interval -4.6% to 0.9%, p=0.20). We identified no significant safety issues. Conclusion: Oral HCQ taken as prescribed appeared to be safe in a group of HCW. No significant clinical benefits were observed. The study was underpowered to rule out a small but potentially important reduction in COVID-19 infections.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.19.21262275v1" target="_blank">Hydroxychloroquine for pre-exposure prophylaxis of COVID-19 in health care workers: a randomized, multicenter, placebo-controlled trial (HERO- HCQ)</a>
</div></li>
<li><strong>Prioritizing COVID-19 vaccination efforts and dose allocation within Madagascar</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background: While mass COVID-19 vaccination programs are underway in high-income countries, limited availability of doses has resulted in few vaccines administered in low and middle income countries (LMICs). The COVID-19 Vaccines Global Access (COVAX) is a WHO-led initiative to promote vaccine access equity to LMICs and is providing many of the doses available in these settings. However, initial doses are limited and countries, such as Madagascar, need to develop prioritization schemes to maximize the benefits of vaccination with very limited supplies. There is some consensus that dose deployment should initially target health care workers, and those who are more vulnerable including older individuals. However, questions of geographic deployment remain, in particular associated with limits around vaccine access and delivery capacity in underserved communities, for example in rural areas that may also include substantial proportions of the population. Methods: To address these questions, we developed a mathematical model of SARS-CoV-2 transmission dynamics and simulated various vaccination allocation strategies for Madagascar. Simulated strategies were based on a number of possible geographical prioritization schemes, testing sensitivity to initial susceptibility in the population, and evaluating the potential of tests for previous infection. Results: Using cumulative deaths due to COVID-19 as the main outcome of interest, our results indicate that distributing the number of vaccine doses according to the number of elderly living in the region or according to the population size results in a greater reduction of mortality compared to distributing doses based on the reported number of cases and deaths. The benefits of vaccination strategies are diminished if the burden (and thus accumulated immunity) has been greatest in the most populous regions, but the overall strategy ranking remains comparable. If rapid tests for prior immunity may be swiftly and effectively delivered, there is potential for considerable gain in mortality averted, but considering delivery limitations modulates this. Conclusion: At a subnational scale, our results support the strategy adopted by the COVAX initiative at a global scale.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.23.21262463v1" target="_blank">Prioritizing COVID-19 vaccination efforts and dose allocation within Madagascar</a>
</div></li>
<li><strong>Discordant humoral and T cell immune responses to SARS-CoV-2 vaccination in people with multiple sclerosis on anti- CD20 therapy</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background: Sphingosine-1-phosphate receptor (S1P) modulators and antiCD20 therapies impair humoral responses to SARS-CoV-2 mRNA vaccines. Whether disease modifying therapies (DMTs) for multiple sclerosis (MS) also impact T cell immune response to vaccination is unknown. Methods: In 101 people with MS, we measured humoral responses via an immunoassay to measure IgG against the COVID-19 spike S1 glycoprotein in serum. We also measured T cell responses using FluoroSpot assay for interferon gamma (IFN-gamma; Mabtech,Sweden) using cryopreserved rested PBMCs and then incubated in cRPMI with 1microg/ml of pooled peptides spanning the entire spike glycoprotein (Genscript, 2 pools; 158 peptides each). Plates were read on an AID iSpot Spectrum to determine number of spot forming cells (SFC)/10 6 PBMCs. We tested for differences in immune responses across DMTs using linear models. Findings: Humoral responses were detected in 22/39 (56.4%) participants on anti-CD20 and in 59/63 (93.6%) participants on no or other DMTs. In a subset with immune cell phenotyping (n=88; 87%), T cell responses were detected in 76/88 (86%), including 32/33 (96.9%) participants on anti-CD20 therapies. AntiCD20 therapies were associated with an increase in IFN-gamma; SFC counts relative to those on no DMT or other DMTs (for antiCD20 vs. no DMT: 425.9% higher [95%CI: 109.6%, 1206.6%] higher; p&lt;0.001; for antiCD20 vs. other DMTs: 289.6% [95%CI: 85.9%, 716.6%] higher; p&lt;0.001). Interpretation: We identified a robust T cell response in individuals on anti-CD20 therapies despite a reduced humoral response to SARS-CoV-2 vaccination. Follow up studies are needed to determine if this translates to protection against COVID-19 infection.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.23.21262472v1" target="_blank">Discordant humoral and T cell immune responses to SARS-CoV-2 vaccination in people with multiple sclerosis on anti-CD20 therapy</a>
</div></li>
<li><strong>Reduction in initiations of HIV treatment in South Africa during the COVID pandemic</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background: In response to the global pandemic of COVID-19, countries around the world began imposing stay-at- home orders, restrictions on transport, and closures of businesses in early 2020. South Africa implemented a strict lockdown in March 2020 before its first COVID-19 wave started, gradually lifted restrictions between May and September 2020, and then re-imposed restrictions in December 2020 in response to its second wave. There is concern that COVID-19-related morbidity and mortality, fear of transmission, and government responses may have led to a reduction in antiretroviral treatment (ART) initiations for HIV-infected individuals in countries like South Africa. Methods: We analyzed national, public sector, facility-level data from the South Africa District Health Information System (DHIS) from January 2019 to March 2021 to quantify changes in ART initiation rates stratified by province, setting, facility size and type and compared the timing of these changes to COVID-19 case numbers and government lockdown levels. We excluded facilities with missing data, mobile clinics, and correctional facilities. We estimated the total number of ART initiations per study month for each stratum and compared monthly totals, by year. Results: At the 2471 facilities in the final data set (59% of all ART sites in the DHIS), 28% fewer initiations occurred in 2020 than in 2019. Numbers of ART initiations declined sharply in all provinces in April-June 2020, compared to the same months in 2019, and remained low for the rest of 2020, with some recovery between COVID-19 waves in October 2020 and possible improvement beginning in March 2021. Percentage reductions were largest in district hospitals, larger facilities, and urban areas. After the initial decline in April-June 2020, most provinces experienced a clear inverse relationship between COVID-19 cases and ART initiations but little relationship between ART initiations and lockdown level. Conclusions: The COVID-19 pandemic and responses to it resulted in substantial declines in the number of HIV-infected individuals starting treatment in South Africa, with no recovery of numbers during 2020. These delays may lead to worse treatment outcomes for those with HIV and potentially higher HIV transmission. Exceptional effort will be needed to sustain gains in combating HIV.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.18.21262046v1" target="_blank">Reduction in initiations of HIV treatment in South Africa during the COVID pandemic</a>
</div></li>
</ul>
<h1 data-aos="fade-right" id="from-clinical-trials">From Clinical Trials</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Pulmonary Rehabilitation Post-COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Other: Exercise program (virtual/remote)<br/><b>Sponsors</b>:   University of Manitoba;   Health Sciences Centre Foundation, Manitoba;   Health Sciences Centre, Winnipeg, Manitoba<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Phase III Study to Evaluate the Efficacy and Safety of Proxalutamide (GT0918) in Hospitalized Subjects With COVID-19</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Drug: GT0918;   Drug: Standard of care;   Drug: Matching placebo<br/><b>Sponsor</b>:   Suzhou Kintor Pharmaceutical Inc,<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Study of PF-07321332/Ritonavir in Non-hospitalized Low-Risk Adult Participants With COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: PF-07321332;   Drug: Ritonavir;   Drug: Placebo<br/><b>Sponsor</b>:   Pfizer<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Targeting de Novo Pyrimidine Biosynthesis by Leflunomide for the Treatment of COVID-19 Virus Disease</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Drug: leflunomide<br/><b>Sponsor</b>:  <br/>
Ashford and St. Peter’s Hospitals NHS Trust<br/><b>Active, not recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Andrographis Paniculata vs Boesenbergia Rotunda vs Control in Asymptomatic COVID-19</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Drug: Andrographis Paniculata;   Drug: Boesenbergia;   Other: Standard supportive treatment<br/><b>Sponsors</b>:   Mahidol University;   Ministry of Health, Thailand<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Efficacy of PJS-539 for Adult Patients With COVID-19.</strong> - <b>Conditions</b>:   Covid19;   COVID-19 Pneumonia<br/><b>Interventions</b>:   Drug: PJS-539 Dose 1;   Drug: PJS-539 Dose 2;   Drug: Placebo<br/><b>Sponsors</b>:   Hospital do Coracao;   Covicept<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Enhancing COVID Rehabilitation With Technology</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Behavioral: NexJ Connected Wellness;   Other: Usual Care<br/><b>Sponsors</b>:   University of Ottawa;   Canadian Institutes of Health Research (CIHR);   Ottawa Hospital Research Institute<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Phase I/II Clinical Trial of Recombinant COVID-19 Vaccine (Sf9 Cells) in Children and Adolescents</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Biological: Recombinant COVID-19 vaccine (Sf9 cells);   Other: Placebo control<br/><b>Sponsors</b>:   WestVac Biopharma Co., Ltd.;   West China Hospital<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>COVID-19 Methylene Blue Antiviral Treatment</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Drug: Methylene Blue;   Drug: Saline nasal spray<br/><b>Sponsors</b>:   Irkutsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences;   Irkutsk State Medical University<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Treatment of Covid-19 With a Herbal Compound, Xagrotin</strong> - <b>Condition</b>:   Covid19<br/><b>Intervention</b>:   Combination Product: Xagrotin<br/><b>Sponsors</b>:  <br/>
Biomad AS;   Directorate of health of Sulaimani, Iraq -KRG<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Trial of Recombinant Novel Coronavirus Vaccine (Adenovirus Type 5 Vector, Ad5-nCoV) in Adults Living With HIV</strong> - <b>Condition</b>:   Covid19<br/><b>Intervention</b>:   Biological: Recombinant Novel Coronavirus Vaccine (Adenovirus Type 5 Vector) (Ad5-nCoV)<br/><b>Sponsors</b>:   Fundación Huésped;   Canadian Center for Vaccinology;   CanSino Biologics Inc.;   Hospital Fernandez<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Philippine Trial to Determine Efficacy and Safety of Favipiravir for COVID-19</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Combination Product: Favipiravir + Standard of Care;   Procedure: Standard of Care<br/><b>Sponsors</b>:   University of the Philippines;   Department of Health, Philippines<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Evaluation of the Effects of Bradykinin Antagonists on Pulmonary Manifestations of COVID-19 Infections (AntagoBrad- Cov Study).</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Drug: C1 Inhibitor Human;   Drug: Icatibant Injection;   Other: Placebo<br/><b>Sponsor</b>:   GCS Ramsay Santé pour l’Enseignement et la Recherche<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Combination of Dietary Supplements Curcumin, Quercetin and Vitamin D for Early Symptoms of COVID-19</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Drug: Standard of care;   Dietary Supplement: combination of curcumin, quercetin and Vitamin D<br/><b>Sponsor</b>:   Ayub Teaching Hospital<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Study to Evaluate the Safety and Efficacy of Artemisinin- a Herbal Supplement on COVID-19 Subjects</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Dietary Supplement: Artemisinin;   Drug: Dexamethasone<br/><b>Sponsors</b>:   Mateon Therapeutics;   Windlas Biotech Private Limited<br/><b>Completed</b></p></li>
</ul>
<h1 data-aos="fade-right" id="from-pubmed">From PubMed</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Investigation of Interaction between the Spike Protein of SARS-CoV-2 and ACE2-Expressing Cells Using an In Vitro Cell Capturing System</strong> - CONCLUSIONS: This study provides a new in vitro system for investigating the interaction between SARS-CoV-2 and host cells and purifying ACE2-expressing cells.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Inhibition of multiple SARS-CoV-2 proteins by an antiviral biomolecule, seselin from Aegle marmelos deciphered using molecular docking analysis</strong> - Our earlier experimental and computational report produced evidence on the antiviral nature of the compound seselin purified from the leaf extracts of Aegle marmelos against Bombyx mori Nuclear Polyhedrosis Virus (BmNPV). In the pandemic situation of COVID-19 caused by the SARS-COV-2 virus, an in silico effort to evaluate the potentiality of the seselin was made to test its efficacy against multiple targets of SARS-COV-2 such as spike protein S2, COVID-19 main protease and free enzyme of the…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Concise Update on Genomics of COVID-19: Approach to Its latest Mutations, Escalated Contagiousness, and Vaccine Resistance</strong> - The novel coronavirus disease 2019 (COVID-19) that started to invade the world from the Chinese fish market, causes an acute respiratory distress syndrome. COVID-19 is a dreadful infectious disease that surfaced only less than 8 months ago and caused the deadly COVID-19 pandemic. In this new species with a positive, single-strand RNA genome and a huge size, from the proteomics point view, there are no changes in sequences of amino acids in NSP7, 13, matrix, or envelope or other proteins…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Profile of humoral and cellular immune responses to single doses of BNT162b2 or ChAdOx1 nCoV-19 vaccines in residents and staff within residential care homes (VIVALDI): an observational study</strong> - BACKGROUND: Residents of long-term care facilities (LTCFs) have been prioritised for COVID-19 vaccination because of the high COVID-19 mortality in this population. Several countries have implemented an extended interval of up to 12 weeks between the first and second vaccine doses to increase population coverage of single-dose vaccination. We aimed to assess the magnitude and quality of adaptive immune responses following a single dose of COVID-19 vaccine in LTCF residents and staff.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Cancer Informatics for Cancer Centers: Scientific Drivers for Informatics, Data Science, and Care in Pediatric, Adolescent, and Young Adult Cancer</strong> - Cancer Informatics for Cancer Centers (CI4CC) is a grassroots, nonprofit 501c3 organization intended to provide a focused national forum for engagement of senior cancer informatics leaders, primarily aimed at academic cancer centers anywhere in the world but with a special emphasis on the 70 National Cancer Institute-funded cancer centers. This consortium has regularly held topic-focused biannual face-to-face symposiums. These meetings are a place to review cancer informatics and data science…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Inhibitors of anti-apoptotic Bcl-2 family proteins exhibit potent and broad-spectrum anti-mammarenavirus activity via cell cycle arrest at G0/G1 phase</strong> - Targeting host factors is a promising strategy to develop broad-spectrum antiviral drugs. Drugs targeting anti-apoptotic Bcl-2 family proteins that were originally developed as tumor suppressors have been reported to inhibit multiplication of different types of viruses. However, the mechanisms whereby Bcl-2 inhibitors exert their antiviral activity remain poorly understood. In this study, we have investigated the mechanisms by which obatoclax (OLX) and ABT-737 Bcl-2 inhibitors exhibited a potent…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Impact of the Declaration of the State of Emergency on the Spread of COVID-19: A Modeling Analysis</strong> - When encountering the outbreak and early spreading of COVID-19, the Government of Japan imposed gradually upgraded restriction policies and declared the state of emergency in April 2020 for the first time. To evaluate the efficacy of the countering strategies in different periods, we constructed a SEIADR (susceptible-exposed-infected-asymptomatic- documented-recovered) model to simulate the cases and determined corresponding spreading coefficients. The effective reproduction number R (t) was…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Structure-Based Virtual Screening and Molecular Dynamics Simulation to Identify Potential SARS-CoV-2 Spike Receptor Inhibitors from Natural Compound Database</strong> - The outbreak of respiratory disease, COVID-19 caused by SARS-CoV-2 has now been spread globally and the number of new infections is rising every moment. There are no specific medications that are currently available to combat the disease. The spike receptor of SARS-CoV-2 facilitates the viral entry into a host cell and initiation of infection. Targeting the viral entry at the initial stage has a better advantage than inhibiting it in later stages of the viral life cycle. This study deals with…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>DNA-encoded chemistry technology yields expedient access to SARS-CoV-2 M(pro) inhibitors</strong> - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has killed more than 4 million humans globally, but there is no bona fide Food and Drug Administration-approved drug-like molecule to impede the COVID-19 pandemic. The sluggish pace of traditional therapeutic discovery is poorly suited to producing targeted treatments against rapidly evolving viruses. Here, we used an affinity-based screen of 4 billion DNA-encoded molecules en masse to identify a potent class of virus-specific…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>CuCl(2)-catalyzed inexpensive, faster and ligand/additive free synthesis of isoquinolin-1(2H)-one derivatives via the coupling-cyclization strategy: Evaluation of a new class of compounds as potential PDE4 inhibitors</strong> - In spite of possessing a wide range of pharmacological properties the anti-inflammatory activities of isoquinolin-1(2H)-ones were rarely known or explored earlier. PDE4 inhibitors on the other hand in addition to their usefulness in treating inflammatory diseases have been suggested to attenuate the cytokine storm in COVID-19 especially TNF-α. In our effort, a new class of isoquinolin-1(2H)-ones derivatives containing an aminosulfonyl moiety were designed and explored as potential inhibitors of…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Coronavirus disease-2019: A review on the disease exacerbation via cytokine storm and concurrent management</strong> - Setting up treatment strategies is the highest concern today to reduce the fatality of COVID-19. Due to a very new kind of virus attack, no specific treatment has been discovered to date. The most crucial way to dominate the disease severity is now the repurposing of drugs. In this review, we focused on the current treatment approaches targeting the crucial causative factors for the disease burden through cytokine storm or cytokine release syndrome. Several vaccines have been developed and have…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Persistent clotting protein pathology in Long COVID/Post-Acute Sequelae of COVID-19 (PASC) is accompanied by increased levels of antiplasmin</strong> - CONCLUSIONS: Clotting pathologies in both acute COVID-19 infection and in Long COVID/PASC might benefit from following a regime of continued anticlotting therapy to support the fibrinolytic system function.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Paradoxical effects of cigarette smoke and COPD on SARS-CoV-2 infection and disease</strong> - CONCLUSIONS: ACE2 levels were decreased in both bronchial and alveolar epithelial cells from COPD patients versus controls, and from CS-exposed versus air-exposed mice. CS-pre-exposure potently inhibited SARS-CoV-2 replication in vitro. These findings urge to investigate further the controversial effects of CS and COPD on SARS-CoV-2 infection.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Brief report: Tempol, a novel antioxidant, inhibits both activated T cell and antigen presenting cell derived cytokines in-vitro from COVID-19 patients</strong> - COVID-19 is characterized by a dysregulation of inflammatory cytokines ultimately resulting a cytokine storm that can result in significant morbidity and mortality. We developed an in-vitro assay using activated peripheral blood mononuclear cells (PBMCs) stimulated with lipopolysaccharide (LPS) or CD3 + CD28 to examine secretion of cytokines from antigen presenting cells (APCs) and T cells, respectively, in donor patients with a history of COVID-19 (convalescent) and uninfected negative…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The early interferon catches the SARS-CoV-2</strong> - Interferons establish innate antiviral immunity. Two recent papers in JEM by Lopez et al. (2021. J. Exp. Med.https://doi.org/10.1084/jem.20211211) and Cheemarla et al. (2021. J. Exp. Med.https://doi.org/10.1084/jem.20210583) show that an appropriate supply of antiviral interferon enables epithelial cells of the nasopharyngeal mucosa to inhibit SARS-CoV-2 growth and that interferon-induced mucosal genes serve as biomarkers of infection.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-patent-search">From Patent Search</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Anti-Sars-Cov-2 Neutralizing Antibodies</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857732">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Expression Vector for Anti-Sars-Cov-2 Neutralizing Antibodies</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857737">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>DEVELOPMENT OF CNN SCHEME FOR COVID-19 DISEASE DETECTION USING CHEST RADIOGRAPH</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857177">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>SARS-COV-2 BINDING PROTEINS</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333402004">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A PROCESS FOR PREPARING MONTELUKAST SODIUM FOR TREATING COVID 19 PATIENTS</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857132">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>IDENTIFICATION OF ANTI-COVID 19 AGENT SOMNIFERINE AS INHIBITOR OF MPRO &amp; ACE2-RBD INTERACTION</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857079">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Deep Learning Based System For Detection of Covid-19 Disease of Patient At Infection Risk.</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857030">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>자외선살균등</strong> - 본 발명은 사람의 의복이나 사용한 마스크 등에 부착하여 있다 호흡기로 유입되어 감염을 유발할 수 있는 COVID-19와 같은 유해균류를 간편하게 살균하기 위한 휴대용 자와선살균등에 관한 것이다. 반감기가 길고 인체에 유해한 오존을 발생하지 않으면서 탁월한 살균능력이 있는 250~265nm(최적은 253.7nm) 파장의 자외선을 발광하는 자외선램프를 본 발명의 막대형의 자외선살균등 광원으로 사용하고 비광원부를 손으로 잡고 의복이나 사용한 마스크 등 유해균류가 부착되었을 것으로 의심되는 곳에 자외선을 조사하여 간편하게 유해균류를 살균하므로써 감염을 예방하기 위한 휴대용 자외선살균등에 관함 것이다. - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=KR332958765">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Protein chip and kit for detecting the SARS-CoV-2 S antigen</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333400883">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>一种新冠病毒疫苗的表达载体及其构建方法、应用和疫苗</strong> - 本发明适用于生物技术领域，提供了一种新冠病毒疫苗的表达载体及其构建方法、应用和疫苗，该表达载体的构建方法包括以下步骤：将表达新冠病毒S蛋白与NP蛋白的核苷酸序列使用2A肽进行连接，合成融合基因；在融合基因的两端分别包含两个酶切位点，并装载到质粒，得到重组质粒；对重组质粒进行双酶切，切胶回收目的基因片段；对原始的质粒进行双酶切，切胶回收载体片段；将目的基因片段和载体片段进行连接，得到所述表达载体。本发明实施例通过同时表达冠状病毒S蛋白受体结合区与NP蛋白，使该表达载体感染的细胞不但可以诱导抗体反应还能诱导T细胞反应，从而有效诱导体液免疫和细胞免疫，为受试者提供更强的免疫保护。 - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=CN333442015">link</a></p></li>
</ul>
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<h1 data-aos="fade-down" id="daily-dose">Daily-Dose</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-new-yorker">From New Yorker</a></li>
<li><a href="#from-vox">From Vox</a></li>
<li><a href="#from-the-hindu-sports">From The Hindu: Sports</a></li>
<li><a href="#from-the-hindu-national-news">From The Hindu: National News</a></li>
<li><a href="#from-bbc-europe">From BBC: Europe</a></li>
<li><a href="#from-ars-technica">From Ars Technica</a></li>
<li><a href="#from-jokes-subreddit">From Jokes Subreddit</a></li>
</ul>
<h1 data-aos="fade-right" id="from-new-yorker">From New Yorker</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Afghanistan, Again, Becomes a Cradle for Jihadism—and Al Qaeda</strong> - The terrorist group has outlasted the trillion-dollar U.S. investment in Afghanistan since 9/11. - <a href="https://www.newyorker.com/news/daily-comment/afghanistan-again-becomes-a-cradle-for-jihadism-and-al-qaeda">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Have You Already Had a Breakthrough COVID Infection?</strong> - The question of what “infection” means is just one of the riddles posed by the late-stage pandemic. - <a href="https://www.newyorker.com/science/medical-dispatch/have-you-already-had-a-breakthrough-covid-infection">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Meeting “the Other Side”: Conversations with Men Accused of Sexual Assault</strong> - In 2011, I helped launch a movement to aid survivors on college campuses. That meant I also had to think hard about the rights of those under scrutiny. - <a href="https://www.newyorker.com/news/annals-of-activism/meeting-the-other-side-conversations-with-men-accused-of-%20sexual-assault">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Should the Government Impose a National Vaccination Mandate?</strong> - Despite claims to the contrary, there are many routes to legally requiring COVID inoculation. - <a href="https://www.newyorker.com/news/our-columnists/should-the-government-impose-a-national-vaccination-mandate">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Slow-Walking the Climate Crisis</strong> - “Greenwashing” is too kind a term; this is more like careful sabotage. - <a href="https://www.newyorker.com/news/annals-of-a-warming-planet/slow-walking-the-climate-crisis">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>A vacation town promises rest and relaxation. The water knows the truth.</strong> -
<figure>
<img alt="An illustration of an eerie Georgia creek at night with people’s faces reflected in the water.
The author of the piece is looking down at her ancestors’ reflections in the water." src="https://cdn.vox-
cdn.com/thumbor/fUlFS8Cm4Hz7sEy1BLOlpXnJyrU=/183x0:1383x900/1310x983/cdn.vox-
cdn.com/uploads/chorus_image/image/69733871/PSX_20210809_154200.0.jpg"/>
<figcaption>
Nokwanda Themba for Vox
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
On the Georgia coast, leisure and a grim history of slavery co-exist.
</p>
<div class="c-float-left">
<figure class="e-image">
<img alt=" " src="https://cdn.vox-
cdn.com/thumbor/YYgW4HsU995yniG4Y5QuEoQvF0Y=/800x0/filters:no_upscale()/cdn.vox-
cdn.com/uploads/chorus_asset/file/21899595/VOX_The_Highlight_Box_Logo_Horizontal.png"/>
</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Zzw2ZJ">
Part of the <a href="https://www.vox.com/e/22392894">Leisure Issue</a> of <a href="https://www.vox.com/the-
highlight">The Highlight</a>, our home for ambitious stories that explain our world.
</p>
<hr class="p-entry-hr" id="R5wpJ8"/>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WQwdud">
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rJWjNV">
My debut as a tightrope artist came not on a twisted maze of natural fibers and yarn but on the concrete slatted bridge, misty air jutting through the cracks, over Dunbar Creek in St.  Simons Island, Georgia. It was here, in 1803, that an estimated 75 captive Igbo Nigerians opted to dance with the depths of the water, to walk until they could walk no more, rather than live a life enslaved.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DX4sxv">
The small, otherwise unremarkable bridge on Sea Island Road sits above Dunbar Creek, where hundreds of cars pass over on an average day, bound for exploring St. Simons Island. It feels like nothing of significance or worth remembering; it is somewhere grotesquely beautiful that has been intentionally forgotten and neglected. I walked it at my own risk, trying to keep my balance on a narrow ledge, afraid, praying I’d make it the length of the bridge unscathed.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="f0NNYC">
As I stepped off the bridge and back onto the sharp incline of rocks, sand, and mud, I felt saddened for reasons even I was surprised to admit to myself. It was not that this was a place where despair led to a lasting choice, but that the area was filled with trash and rotting construction signs rather than any commemoration for the lives that were lost. Cars continue to zoom over the bridge, over this smaller body of water, like nothing ever was.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kM5z1X">
Heading back to my car, which I’d haphazardly parked in a patch of grass right off the bridge, a calm settled over me. I knew why my ancestors had chosen this point in the water to make an impossible choice: This winding, murky creek offered them a kind of peace, a kind of stillness. A chance to both release and reclaim what had been ripped from them.
</p>
<hr class="p-entry-hr" id="D3y5gx"/>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IeRWkr">
A part of Georgia’s Golden Isles, St. Simons is a 17.7-square-mile island off the Atlantic Coast in Glynn County. Halfway between Savannah and Jacksonville, the sprawling marshlands give way to sweeping coastal landscapes. Native Americans called St. Simons Island home before Spanish, French and English colonists wrangled over the land, and the English ultimately won their quest. Beginning in the 1790s, enslaved Africans cultivated the land on this island, growing and harvesting rice, sugar, and cotton, yielding a bountiful harvest for a nation that offered them nothing in return.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ldw3zg">
St. Simons Island — like the rest of the Golden Isles of Jekyll, Little St. Simons, and Brunswick — has beaches and coastlines stretching its full length. Lush oak trees and sagging weeping willows surround hotels, bed-and-breakfasts, and rental vacation homes that some visitors call their residences for months out of the year, typically in the summer. Luxury cars full of families traverse the island, while throngs of others walk or ride bikes on the tree-lined streets.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rXFdkZ">
A place like St. Simons Island oozes idyllic Southern charm. The drawls are as grand as the morning sunrises and the evening sunsets over marshland, the swaying patches of brown and green grass cradling both mud and smaller tributaries of water. For such a small island, the days feel longer, especially in the summer, particularly when you’re strolling on East Beach, golfing on any of the six golf courses, or eating plentiful amounts of meaty coastal oysters, crab, lobster, and plump — and slightly sweet — Georgia shrimp.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BYFywY">
The key to enjoying St. Simons is to embrace ease and relaxation — a slower pace of life. While ease and relaxation are easily embraced, the legacy of those who have been lost and exploited is visible in stray glances, if you notice, in things like restaurants or buildings made from tabby oyster shells, cream-colored and gritty in appearance. Slave cabins were often constructed from tabby. Yet the history is often obscured, like that of Igbo Landing.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="oilTCa">
<a href="https://www.georgiaencyclopedia.org/articles/history-archaeology/ebos-
landing">The details and what happened at Igbo Landing</a> — also referred to as Ebo or Ibo Landing — are too visceral, too real to be the result of families huddled together relishing in the age-old African art of storytelling. The water knows.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QzsKZ6">
Dunbar Creek, the way it ripples and settles with ease, holds something other than fish, trash, mud, and marshland treasures. No one else was there when I visited, and from what I know, no one visits here often — although it’s a stone’s throw from some of St. Simons’s many vacation homes and a plaza with a CVS and a grocery store.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hQdSrE">
I learned the story at the <a href="https://nmaahc.si.edu/">National Museum of African American History and Culture in Washington, DC</a>. Months after the museum opened in 2016, my father lucked out with coveted tickets, and my family braved the cold and the long lines Thanksgiving weekend.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bAUf38">
One of my sisters and I began at the very bottom of the museum, where the oldest histories are housed. A dimly lit space that felt more like a claustrophobic ambling in the dark, it echoes what it might have felt like on a slave ship on a brutal journey to an unknown land, stolen from the only home you’d known. It was there, pausing somberly and squinting to read the placards, that I read about a group of Igbo Nigerians — from whom I am descended and who I consider my ancestors — who made the Middle Passage journey to Savannah. These roughly 75 people were boarded <a href="http://www.glynncounty.com/History_and_Lore/Ebo_Landing/">upon a smaller ship</a>, bound for St. Simons Island. Once the ship arrived, those held captive took control of the ship. As this story of resistance goes, shackled and connected to one another, they walked into the waters of Dunbar Creek chanting in Igbo, “The Sea brought me and the Sea will take me home.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="omVa8a">
Aside from my immediate sadness in reading about it, I felt something else rising to the surface — my ears started to ring, my hands trembled, my face grew hotter, my heart began to race so fast I had to take deep breaths to steady myself. I was filled with endless questions.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Mnnjd3">
Why was this the first time I’d heard about this? Why hadn’t we been taught about the horror of what happened that day on Georgian soil, mere hours from where I grew up?
</p>
<hr class="p-entry-hr" id="YTm7K5"/>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gPmAWd">
Not knowing is a violence.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="49QJa4">
The absence of knowing robs you of the chance to mourn, to grieve. We lose our humanity, the space to be bereft, the chance to avenge and honor our ancestors, to fight for their legacy to live among everyday consciousness. These are our losses when our histories are not told, shared, or known by those they directly affect.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RnxyLu">
This is the case for Igbo Landing, which rightfully could be considered a slave rebellion. It is one instance among many in which those due to be enslaved fought back, who made an impossible choice faced with a litany of unthinkable decisions.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NBVhxN">
In recent years, popular culture has brought the story of Igbo Landing in front of both Black and white audiences, even if it didn’t appear that way on the surface. The same year I learned of Igbo Landing for the first time, it seemed to garner a reference in Beyonce’s genre-shifting work <em>Lemonade</em>. “<a href="https://www.q-zine.org/non-fiction/beyonces-love-drought-video-slavery-and-the-story-of-igbo-landing/">Love Drought</a>” begins with an ethereal image of women walking solemnly into the water in a straight line behind one another. They are adorned in all white with black sashes at their waist in the shape of a cross. The walk is shown to be a ritual, a communing with the water.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Py94We">
<em>Black Panther</em> also touched on the story of Igbo Landing, when <a href="https://medium.com/@vasta/bury-me-in-the-ocean-with-my-ancestors-that-jumped-from-the-ships-
because-they-knew-death-was-1200405fa322">Michael B. Jordan’s character, Killmonger</a>, said words that have been repeated with fervor since — “Bury me in the ocean with my ancestors that jumped from the ships because they knew death was better than bondage.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tIF7jM">
The references to Igbo Landing, whether blatant or suggestive at best, go even further back. <a href="https://www.newyorker.com/culture/richard-brody/the-return-of-julie-dashs-historic-
daughters-of-the-dust">Julie Dash’s <em>Daughters of the Dust</em></a>, released in 1991 and praised because of its emphasis on the complexities of Black womanhood, is set in Igbo Landing, and its Peazant family members are direct descendants of the enslaved there.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DmLiGN">
Six years earlier, Virginia Hamilton published <a href="https://go.redirectingat.com?id=66960X1516588&amp;xs=1&amp;url=https%3A%2F%2Fwww.penguinrandomhouse.com%2Fbooks%2F74385%2Fthe-
people-could-fly-by-virginia-hamilton-illustrated-by-leo-and-diane-
dillon%2F&amp;referrer=vox.com&amp;sref=https%3A%2F%2Fwww.vox.com%2Fthe-highlight%2F22621604%2Fst-simons-island-igbo-
landing-ebo-slavery-vacation" rel="sponsored nofollow noopener" target="_blank"><em>The People Could Fly</em></a><em>,</em> a compilation of African American folktales that included Igbo Landing. Black people flying and taking to the skies is popular in folklore, because our ancestors imagine a life and world where we were free: the open skies, the blue waters of the ocean, the murky ones of Dunbar Creek. Being elsewhere meant that they had choices other than a certain death trapped in a system that worked to devalue, demean, and break their spirits.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ttiVE8">
These references to Igbo Landing through the years serve as remembrance, a true recollection of what happened at Dunbar Creek — of what happened in St. Simons Island all those years ago — depending on whom you ask.
</p></li>
</ul>
<hr class="p-entry-hr" id="yX97jC"/>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YoejIN">
Toni Morrison once said, “All water has a perfect memory and is forever trying to get back to where it was.” I thought about this as I stood over Dunbar Creek, craning my neck to take in the area and memorialize what I saw with my camera. My shutter clicked as I swatted mosquitoes from my face and attempted to distract myself from being inches away from cars driving by at full speed. One stumble in the wrong direction and I’d be flung into oncoming traffic — or down below into water so murky I couldn’t be sure of the depth.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wRFRwR">
I was terrified. But I desperately wanted to remember. I wanted to recall a space, place, and time that I had not known. And I was convinced this moment would connect me to something bigger. The water had something to teach me: about pain, the weight of forgetfulness, and existing in a space of liminality.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Od84pa">
There is deep irony in places like St. Simons Island. Families and friends road-trip to this island, where they can feast on seafood and drink cheap beers in timeshares, or in second or third homes. This is their version of paradise and relaxation, leisure and ease they have earned. Leisure they feel a right to. But this leisure is decidedly white in its aims.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OIPqmE">
That weekend this summer, I didn’t see many Black people on St. Simons Island. They exist. They go there, too. But a coastal island in the marshlands of Georgia, St. Simons has a particular history that cannot be erased, because of its proximity to water and its connection to slavery. Places like these were prime real estate because of their ease of connection to precious cargo. Humans were shuttled like animals, chained and shackled, and sold. Sometimes they were held in slave depots until they could be sold or a sale was finalized — these were our earliest prisons.
</p>
<div class="c-float-right">
<div id="pBdAhP">
<div>
</div>
</div>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dnPOwl">
Multiple truths, different versions of truth, can coexist. Concepts like leisure and rest shouldn’t fall into that category, and yet they do.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="G8HVfS">
As in so many other places that are vacation and getaway central, Black leisure doesn’t exist here. Not when our pain is not validated and is instead erased. Not when Igbo Landing itself is largely inaccessible due to private land disputes.
</p>
<hr class="p-entry-hr" id="HaGZeD"/>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LpbeuC">
My first few attempts<strong> </strong>to access Dunbar Creek via the bridge on Sea Island were dead-end, fruitless chases. Multiple times, I ended up on the other side of a wastewater plant, which has been there since the 1940s. The more direct route landed me tightrope-walking on that bridge — the closest I could get, since the area is on multiple acres of private property. That is why there is not even a commemorative marker.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jYSYl5">
<a href="https://ssiheritagecoalition.org/">The Saint Simons African American Heritage Coalition</a> wanted to do something about that. In 2002, the group <a href="https://accesswdun.com/article/2002/9/190609">invited 75 people</a> to pay homage to those who died at Igbo Landing and included some discussion on Igbo customs and traditions, in the hopes of giving the spirits lingering near the water some rest. Some of the coastal schools have also incorporated the story of Igbo Landing into their curricula. But there’s still so much to be done. Official marking would seal the history.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="floIb3">
When I arrived back in Atlanta, where I live, the sand gathered underneath my feet on my car mat felt like a ceremonious parting gift. A trinket, a souvenir, a sentimental, heart-strung charm for the road, so that I never forgot what I saw, never forgot what it felt like to be there, breathing in that air, taking in that same view that my ancestors took in centuries ago. I felt connected because I had chosen to be a witness to their pain — and to their ultimate glory.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="smIxsY">
<em>Nneka M. Okona is a contributing writer for the Counter and the author of “Self- Care for Grief.” She previously wrote about </em><a href="https://www.vox.com/the-
highlight/2019/9/18/20862468/heritage-african-american-ancestry-23-and-me-dna-testing"><em>“heritage” tourism among African Americans</em></a><em> for The Highlight.</em>
</p>
<ul>
<li><strong>Caring for the elderly has never been more expensive, exhausting, or invisible</strong> -
<figure>
<img alt="An elderly person in a wheelchair and his caretaker are shown on top of a flattened house" src="https://cdn.vox-cdn.com/thumbor/YQZZ6PHuYxbz8niL1EBy3zcG2Uo=/375x0:2626x1688/1310x983/cdn.vox-
cdn.com/uploads/chorus_image/image/69777742/vox_lead_resize.0.png"/>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
As millions “age in place,” millions more must figure out how to provide their loved ones with increasingly complex care.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GXRnAu">
When Laura sent me an email in early August, the first thing she did was apologize. “Please excuse how inelegant and disjointed this will be,” she wrote. “It matches my brain after being a caregiver since 2013.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="79Vzhh">
In 2013, Laura was several decades into a career as a marketing consultant. Her work was rewarding and challenging; she felt like she got to be creative every day and was never bored. She had gone freelance in the early 2000s and reveled in the freedom of being her own boss. Then her 78-year-old mom began experiencing severe back pain. She was scheduled for surgery, but the symptoms only worsened after the procedure. She was soon rushed back to the hospital following the collapse of her spinal cord. After emergency surgery, her pain lessened, at least somewhat, but then Laura was left to deal with her mom’s quickly accelerating dementia. “She went from normal cognition to thinking it was her wedding day and that I was her mother,” Laura told me. “She didn’t know how to walk, and didn’t remember what had happened to her.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xLx0eb">
According to elder care experts, Laura’s description of what happened to her mom is pretty common. As someone ages, their health appears to gradually deteriorate in a way that doesn’t seem alarming. Most of the time, though, they’re inching toward a cliff — and when they fall off, they find themselves on another health cliff, and another, and another. With each cliff, it gets more difficult for a family member to catch them.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YYU7sz">
Some older adults have diligently prepared for their future. They purchased long-term care insurance when it was still affordable, then paid the premiums each month, even as they continued to rise. This is not the norm. Many adults have no plan at all, or assume that Medicare, which currently kicks in at age 65, will cover their health costs. Medicare, however, doesn’t cover the long-term daily care — whether <a href="https://www.vox.com/the-
highlight/2019/8/21/20694768/home-health-aides-elder-care">in the home</a> or in a full-time nursing facility — that millions of aging Americans require. For that, you either need to pay out of pocket (the <a href="https://www.genworth.com/aging-and-you/finances/cost-of-care/cost-of-care-trends-and-insights.html">median yearly cost</a> of in-home care with a home health aide in 2020 was $54,912, and the median cost for a private room in a nursing home was $105,850) or have less than $2,000 in assets so that you can qualify for Medicaid, which provides health care, including home health care, for more than 80 million low-income Americans. Even if you qualify, the waiting list for home care assistance for those with Medicaid tops 800,000 people and has an average wait time of <a href="https://www.aging.senate.gov/imo/media/doc/CASEY%20Aging%20Newsletter%20Issue%201.1.pdf">more than three years</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="g2Xfz4">
That’s how millions of Americans find themselves in situations like Laura’s. A nursing home is too expensive; or, because of <a href="https://www.reuters.com/article/us-health-coronavirus-nursinghomes-
speci/special-report-pandemic-exposes-systemic-staffing-problems-at-u-s-nursing-homes-idUSKBN23H1L9">ongoing staffing shortages</a>, there aren’t even open beds in the area. Over the past year and a half, many have also deemed them too risky because of Covid-19 concerns. In-home care seems more complicated, but it’s <a href="https://apnorc.org/projects/long-term-care-in-america-americans-want-to-age-at-home/">almost always</a> what the care recipient wants, especially if it means the ability to stay in their own home. So the family decides to make it work, without a real understanding of the often-invisible costs that will quickly begin to accumulate.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="U2LS9s">
“My mother and I had always been close, as much friends as mother and daughter,” Laura told me. Laura thought, with the freedoms of her job, she could manage care for her mother at her parents’ home, even if it meant slightly decreasing the number of clients she took on. “Looking back, I realize how naive I was,” she said. “My clients dropped away, some after more than 20 years of working together. You can’t care for someone with such high needs and still manage to put in a day of work.”
</p>
<div class="c-float-right c-float-hang">
<aside id="YWb4hi">
<q>“It’s a weird sort of amnesia I’m left with. I think this is PTSD.” </q>
</aside>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mMMANU">
In the years that followed, Laura’s mother broke her hip. Her dementia worsened. Her father was also diagnosed with dementia, and would occasionally hit people. Laura attempted to go along with their realities to avoid agitation, which made her feel like she was living in “this weird, make-believe version” of the world. Without any outside help, she felt herself receding into an automated routine of changing diapers, bathing, washing bedding, cooking meals. The feeling was not dissimilar from caring for a baby, only babies get older and their care gets easier. The opposite is true for elder care.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZIdIFR">
“Watching people you love suffering is debilitating, but you have to keep going,” Laura said. “That’s just another thing you tamp down. You have to stuff away anything you’re feeling because there isn’t time for that. You have too much to do.” Her parents’ medical needs kept getting more intense, but as is the case with so many elders “aging in place” — living in their own homes, which AARP found the <a href="https://www.aarp.org/retirement/planning-for-
retirement/info-2018/retirees-age-in-place-aarp-study.html">vast majority of</a> older adults prefer — or moving in with a family member, they were too much for Laura but too little to justify (at least to insurers, or Medicare) a full-time nursing facility.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ULw1tG">
Laura’s mother died last year. Her father died four months ago, but not before developing kidney cancer that eventually did necessitate nursing home care. Once there, he became so agitated and combative that the staff required Laura to sleep in the room — in the middle of an active Covid-19 outbreak — just to keep an eye on him. After he died, in what Laura described as a “crazy mess of death,” Laura found herself with a decimated retirement account, no other savings, and no income. “I’m 63, and need to find a job,” she said. “But who wants a 63-year-old? I can’t even manage to put together a decent résumé. I’ve gone from a strong, confident woman who could handle anything to someone who can barely function.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IIQZMS">
Over the past eight years, Laura lost much of her support system; she couldn’t go anywhere, couldn’t socialize, couldn’t maintain friendships. She can’t remember what her family used to be like and keeps replaying scenes in her mind, wondering whether she could have provided better care. “It’s a weird sort of amnesia I’m left with,” she said. “I think this is PTSD.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Teqz7K">
Depending on your own experience with elder care, Laura’s case might sound extreme. But it isn’t, not really. It’s just that most of this care work — both paid and unpaid — remains invisible. According to the <a href="https://www.aarp.org/content/dam/aarp/ppi/2020/05/full-report-caregiving-in-the-united-
states.doi.10.26419-2Fppi.00103.001.pdf">most recent data</a> from the AARP, an estimated 41.8 million people, or 16.8 percent of the population, currently provides care for an adult over 50. That’s up from 34.2 million (14.3 percent) in 2015.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cuHhFP">
Of those caregivers, 28 percent have stopped saving, 23 percent have taken on more debt, 22 percent have used up their personal short-term savings, and 11 percent reported being unable to cover basic needs, including food. The average age of someone providing care for an adult is 49, but 23 percent are millennials and 6 percent are Gen Z. Sixty-one percent are women, and 40 percent provide that care within their own homes, up from 34 percent in 2015.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OmOdiB">
A lot of these caregivers are really, really struggling. What’s required of them is more complex and time-consuming than just 10 years ago, as caregivers deal with overlapping diagnoses related to physical health, mental health, and memory loss as the elderly live longer. The work is much more than just clearing out the guest room or setting another place at the dinner table. Depending on the health of the care recipient, it’s monitoring medication, preparing special meals, changing diapers, and bathing, plus figuring out finances, providing transportation to and from medical appointments, and more. But only three in 10 have additional paid help, and 27 percent struggle to hire affordable care in their area. One in four caregivers find it difficult to take care of their own health, and the same percentage report that their health has deteriorated because of caregiving.
</p>
<div class="c-float-left c-float-hang">
<aside id="HG8iKg">
<q>So much of the labor — and struggle — associated with caregiving goes unnoticed, unappreciated, and underdiscussed</q>
</aside>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rsHor0">
So much of the labor — and struggle — associated with caregiving goes unnoticed, unappreciated, and underdiscussed. There’s a whole host of reasons for that, mostly the fact that family caregiving is largely performed by women in the home and thus discounted as labor; when it is paid, it’s almost entirely performed by women of color, particularly immigrant women, and socially devalued. Then there’s the fact that most Americans are also terrified of death and the dying process and horrible at talking openly with others about the realities of aging.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iSJXpG">
As Laura’s story demonstrates, that sustained invisibility has cascading consequences on not only the caregiver’s mental health but also their capacity to save for their own eventual care needs. Paid caregivers’ situations are different but no less extreme. In most states, they have close to no labor protections for incredibly physically taxing work. Most barely earn enough to provide for their own families, let alone save for retirement.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kx6cJP">
Since the difficulty of this care remains largely imperceptible to all save those who provide it, there have been few attempts, governmental or otherwise, to make it better, easier, or less of a life-swallowing burden. Right now, there are resources for the poor (who go on Medicaid, the services for which have become harder and harder to access and arrange) and resources for the rich (who can pay for Cadillac versions of care, including consultants to navigate the process). For everyone in between, as Caroline Pearson, senior vice president at the University of Chicago’s NORC (formerly the National Opinion Research Center), put it to me, “There is no system at all.” There are just individual families and the caregivers within them carving out their own paths as best as possible — and, in many cases, significantly denting their savings and earning power, making their already precarious footing in the middle class all the more so.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6Am1VZ">
How do we make this labor visible enough that we can begin to make it navigable and to prevent, or at least significantly alleviate, millions of care situations like Laura’s? Our current elder care reality has everything to do with who’s done this labor in the past, paired with an enduring unwillingness to update social policy to match seismic societal shifts. There’s a way to value this work. The first step is seeing it not just as valuable labor but as labor in the first place.
</p>
<hr class="p-entry-hr" id="mfaJR1"/>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gXiCj5">
When academics and analysts put together surveys to try and figure out just how many hours people in the United States spend providing care, they have to be clever. “You and I, in our conversation, we’re using this word ‘caregiver,’” Christian Weller, an economist who studies retirement, told me. “But the people who design the surveys, they have to be very careful not to use that word.” According to Weller, many people, particularly those caring for family members, will say, “Oh, I’m just spending time with my mom” — they just happen to feed, bathe, and supervise all their daily needs while doing so.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Dj673j">
The people providing this care don’t think of themselves as caregivers, for many of the same reasons mothers who don’t work outside the home don’t think of themselves as “working moms”: The labor they do is expected, part of their familial role. It’s not labor, or at least not the sort of labor that would earn its own title like “caregiver.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tDeWJS">
Caregiving is work, even if our society has historically concealed that work. For much of the country’s history, the question of who provided long-term care — for young children, for those with disabilities, and for older people — was simple. Women did it for free in the home. The vast majority of men worked outside the home, earning the money that would allow the household to run, and then the women ran it: cooking, cleaning, educating, supervising, bathing, planning, organizing, and just generally doing the labor known as care work. While men’s work outside the home was valorized, women’s work was naturalized: It wasn’t work, it was just what women did.
</p>
<figure class="e-image">
<img alt="A caretaker’s hand holds the
hand of an elderly person with a cane" src="https://cdn.vox-
cdn.com/thumbor/qLWzEWbkb8_nxKkePth3M8GJI6c=/800x0/filters:no_upscale()/cdn.vox-
cdn.com/uploads/chorus_asset/file/22804050/vox_spot_1.png"/>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ePqbrN">
This belief is part of the larger ideology of “family responsibility,” which has become endemic in American society, where the responsibility of caring for dependents is considered, first and foremost, the provenance of the family. You see it in enduring rhetoric about why a mother’s care is always best for children; you see it in the guilt that accumulates around women who chose not to (or cannot) provide that care. As sociologist Sandra R. Levitsky writes in <a href="https://oxford.universitypressscholarship.com/view/10.1093/acprof:oso/9780199993123.001.0001/acprof-9780199993123"><em>Caring for Our Own</em></a>, within this framework, “Caring for family members is understood as a natural or inherent moral obligation, superior to any other form of care.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="datstu">
You might read that and think, “Yes, that is true, that is how human family works.” As Levitsky points out, our not-so-distant past suggests otherwise. Scholars have found that during the 18th and 19th centuries, harsh economic conditions meant many family relations were contingent on some sort of a mutual economic benefit: Children were “worth” the cost to feed them because of the labor (or income) they would eventually provide for the family, whether in the fields or in the factories. The same was true even outside of poor families. In his work on the dynamics of inheritance in the 19th and 20th centuries, historian Hendrik Hartog found that inheritance was often dangled over family members as a means of coercing care.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pPufMA">
It’s only recently that we’ve settled on the understanding that care for elders is natural, moral, and ideal, even when the people providing this care are suffering or lacking the skills to provide the quality of care the recipient requires, or both. Crucially, by locating responsibility for care squarely on the family unit, it also continues to limit or excuse greater society — which is to say, the government — from the responsibility of providing care to the most vulnerable members of society. Our belief that the family is always the best and preferred care provider makes it much harder to advocate for the sort of larger, taxpayer-funded systems that would make all care, regardless of whether it’s provided by a family member, far easier.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dWpwOp">
There are other consequences to this naturalization of family responsibility. When labor is continually framed as something done out of love or instinct, it loses its connotation as labor and, by extension, its value. When women (and white middle-class women in particular) began moving into the workforce en masse in the second half of the 20th century, they didn’t quit their domestic work. They just did two jobs, one layered on top of the other; they would put in a full day in a traditional workplace for pay, then went home and kept working, unpaid.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Gdsd1V">
Many women could only juggle these two separate jobs with the help of other women, both paid and unpaid. Poor working women had been doing this for some time, relying on “kith and kin” for child care in particular. Some middle-class women increasingly began to do the same, relying on friends but mostly family, while some began paying other women to do the work. This domestic labor, whether in the form of child-rearing, laundering, cleaning, or cooking, was essential, but because it had been so thoroughly normalized as unpaid work, it was also easy to normalize incredibly low wages for those who do it, even if that person had no relation to the family.
</p></li>
</ul>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="z83MTW">
This devaluation of domestic labor has been racialized from the start. The rhetoric of a “natural inclination” toward a certain type of work was used to justify slave labor while conveniently eliding the fact that the entire economy of the South would collapse without it. Instead of rebuilding a new economy after the Civil War, the South simply devalued the labor previously performed by enslaved people, whether in the fields or within the home. This standard was codified by law and held in place over the course of the early 20th century by Southern Democrats who insisted that agricultural and domestic workers be exempt from the otherwise sweeping labor protections of the New Deal era.
</p>
<div class="c-float-left c-float-hang">
<aside id="m7tEs5">
<q>When labor is continually framed as something done out of love or instinct, it loses its connotation as labor and, by extension, its value</q>
</aside>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="K2JXdg">
These two currents of labor devaluation — of women’s work and of racialized work — converge in caregiving. The systemic undervaluing of this labor affects those providing unpaid and paid care differently, but the impacts are interlocking. In <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674064157"><em>Forced to Care: Coercion and Caregiving in America</em></a><em>, </em>Evelyn Nakano Glenn argues, “By virtue of its location in the home, caring work, whether paid or unpaid, is treated as though it is governed by the altruism and status obligations,” meaning the obligation to care for someone because of your relationship to them (daughter, son, sibling). “As a result,” Nakano Glenn continues, “paid domestic workers suffer various forms of exclusion from benefits and rights accorded other paid workers. Instead, like family members performing unpaid care, they are treated as dependents rather than true workers.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qRcKUa">
In both child and elder care, this “social organization of care,” as Nakano Glenn calls it, has remained unaddressed for decades, societally “tolerable” only because the people bearing the greatest burden have been women, particularly women of color. Even as more and more women have entered the workforce each decade, and more and more elders require more and more complex care, the governmental understanding of who should provide that care has remained stubbornly rooted in the ideology of family responsibility. In practice, that means continually undervaluing those who provide paid care, while also making it incredibly difficult for family members in most states to receive Medicaid payment or reimbursement for their labor as a part- or full-time caregiver.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RiQynX">
The continued devaluation of caregiving means that turnover for paid caregivers is high. As soon as someone can find a job that pays better, offers medical benefits or worker’s comp, or puts less physical strain on the body, they quit. In many states, particularly those where care workers haven’t been able to unionize and bargain for protections and better pay, there’s an ongoing labor shortage that only gets worse every year.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GPZ3aI">
This shortage has direct effects on the family members supervising that care. The lack of affordable or even available assistance means more “coerced” caregiving by family members who feel they have no other choice; according to the <a href="https://www.aarp.org/content/dam/aarp/ppi/2020/05/full-report-caregiving-in-the-united-
states.doi.10.26419-2Fppi.00103.001.pdf">AARP</a>, this accounted for 53 percent of caregivers in 2020. What’s more, finding replacement caregivers and then coordinating their hours is one of the most mentally taxing components of familial caregiving, a task that only gets harder when labor is in short supply. When you make a job a bad job, you create more labor for the people who rely on assistance from that job.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RH2P09">
The result is caregiver burnout, poor care, and poor caregivers. As Kate Washington writes in <a href="https://go.redirectingat.com?id=66960X1516588&amp;xs=1&amp;url=https%3A%2F%2Fbookshop.org%2Fbooks%2Falready-toast-
caregiving-and-burnout-in-america%2F9780807011508&amp;referrer=vox.com&amp;sref=https%3A%2F%2Fwww.vox.com%2Fthe-
goods%2F22639674%2Felder-care-family-costs-nursing-home-health-care" rel="sponsored nofollow noopener" target="_blank"><em>Already Toast: Caregiving and Burnout in America</em></a>, “Burnout kills empathy and makes worse caregivers of all of us who suffer from it.” For paid caregivers, burnout arrives for the same reasons it arrives in any low-paying, highly demanding field: They’re simply not paid enough. The combination of low, stagnant wages and inconsistent scheduling made for a <a href="https://www.bls.gov/oes/current/oes311120.htm#st">median income of $27,080</a> as of May 2020, and that figure varies wildly from state to state. (In Houston, for example, the annual mean wage was $21,120; in Seattle, $33,770.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="likKvK">
This was exacerbated during the pandemic, when the narrative of “aging in place” at all costs became even more forceful. Paid caregivers in 21 states were offered some form of hazard pay or pay increase, but those workers were the exception, not the rule. Even as demand has skyrocketed, pay in most states has remained stubbornly low, and because home health workers weren’t designated as “essential,” they didn’t have the <a href="https://aspe.hhs.gov/reports/covid-19-intensifies-home-care-workforce-challenges#findings">same access to regular testing</a>, PPE, or vaccines as other health care employees.
</p>
<div class="c-float-right c-float- hang">
<aside id="JcMj8v">
<q>Just as with so many parents operating without societal support, life becomes a matter of sheer endurance</q>
</aside>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5PqVtV">
For unpaid caregivers, the burnout comes from the combination of performing physically and mentally exhausting work, coordinating care and medications, managing their own jobs and families, and navigating the bureaucracies of care and finance. Compassion fatigue and <a href="https://www.acf.hhs.gov/trauma-toolkit/secondary-traumatic-stress">secondary traumatic stress</a>, with symptoms ranging from depression to insomnia to substance abuse, are widespread and largely undiagnosed. Just as with <a href="https://www.vox.com/the-goods/22360152/child-care-free-public-funding">so many parents who operate without societal support</a>, life becomes a matter of sheer endurance. But at some point, as care needs become even more acute, no amount of endurance or will or grit can make the situation tenable. There are no solutions and no real relief, other than eventual death, shaded with the peculiar mix of relief and regret.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="x3gij5">
Unpaid caregivers told me that part of their frustration and exhaustion stems from their sustained invisibility. Liz O’Donnell, author of <a href="https://www.amazon.com/Working-Daughter-Parents-Making-Living/dp/1538124653"><em>Working Daughter: A Guide to Caring for Your Aging Parents While Making a Living</em></a>, said that in the Facebook group she runs for unpaid caregivers, one recurrent frustration is that the press is filled with articles about <a href="https://www.vox.com/22321909/covid-19-pandemic-school-work-parents-remote">how hard it is to parent during Covid-19</a> — which is important — but there is very, very little about the challenges of caring for adults in isolation, especially while trying to work. “I’m lucky that I have teens who can handle their own Zoom calls,” O’Donnell said. “But it was also really, really hard for people who have a parent with dementia who didn’t understand that you were on a Zoom call.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CZG9Bi">
We don’t know how to talk about the challenges of elder care with each other, especially at work. When O’Donnell was still trying to juggle care for her parents, who have since died, and a full-time job, she found there was no repertoire, no familiarity, no way for her coworkers to understand. You don’t just come into work one day and declare, “I provide elder care now!” Unlike with, say, the birth of a child, there’s no office- wide email, no celebration, nothing that visibly changes, no employee resource group — no resources, period.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="u1w5BG">
Just incredible stress, and the feeling, particularly among women caregivers, that you have no other option but to keep juggling care and work responsibilities.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ai3WSS">
“You see a lot of statistics about the 65 percent of caregivers who make some change at work, or the $300,000 in total lost wages and benefits for women, or people who take time off or switch to a less demanding job or quit altogether,” O’Donnell said. “But there’s also a lot of just hanging on. Women know how dangerous it is to leave the workforce, and we know it’s not something that many of us can afford. The average family caregiver is a woman in her late 40s and early 50s. If that woman takes her foot off the gas pedal in her career, does she ever get back in?” The care itself is exhausting, O’Donnell said, but the additional anguish over what the care has taken from your life and from your future? That’s debilitating.
</p>
<hr class="p-entry-hr" id="6GAbJh"/>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BuV9I9">
If you haven’t faced figuring out care for yourself or a loved one, you might think this isn’t your problem. It likely will be at some point, but even if it isn’t, it still matters. When one pillar of society is broken, the rest of the pillars are asked to bear even more weight. Some calculations are hard to parse, but some are straightforward: If your mom stops working to take care of her parents and drains her savings to do so, that will affect you when she needs care. The <a href="https://aparc.fsi.stanford.edu/research/impact-robots-
nursing-home-care-japan">promise of automation</a> won’t fix the labor shortfall. Increasing immigration quotas might help, but the job itself is still a bad one with high turnover. Everyone’s miserable, and nothing’s even close to optimal — not for elders, and certainly not for the ones providing care.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NseHVH">
The current situation is a prime example of what political scientist Jacob Hacker calls “policy drift,” where the needs of a society have changed dramatically but the social policy created to address those needs remains mired in a previous reality. In this case, a reality decades in the past, when far less of the population was aging, when the care needs were far less complex, and when far fewer women worked outside the home. That’s not to say that the situation was optimal in that previous reality, but now it’s falling on the shoulders of millions of paid and unpaid caregivers.
</p>
<figure class="e-image">
<pre><code> &lt;img alt="An empty wheelchair" src="https://cdn.vox-</code></pre>
cdn.com/thumbor/8ywRJDd80jl2ygTJibJOVn5kznE=/800x0/filters:no_upscale()/cdn.vox- cdn.com/uploads/chorus_asset/file/22804058/vox_spot_2.png" /&gt;
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="csMEmh">
So how do we correct that drift? The tech industry has recently realized that the family caregiver market is massive and hugely underserved, and various startups are trying to make certain aspects of caregiving less unnecessarily burdensome. Carefull, headed by former consultant Todd Rovak, aims to alleviate the massive stress of elder financial management. “Right now, people are essentially becoming the CFO for their parents,” Rovak told me. “They don’t have the skills for it, and the system fights them all the way. It’s not built for them to do it with any efficiency.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="p4p9XB">
Most caregivers get their parents’ passwords to help with smaller tech issues such as paying a bill online, only to find themselves dealing with repeated commemorative coin purchases, fraud, identity theft, and political donations that unwittingly turned into recurring ones. Carefull is sort of like a smarter <a href="http://mint.com">Mint.com</a>, with alerts for behaviors that are common among aging adults: double-paid bills, missed payments, orders to a company in the middle of Canada they’ve never purchased from before. (Erratic or odd bank account behaviors can <a href="https://www.jhsph.edu/news/news-releases/2020/older-adults-with-dementia-exhibit-financial-symptoms-up-to-six-
years-before-diagnosis.html">signal cognitive decline</a> years before an official diagnosis.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xRbIHr">
This sort of tool is useful when elders still live autonomously, and in other ways when they need a full-on financial caregiver; it also makes it far easier to distribute the labor among multiple family members. Lessening one component of the psychological and time burden of care is important, as is protecting against the cascading financial effects of fraud on credit scores within the family (one family member attempts to correct another’s debt, then finds themselves deeper in debt or late on payments, and so on). Tools like Carefull create a system where there was none and then make it easier to navigate, ultimately clarifying an unnecessarily convoluted corner of care labor.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uvjYfA">
A handful of employers are trying to fill gaps, too, drafting policies that acknowledge and accommodate elder care responsibilities. The tech company Hyperscience, for example, recently implemented a new <a href="https://hyperscience.com/blog/striving-towards-equality-for-all-with-our-benefits/">elder care benefit</a> that provides up to $36,000 a year per dependent for elder care, plus access to a “concierge” service to help coordinate care. It’s a great perk — for the 300 or so people who work at Hyperscience. It doesn’t actually address the larger quagmire, and no app or private benefit will. The primary intervention has to happen at the state and federal level.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yHpCA9">
The most straightforward fix, according to Caroline Pearson, the elder care expert from NORC, is to invest federal dollars in creating an actually useful program for those navigating elder care, including far more robust websites with discernible care options for each state, as well as increased funding and footprint for local <a href="https://www.n4a.org/">Area Agencies on Aging</a>. That’s the stuff that’s easy to wedge into any federal budget. Much harder — but more important, and what we should start advocating for — is a comprehensive program for long-term care, which starts with making long-term care insurance universal, mandatory, and at least partially funded through a payroll tax. (At this point, there are funds earmarked for elder care in the <a href="https://www.vox.com/22577374/reconciliation-bill-biden-medicare-climate">budget reconciliation bill</a>, but the breakdown of those funds is incredibly unclear.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="D853sR">
At the same time, we need to make home health care a “good American job,” with the corresponding ability to unionize and bargain for worker’s comp, health benefits, and higher pay — which will then attract more workers, reduce turnover, and reduce subsequent stress on family caregivers. For people who do<em> </em>still want to provide familial care, more states should remove the restrictions on who can be compensated for it, thus preventing caregivers from draining their own savings entirely in the process. Finally, there are ways to make care outside the home an actually affordable option. It doesn’t mean reducing the quality of care but requires <a href="https://www.nature.com/articles/s43587-020-00018-y">reimagining what nursing home care looks like</a>, particularly <a href="https://www.politico.com/news/agenda/2021/04/30/nursing-home-future-483460">in terms of size</a>, and addressing longstanding staffing shortages by making those jobs desirable as well.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="w0jCN4">
Does this sound expensive? Like a cost you’d rather not pay via your individual taxes? Or something that will never benefit you personally because you’ll figure out how to take care of your parents and your kids will figure out how to take care of you? Like you can just go get a job at a place like Hyperscience and start using an app like Carefull and have everything figured out just fine?
</p>
<div class="c-float-right c-float-hang">
<aside id="xvbyHU">
<q>In our lifetimes, at least, it’s a problem that’s just going to get worse and worse, much like the health of the people who need care</q>
</aside>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UoWt2d">
First off, you’re almost certainly wrong, and second, that attitude of personal responsibility is what led us here in the first place. This isn’t a problem we age out of in the way we age out of being the parent of a small child. In our lifetimes, at least, it’s a problem that’s just going to get worse and worse, much like the health of the people who need care. You might remember how, a few branches back in your family tree, people moved in with their family members in their later years and everything worked out fine. Or, more recently, a relative survived on their pension until the last year of their lives, was able to cover private at-home care, and hardly even touched their savings. Today, those stories are effectively fairy tales — stories we tell ourselves to avoid confronting reality. Your grandparents’ reality, your great-grandparents’ reality, it is not your reality.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CQiQSP">
As a society, we are living so much longer, and the diseases and conditions we live with require so much more: more care, more medicine, more vigilance, more maintenance. Which is why piecemeal solutions are laughably insufficient. We need to actually create a viable system, one that doesn’t ask people to be unspeakably wealthy, <a href="https://www.nytimes.com/2017/07/21/your-money/estate-planning/the-ethics-of-adjusting-your-assets-to-qualify-for-
medicaid.html">furtively siphon off their assets</a>, or wait for years for affordable care. Then we need to make the people working within that system visible and their labor, in turn, valuable.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="w3CNo6">
That requires legislative buy-in and, perhaps even more difficult, an ideological shift in our conception of what makes labor essential and a rejection of the belief that we don’t need social safety nets in this country because <a href="https://annehelen.substack.com/p/other-countries-have-social-safety">we have women</a>. None of that work can start if we pretend our loved ones won’t fall off a cliff and suddenly need our whole selves to cushion the fall, if they haven’t already.
</p>
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Talking to dozens of adult caregivers, I heard variations on the same theme over and over again: It’s brutal, it’s tearing my family apart, it makes me resent everyone, including the people for whom I’m providing care. The suffering is not new. The crisis has just further expanded within the middle class and the population at large, gradually making it less and less ignorable. “We can’t have a strong economy if we have millions of people working as full-time caregivers and making so little that they are still living in poverty,” Secretary of Commerce Gina Raimondo recently <a href="https://www.nytimes.com/2021/08/12/opinion/caretakers-elderly-home-health-
aides.html">told</a> the New York Times. “We can’t have a strong economy when we have millions of other people dropping out of the work force to take care of elderly loved ones.”
</p>
<p class="c-end-para" data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kljPHM">
Right now, several experts told me, the public alarm around the state of elder care is about where it was with child care 10, 15 years ago. We didn’t act on the alarm bells when it came to child care, and now the <a href="https://www.vox.com/the-
goods/22360152/child-care-free-public-funding">system is in a pandemic-accelerated crisis</a>, with rippling effects across the economy. The question, then, is whether we want to wait the 10, 15 years for that implosion, right as even more Gen X-ers, millennials, and older Gen Z-ers age into caregiving roles and, shortly thereafter, need their own care. Or do we want to address the problem now, before it risks collapsing us, and our families, entirely?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hq8ZyV">
<em>If you’d like to share with The Goods your experience as part of the hollow middle class, email </em><a href="mailto:annehelenpetersen@vox.com"><em><strong>annehelenpetersen@vox.com</strong></em></a><em> or fill out </em><a href="https://docs.google.com/forms/d/e/1FAIpQLScc-
Rm_NMsyRPfevs25lhxHFoq2k72fwxyhGpgEOpWbSxZjoQ/viewform?gxids=7628"><em><strong>this form</strong></em></a><em>.</em>
</p>
<ul>
<li><strong>4 lessons from the early pandemic that no longer apply</strong> -
<figure>
<img alt="" src="https://cdn.vox-
cdn.com/thumbor/OpJDTmInlYy_Op9q7N0UA9Vrblc=/0x0:2667x2000/1310x983/cdn.vox-
cdn.com/uploads/chorus_image/image/69774941/GettyImages_1234841570_copy.0.jpg"/>
<figcaption>
Earlier this week the FDA granted full approval to the Pfizer/BioNTech Covid-19 vaccine for people age 16 and older. | Michael Nagle/Xinhua via Getty Images
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</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
We need new mental models to make sense of the pandemic as it exists today.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Jg7xNz">
Back in the blissfully naive days of early 2020, when you heard about the emerging pandemic and the coming lockdowns, you might have thought to yourself: I really don’t want to get Covid-19, so I’ll just be extremely careful for a while and wait till the virus goes away — then I’ll go back to normal!
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7GLL4t">
The public health messaging seemed to support this wait-it-out strategy. People<strong> </strong>were told to stay home as much as possible, “flatten the curve” so as not to overwhelm our local hospitals, and hang tight until the vaccines arrived.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mbRETC">
Now, the vaccines have arrived (for those of us fortunate enough to be in a <a href="https://www.vox.com/future-perfect/22440986/covax-challenges-covid-19-vaccines-global-inequity">rich country</a>, at least). But the reality is bleaker than we’d hoped. “Covid is not going away,” said Krutika Kuppalli, an infectious disease expert at the Medical University of South Carolina. “It’s going to be endemic.” That means the virus will keep circulating in parts of the global population for years, but it’ll come down to relatively manageable levels, so it becomes more like the flu than a world-stopping disease.
</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LkTZdT">
It’s important to note that for an infectious disease to be classed in the <a href="https://www.nature.com/articles/d41586-021-00396-2">endemic phase</a>, the rate of infections has to more or less stabilize across years (though occasional increases, say, in the winter, are expected).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vCUP21">
The delta variant, however, has been causing infections to surge in a massive way. And most of the global population doesn’t yet have immunity, whether through vaccination or infection, so susceptibility is still high.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="t5j84a">
“We have to remember that we are still in a pandemic with this virus,” said Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation. “We’re not yet at a point where we’re living with endemic Covid. When we get to that point some of this will be much easier, but we’re not there. We’re not totally on a clear path here.”
</p>
<aside id="6weAKJ">
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</aside>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="EyuGOl">
This is partly why many people are confused as to how they<strong> </strong>should be thinking about the virus these days. America is<strong> </strong>past the early phase of the pandemic — and the messaging of the early phase has not set us up well to deal with the current phase. But we’re also not yet in the endemic phase, so we can’t quite act as if Covid-19 is an everyday virus, like a bad cold or flu.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wNHcyw">
The truth is we’re in a radically different place than we were in the first half of 2020. We need new mental models to make sense of the pandemic as it exists right now, because early-pandemic thinking is steering us in the wrong direction in at least four ways. Let’s break them down.
</p>
<h3 id="OtFHl0">
Hospitalizations and deaths — not infections — may now be the numbers to watch
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="eru1aV">
In early 2020, <a href="https://www.vox.com/future-perfect/2020/3/26/21193851/coronavirus-covid-19-staying-home-social-
distancing">everyone was talking about R0</a> — the number that indicates how many other people one sick person will infect on average, in a group that doesn’t already have immunity. For the original version of the virus, experts estimated the R0 at 2-3. In other words, each infected person was expected to lead to two or three more cases.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IA3raX">
Case counts became the primary metric the public used to think about the severity of the pandemic. Public health experts gave us a clear goal: The<strong> </strong>mission was to prevent a huge spike in cases — to flatten the curve. Many of us developed a behavioral habit of checking the local case count online every day. We also developed a cognitive habit: thinking of all infections as dangerous infections.
</p>
<div class="c-float-right c-float-hang">
<aside id="ls5LB3">
<q>“We have to remember that we are still in a pandemic with this virus” —Jen Kates</q>
</aside>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="a0WUmm">
That made sense at the time, because in our unvaccinated state, there was a non-trivial risk of infection leading to hospitalization or death. But for vaccinated people, it’s really worth differentiating between asymptomatic or mild cases on the one hand, and severe illness leading to hospitalization or death on the other. The vaccines available in the US are highly effective at preventing the latter, including where delta is involved.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bDTbza">
In a vaccinated or even half-vaccinated society, case counts are no longer the primary metric we should be laser-focused on, according to Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="285Epi">
“If you continue to follow cases with an endemic respiratory virus, there is no off-ramp, because it’s not going anywhere. We’re always going to have some baseline level,” Adalja told me. “In general, the idea of cases having the same consequences as they did before the vaccine, that’s really not something you can think about in a country where at least 40 percent of the population is fully vaccinated. There, what we’ve seen is a decoupling of cases and hospitalizations.”
</p>
<div class="c-wide-block">
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<img alt=" " src="https://cdn.vox-
cdn.com/thumbor/Oo-Xf-k8IfM5IFQdKiQE92JcM7Q=/800x0/filters:no_upscale()/cdn.vox-
cdn.com/uploads/chorus_asset/file/22804920/GettyImages_1234489797_copy.jpg"/> <cite>Houston Cofield/Bloomberg via Getty Images</cite>
<figcaption>
Nurses check on a patient in a Covid-19 ICU ward in Jonesboro, Arkansas, on August 4. Mississippi and Arkansas are facing shortages of intensive care beds due to the delta variant.
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</ul>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VU4qle">
This isn’t to say that case counts are totally irrelevant. First, cases can turn into <a href="https://www.vox.com/22298751/long-term-side-effects-covid-19-hauler-symptoms">long Covid</a><strong> </strong>in a minority of people; the disability sometimes associated with that condition isn’t discussed as often as hospitalizations and deaths, but it matters.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="t87tyH">
Second, delta is much more transmissible than the original version of the virus, with an<strong> </strong>R0 now estimated at <a href="https://www.npr.org/sections/goatsandsoda/2021/08/11/1026190062/covid-delta-variant-transmission-cdc-
chickenpox">between 6 and 7</a>, so it can spread all too easily in areas with low vaccination rates.<strong> </strong>“Certainly R0 is important when you’re looking at largely unvaccinated populations — a state like Missouri or some counties in Mississippi,” Adalja acknowledged.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uGlnhF">
But by and large, he said, “We have to move away from focusing solely on cases and really look at hospital stress. It’s not just, ‘Did hospitalizations go up?’ It’s: ‘What are hospitalizations as a percentage of capacity in the ICU? Are hospitals reporting stress scenarios?’ That’s what’s important.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5nKOYE">
In 2020, we didn’t have vaccines to prevent cases or make them less severe, and transmission was high enough that the pandemic was expanding. “The only way to alter that was to find interventions to bring the R0 down below 1,” Kates said. “Everything was focused on that. That’s why we had lockdowns, social distancing, masking. All those activities were designed to buy time for the health care system and to buy time for countries to figure out if we can find vaccines.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PH2pm3">
Now that we have such highly effective vaccines, our new mission is clear, but distinct from last year’s. “The goal is to vaccinate as many people as possible,” Kates said. “Why is that the goal? Because that single thing will drive deaths and hospitalizations very low.”
</p>
<h3 id="08RoHC">
Instead of trying to eliminate risk, aim to reduce it
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CH33pN">
When it comes to HIV and various sexually transmitted diseases, many public health experts have come to embrace an approach called harm reduction. They’ve realized that pushing an abstinence-only approach (avoiding all activities that involve any risk) doesn’t work; people need to have pleasure in their lives, so the best thing to do is explain how to make an activity safer — <a href="https://www.vox.com/22315478/covid-19-coronavirus-harm-reduction-abstinence">how to reduce harm</a> — rather than just expecting people to avoid it altogether.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rRsQ96">
“I think what happened in the early pandemic is that many public health experts … went back to an abstinence-only approach,” Adalja told me. “That approach basically told people: don’t do anything, none of it is safe, there is no acceptable level of risk. It didn’t allow people to think about graded risk — outdoors versus indoors, masked versus not masked. It also stunted the ability of the average person to be able to make risk calculations.”
</p>
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</aside>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FduXDa">
To be fair, this “abstinence” approach was an understandable reaction at the beginning of the pandemic, when we were seeing hospitals go into crisis in places like New York City and we still knew relatively little about the novel coronavirus. That kind of crisis encourages short-term thinking: Use a blunt tool now, like telling people to mask everywhere and stay at home whenever possible, to get things under control, and sort out the pros and cons later.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="F4Jrap">
But as the months passed, some experts expressed concerns that the cons of an abstinence-only approach were serious. “What are the negative consequences in terms of decreased childhood vaccinations or psychiatric illnesses or substance abuse or [decreased]<strong> </strong>cancer screenings? You couldn’t even say that. If you said that, you were actually considered like a Covid denier,” Adalja told me. “I’ve been advocating harm reduction from the very beginning, and I was criticized, ostracized, yelled at …. It was considered completely heretical.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="8Dn38D">
Some experts kept pushing for harm reduction, and their views became accepted to some degree. But the zero-tolerance approach to risk we inherited from the pandemic’s early days has been, for some, very hard to shake. Again, this mindset is entirely understandable given the trauma we’ve all been through. Yet it’s clear that we’ll likely always have some level of Covid-19 circulating, and <a href="https://www.vox.com/22621760/covid-19-risk-delta-vaccines-provincetown-study">we have to learn to accept some risk</a>.
</p>
<h3 id="hA6EjQ">
Are kids less vulnerable or more vulnerable than adults?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FTGSin">
Although early 2020 was a scary time, one comforting message we kept getting was: The kids are all right. Children, we were told, are far less likely to get seriously ill from Covid-19. The main danger is to older and immunocompromised adults.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KRrqDJ">
It’s still true that kids are at relatively low risk of getting seriously ill. But two things have changed.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Pbo4tb">
First, adults are eligible to be vaccinated, while children under 12 — who number <a href="https://www.statista.com/statistics/457786/number-of-children-in-the-us-by-age/">around 50 million in the US</a> — are not. So while we adults got used to thinking of ourselves as more vulnerable than kids last year, those who are vaccinated are now the ones who’ve got a protective coat of armor kids lack.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="faPGeO">
Second, the delta surge is landing more <a href="https://www.aap.org/en/pages/2019-novel-coronavirus-
covid-19-infections/children-and-covid-19-state-level-data-report/">kids in the hospital</a> than at any previous point in the pandemic. As the Atlantic’s Katherine J. Wu <a href="https://www.theatlantic.com/health/archive/2021/08/delta-
variant-covid-children/619712/?utm_source=facebook&amp;utm_campaign=the-
atlantic&amp;utm_medium=social&amp;utm_content=edit-
promo&amp;utm_term=2021-08-10T23%3A39%3A58&amp;fbclid=IwAR090QAgenisMQpidXE8zcTrjaCWbsImbHgqSIIWg24Ai01hdnp72MksYEI">reports</a>, “Across the country, pediatric cases of COVID-19 are skyrocketing alongside cases among unimmunized adults; child hospitalizations have now reached an <a href="https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions">all- time pandemic high</a>. In the last week of July, <a href="https://downloads.aap.org/DOFA/AAP%20Letter%20to%20FDA%20on%20Timeline%20for%20Authorization%20of%20COVID-19%20Vaccine%20for%20Children_08_05_21.pdf">nearly 72,000 new coronavirus cases</a> were reported in kids.”
</p>
<div class="c-float-right c-float-hang">
<aside id="HdVAdC">
<q>The best thing parents can do is be fully vaccinated themselves and encourage other people to get fully vaccinated</q>
</aside>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ciAGAT">
All this makes it very difficult for parents to reason through what they should and shouldn’t let their kids do. And it’s no wonder they’re confused. Although the experts <a href="https://www.statnews.com/2021/08/17/whats-safe-to-do-during-summers-covid-surge-stat-asked-public-health-experts-
about-their-own-plans/">agree</a> on many things — it’s a bad idea to send a child to school without a mask, for example — their approaches diverge in some ways.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yBuqBl">
“When you look at other respiratory viruses that we deal with in children — influenza and RSV [respiratory syncytial virus] — they exact a bigger morbidity and mortality toll than Covid does,” Adalja told me.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7lULOK">
“So I often say, ‘Would you do this for the flu? Would you do this for RSV?’ Many people have incorporated flu and RSV into their daily lives and how they think about their children. And I think that’s what you have to think about,” he added. (The exception, he said, is if you have a child who’s immunocompromised or has asthma or other medical conditions; then more caution is merited.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AC2KBN">
Kates said she’s not yet ready to consider Covid-19 in the same light as the flu because we’re still seeing a big increase in cases — it’s not yet endemic. Some of this is subjective, she explained: We consider a virus endemic when we as a society are okay with accepting the level of impact it has, but people will differ as to what constitutes an acceptable level.
</p>
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For her part, “because there’s still so much spread, I think that’s a risky proposition at this point,” she said. “Kids can spread this virus. So part of what we’re also trying to do — because they cannot get vaccinated yet — is reduce their risk of exposure, not just for them, but for everybody else.” Roughly half the US is still not fully vaccinated.
</p>
<figure class="e-image">
<img alt=" " src="https://cdn.vox-
cdn.com/thumbor/ZAo4G-EhkYTsb6X8OaE5TtdZOa4=/800x0/filters:no_upscale()/cdn.vox-
cdn.com/uploads/chorus_asset/file/22804949/GettyImages_1234610367_copy.jpg"/> <cite>Jeenah Moon/Bloomberg via Getty Images</cite>
<figcaption>
The New York City Health Department has begun a “Vax To School” campaign in preparation for upcoming school reopenings.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MVTNFo">
This doesn’t mean parents should keep their kids home all the time; as mentioned above, the zero-risk approach will have to give way to harm reduction. Kates is still planning to send her child, who’s too young to be vaccinated, to school. She’s relying on mitigation strategies like masks and ventilation, noting that “schools have figured out a lot of things” in the last year.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7ZdsGF">
In general, she added, the best thing parents can do is be fully vaccinated themselves and encourage other people to get fully vaccinated. She also recommends that fully vaccinated parents wear a mask indoors in public places even if their city or state does not require it, so as to lower the risk that they could get infected and bring that infection home.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="y4fh2Q">
“Until we are able to get beyond where we are right now with delta, that is another layer of protection that you can put between yourself and this virus, and therefore protect your child,” she said.
</p>
<h3 id="1iFi2j">
The pandemic was always global. Why are so many health strategies still local?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rtuJCS">
Our focus for most of 2020 was on stamping out the virus in our own cities, our own countries. We used masks and social distancing to avoid overwhelming our local hospital systems. We tried to support and protect our neighbors, whether through <a href="https://www.vox.com/future-perfect/2020/3/24/21188779/mutual-aid-coronavirus-
covid-19-volunteering">mutual aid groups</a> or more informal means.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pI1Xzj">
Toward the <a href="https://www.vox.com/science-and-health/22192061/mutant-coronavirus-covid-19-uk-mutation-vaccine">end of 2020</a>, Americans began to hear that scary mutations originally detected in the UK and South Africa were showing up in the US. The appearance of variants should have driven home the fact that the pandemic always was, and remains, global: When a problem pops up in one country, it’s in all nations’ interest to take notice and help.
</p>
<aside id="nx2orl">
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</aside>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Da2FsM">
And yet, when vaccines became available in the US, America soon accumulated a staggering surplus of doses — and hoarded them. This May, as the virus ravaged populations from India to Brazil, several experts <a href="https://www.vox.com/future-perfect/22432536/biden-donate-vaccine-doses-india-
brazil">told me</a> the US was clearly engaged in “vaccine nationalism,” where every nation just looks out for itself, prioritizing its citizens without regard to what happens to the citizens of other countries, especially lower-income countries that can’t afford to buy doses. (The Biden administration did eventually donate more than <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/08/03/fact-sheet-president-biden-announces-
major-milestone-in-administrations-global-vaccination-efforts-more-than-100-million-u-s-covid-19-vaccine-doses-donated-
and-shipped-abroad/">110 million doses</a> and send other supplies abroad, though many experts still <a href="https://www.washingtonpost.com/health/2021/08/10/health-experts-demand-global-vaccines-pandemic/">say</a> it should do more.)
</p>
<div class="c-wide-block">
<figure class="e-image">
<img alt=" " src="https://cdn.vox-
cdn.com/thumbor/suKJ1aWwdhLTINkdqBcOx2c5Vy0=/800x0/filters:no_upscale()/cdn.vox-
cdn.com/uploads/chorus_asset/file/22804972/GettyImages_1234825077_copy.jpg"/> <cite>Indranil Mukherjee/AFP via Getty Images</cite>
<figcaption>
A Covid-19 vaccination site in Mumbai, India, on August 23.
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</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fGelzC">
But it’s now become blatantly obvious that caring only for our local community or our country is <a href="https://www.vox.com/future-perfect/22598415/covid-vaccinate-world-virus-variant-delta-
lambda">counterproductive</a>: The more we allow the virus to spread unchecked in other parts of the world, the more chances we give it to mutate into dangerous variants like delta.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OUItvx">
To the Medical University of South Carolina’s Kuppalli, that’s a strong argument for working toward global vaccine equity rather than rushing for <a href="https://www.vox.com/future-perfect/22555898/covid-19-booster-shots">booster shots</a> in countries with high vaccine availability, like the US. “Let’s give everybody their first shot before we’re giving people their third shot. If we’re going to get this pandemic under control, we need to get the global rates of infection down,” she said. Otherwise, “we’re going to continue to get variants. Unfortunately, we live in a very individualistic society where people have a really hard time understanding that.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uoAq77">
This phase of the pandemic requires a shift away from the individualist or nationalist mindset. Everyone<strong> </strong>needs to conceive of the fight against Covid-19 as a truly global fight — because it is.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tHiMdi">
</p>
<h1 data-aos="fade-right" id="from-the-hindu-sports">From The Hindu: Sports</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Eng vs Ind third Test | India remove openers but England remain in command</strong> - Despite the twin strikes, it is amply clear that India will need to create something special to come back in the match.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>UP government adopts Indian wrestling till 2032 Olympics</strong> - “In a massive boost for the Indian wrestling, the Uttar Pradesh government has adopted the sport and is expected to pump in an investment of ₹170 cror</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>IPL 2021: KKR sign Southee; RCB, RR &amp; Punjab Kings too announce replacements</strong> - While Southee replaces Pat Cummins at KKR, Rajasthan rope in world’s number 1 ranked T-20 bowler, Tabraiz Shamsi, in place of Andrew Tye for the remainder of the IPL.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Vanshaj, Preeti among six Indians to enter final at Asian Youth Boxing C’ships</strong> - Vanshaj and Preeti made their way into the finals along with four other youth boxers from the Indian contingent on Day 6 at the ASBC Asian Youth &amp;amp</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Wait Until Dark: Visually-impaired para-sprinter Kashafali’s epic journey towards sunshine</strong> - As a kid Salum Ageze Kashafali would wake up at the wee hours to the sound of bombs with debris scattered around in a ball of smoke. The little Congo</p></li>
</ul>
<h1 data-aos="fade-right" id="from-the-hindu-national-news">From The Hindu: National News</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Oral rehydration salts: PIL seeks action against pharma companies</strong> - They are selling products without conforming to World Health Organisation formula, it says</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>From Kashmir to Kanyakumari, India is one: Kejriwal on controversial remarks by Sidhu’s advisers</strong> - “Punjab is a border state. If any statement is to be given then it should be given responsibly.”</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>School curriculum needs books on women freedom fighters: Balabharathi</strong> - Social activists should discuss the features and merits of books like Penne Peraartral on social media and not just confine themselves to sensational topics, CPI(M) leader Balabharathi suggested</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>2022 Assembly polls | Atmosphere ‘extremely favourable’ for Congress in Goa: Chidambaram</strong> - The people of Goa expect that there should be a change in the government and the Congress party will not disappoint them, Former Union Minister Chidambaram said</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Baghel summoned again by Congress’s central leadership</strong> - Power struggle between him and Health Minister T.S. Singh Deo continues</p></li>
</ul>
<h1 data-aos="fade-right" id="from-bbc-europe">From BBC: Europe</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Stalin-era mass grave found in Ukraine</strong> - Thousands of people are thought to be buried at the site - one of the largest ever found in Ukraine.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>German elections 2021: Simple guide to vote ending Merkel era</strong> - Next month, Germans choose a new government. This is how the vote works.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Emmanuel Macron visits Dublin with NI protocol on agenda</strong> - The French president is holding a series of meetings to discuss EU affairs, and the situation in Afghanistan.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Climate change: Europe’s 2020 heat reached ‘troubling’ level</strong> - Temperatures in Europe in 2020 broke the previous high mark by a worrying margin say scientists.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Leopard attacks model in German photoshoot</strong> - The 36-year-old woman was seriously wounded by the animal at a retirement home for show animals.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-ars-technica">From Ars Technica</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Silent changes to Western Digital’s budget SSD may lower speeds by up to 50%</strong> - Most people wouldn’t notice most of the time, but that doesn’t make it OK. - <a href="https://arstechnica.com/?p=1789710">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>FCC seeks $5M fine for robocalls telling Black people that voting helps “the man”</strong> - Robocalls claimed mail-in voting is used to track down warrants, collect unpaid debt. - <a href="https://arstechnica.com/?p=1789874">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>COVID hospitalization averages $20K—and insurers want unvaccinated to pay up</strong> - Delta surcharge is “necessary to address the financial risk” of not getting vaccinated. - <a href="https://arstechnica.com/?p=1789890">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Graphene veils may hold the secret to conserving priceless works of art</strong> - Graphene sticks to any clean surface but can easily be removed without causing damage. - <a href="https://arstechnica.com/?p=1789025">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>As office returns get postponed, workers say they’d take pay cut to work from home</strong> - Some tech firms want workers back at their desks, but expectations have shifted. - <a href="https://arstechnica.com/?p=1789615">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
<ul>
<li><strong>A man invites some of his fetish club over for breakfast….</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
They are catching up on life and swapping stories about work, their grandkids’ birthdays, their recent stock market fortunes, and so on, when the subject of what they’re most proud of comes up.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Gerald, a 35 year old dentist, proudly exclaims, “Of everyone here, I by far, have the largest penis.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
No one argued with Gerald as everyone at the table had seen (or felt) his penis and it was massive. It didn’t matter what room he was in. He probably had the largest penis in it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Craig, a 26 year old DJ, casually said, “Well I have massive fists.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Everyone nodded silently. Craig’s fists were well known and had been in many orifices. He has been known to turn the smallest babbling brook into a vast canyon.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Agnes, a 91 year old retired welder, proudly said, “Well I have the nicest vagina in the room.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Again, no one argued with Agnes. For one, she was the only woman in the room. And for two, despite being 91, she was in good shape and took care of herself to include vagina exercises.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Tim, a 21 year old nurse, and the host of the gathering, smirked and exclaimed, “Well I have the biggest asshole here!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Immediately the group started to murmur amongst itself. They had all been sticking things up their butt for many years (especially Agnes) and there was no way the youngest of the group had the biggest asshole.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Craig immediately stepped up to the challenge. He had been working on a party trick for a while now and this seemed like the appropriate time to show it. He went to the fridge and found an 8” carrot. He then took his pants off, laid down on his stomach and flipped the carrot over his shoulder. It flew in a wide ark and immediately disappeared up his butt.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The group gave a golf clap. The showmanship was impressive but it didn’t answer the question at hand.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Gerald decided it was his time to shine. He went to the pantry and found a potato. He then placed the potato on the counter, took his pants off and sat on the potato. Just to show he didn’t damage the potato he took it out and showed the group. It looked exactly like it had before it had gone in (maybe a little browner).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The group was slightly more impressed by this. Butt stuff was Gerald’s thing though, so it was expected he’d have something to offer.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Now it was time for Agnes to show all these young amateurs what was up. She went into the garage and found a 2 foot long, 2 inch thick wooden dowel. She lifted up her dress and balanced on top of the dowel. She then took a deep breathe and dropped to the floor. When she stood back up the dowel was gone.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
This was truly impressive, but to be fair, this is a <em>largest</em> asshole contest, not a <em>longest</em> asshole contest.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Still smirking, Tim walked into the kitchen and turned on his espresso machine. He steamed the milk and whipped it. He poured in the espresso and added a swirl of caramel and just a touch of cinnamon. He put a doily on a saucer and plated his drink. He casually walked over to the table and placed his drink onto it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Just as he did a giant fat tabby cat came barreling into the room, sliding around on the floor, and slamming into walls as he turned corners. He jump onto the table and immediately swatted the drink off. The cup and saucer shattered and there was liquid everywhere. The cat then peed on the table and tried to scratch Tim.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Agnes, Gerald, and Craig immediately realized the misunderstanding that has happened. An embarrassing quiet fell over the room.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Gerald finally broke the silence, “So your cat is the biggest asshole.” Then he thinks for a second and goes, “Does he hate all coffee or just the fancy stuff?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Tim looks a little confused and says, “It’s just the fancy stuff. But the cat’s not the biggest asshole. The coffee is just how I get him into the room.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Tim then shoves the cat up his ass.
</p>
</div>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Iamheno"> /u/Iamheno </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pbpf4f/a_man_invites_some_of_his_fetish_club_over_for/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pbpf4f/a_man_invites_some_of_his_fetish_club_over_for/">[comments]</a></span></p></li>
<li><strong>I saw a documentary about a submarine that recycles 87% of its garbage</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
But I think this sub is doing even better!
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/bro123126"> /u/bro123126 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pbveii/i_saw_a_documentary_about_a_submarine_that/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pbveii/i_saw_a_documentary_about_a_submarine_that/">[comments]</a></span></p></li>
<li><strong>A woman goes to the doctor..</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
And she asks him: “Doctor, I always wanted to have bigger boobs, but I’m so afraid of surgeries. Isn’t there any other option?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The doctor remains silent for a moment, observes her from top to bottom, and replies: “Well, I think I might have something that can help you out.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Amazing doc, what is it?” The woman replies.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“So, you take a bit of toilet paper, and every morning you rub it between your boobs for about a minute”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The woman looks surprised and asks him how that would ever work.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The doctor says: “I honestly don’t have a clue but it seemed to have worked for your ass!”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/JohnnyL0C0"> /u/JohnnyL0C0 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pbcwvi/a_woman_goes_to_the_doctor/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pbcwvi/a_woman_goes_to_the_doctor/">[comments]</a></span></p></li>
<li><strong>The Taliban has promised they WILL require a Covid Vaccine Pass</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
</p><ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">from all individuals who are seeking to attend public executions.
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"></p>
</li></ul></div>
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SC_ON -->
submitted by <a href="https://www.reddit.com/user/DyLafin"> /u/DyLafin </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pbg99u/the_taliban_has_promised_they_will_require_a/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pbg99u/the_taliban_has_promised_they_will_require_a/">[comments]</a></span></li>
</ul>
<li><strong>A couple wants to have sex but their son is in the house.</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The only way to pull off a Sunday afternoon “quickie” with their 8-year-old son in the apartment was to send him out on the balcony with a Popsicle and tell him to report on all the neighborhood activities…
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“There’s a car being towed from the parking lot,” he shouted.He began his commentary as his parents put their plan into operation.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“An ambulance just drove by!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Looks like the Andersons have company,” he called out.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Matt’s riding a new bike!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Looks like the Sanders are moving!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Jason is on his skate board!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
After a few moments he announced… "The Coopers are having sex. Startled, his mother and dad shot up in bed.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Dad cautiously called out…“How do you know they’re having sex?” “Jimmy Cooper is standing on his balcony with a Popsicle.”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/JosephineAlberts"> /u/JosephineAlberts </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pbhjzu/a_couple_wants_to_have_sex_but_their_son_is_in/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pbhjzu/a_couple_wants_to_have_sex_but_their_son_is_in/">[comments]</a></span></p></li>
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