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<title>23 October, 2023</title>
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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>Quality of life, resources, and coping during the first weeks of the COVID-19 pandemic by people seeking psychological counselling before the pandemic</strong> -
<div>
Objectives. This study aimed to understand the relationship between resource gains and losses, coping, and quality of life during the growth phase of the COVID-19 pandemic. Material and Methods. The Internet-based survey covered 353 individuals who had participated in a psychological support project operated by one of the non-governmental organisations in Lublin, Poland, in the 12 months prior to the outbreak of the pandemic. The questionnaire used in the study contained questions to collect sociodemographic data and psychometric scales to measure resource gains and losses (Conservation of Resources – Evaluation), quality of life (World Health Organization [WHO] Quality of Life-BREF), and strategies of coping with the pandemic situation (modified Brief Cope). Results. Higher global quality of life occurred with higher gains and minor losses, as well as with coping through planning, positive reframing, emotional support seeking, reduced substance use tendency, low self-blame, avoidance, and disengagement. Moreover, helplessness-based coping strategies were found to mediate both the relationship between resource gains and quality of life and between resource loss and quality of life. Conclusions. Factors that may reduce people’s quality of life during the COVID-19 pandemic are an increase in losses and limited gains, experienced over the six months preceding the pandemic, as well as not using active, meaning-oriented, and support-seeking coping strategies, but using avoidance behaviours instead. Coping strategies specific to people experiencing helplessness are a mediating mechanism between losses and limited gains of resources and quality of life.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/psyarxiv/ryv8g/" target="_blank">Quality of life, resources, and coping during the first weeks of the COVID-19 pandemic by people seeking psychological counselling before the pandemic</a>
</div></li>
<li><strong>Virological characteristics of the SARS-CoV-2 Omicron EG.5.1 variant</strong> -
<div>
In middle-late 2023, a sublineage of SARS-CoV-2 Omicron XBB, EG.5.1 (a progeny of XBB.1.9.2), is spreading rapidly around the world. Here, we performed multiscale investigations to reveal virological features of newly emerging EG.5.1 variant. Our phylogenetic-epidemic dynamics modeling suggested that two hallmark substitutions of EG.5.1, S:F456L and ORF9b:I5T, are critical to the increased viral fitness. Experimental investigations addressing the growth kinetics, sensitivity to clinically available antivirals, fusogenicity and pathogenicity of EG.5.1 suggested that the virological features of EG.5.1 is comparable to that of XBB.1.5. However, the cryo-electron microscopy reveals the structural difference between the spike proteins of EG.5.1 and XBB.1.5. We further assessed the impact of ORF9b:I5T on viral features, but it was almost negligible at least in our experimental setup. Our multiscale investigations provide the knowledge for understanding of the evolution trait of newly emerging pathogenic viruses in the human population.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.19.563209v1" target="_blank">Virological characteristics of the SARS-CoV-2 Omicron EG.5.1 variant</a>
</div></li>
<li><strong>Scope+: An open source generalizable architecture for single-cell atlases at sample and cell levels</strong> -
<div>
With the recent advancement in single-cell technologies and the increased availability of integrative tools, challenges arise in easy and fast access to large collections of cell atlas. Existing cell atlas portals rarely are open sourced and adaptable, and do not support meta-analysis at cell level. Here, we present an open source, highly optimised and scalable architecture, named Scope+, to allow quick access, meta-analysis and cell-level selection of the atlas data. We applied this architecture to our well-curated 5 million Covid-19 blood and immune cells, as a portal, Covidscope (https://covidsc.d24h.hk/). We achieved efficient access to atlas-scale data via three strategies, such as server-side rendering, novel database optimization strategies and an innovative architectural design. Scope+ serves as an open source architecture for researchers to build on with their own atlas, and demonstrated its capability in the Covidscope portal for an effective meta-analysis to atlas data at cellular resolution for reproducible research.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2022.12.03.518997v2" target="_blank">Scope+: An open source generalizable architecture for single-cell atlases at sample and cell levels</a>
</div></li>
<li><strong>Perceptions and responses to COVID-19 through wastewater surveillance information and online search behavior: A randomized controlled trial</strong> -
<div>
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Wastewater surveillance is anticipated to be a representative and timely method to assess infectious disease status; however, its influence on public perception and behavior remains unclear. Therefore, in this study, we used a randomized controlled trial to analyze the influence of wastewater surveillance-based information on understanding of, interest in, relief regarding, preventive behavioral intention against, and subsequent online search behavior related to coronavirus disease 2019 (COVID-19). Valid responses were obtained from 1,000 individuals in both control and intervention groups from Yahoo crowdsourcing users aged ≥18 years in Japan. This survey was conducted from August 4 to August 7, 2023, just before the common Japanese tradition of returning to hometowns. The questionnaire not only collected personal attributes but also gauged responses to COVID-19 information. This information highlighted the early detection capabilities and representativeness of wastewater surveillance compared with sentinel surveillance at medical institutions. At one-week post-survey, we obtained the survey participants9 online search history for key words such as “bullet train,” “highway,” “airplane,” and “wastewater.” The findings showed no significant differences between the two groups in terms of COVID-19 interest or preventive behavior before information provision, verifying the effectiveness of participant randomization. Wastewater surveillance-based information did not notably elevate understanding or specific intentions regarding COVID-19, such as wearing masks and receiving vaccination. However, it significantly increased interest in, relief concerning the infection status, and general preventive behavioral intentions. Heightened interest and general preventive intentions did not depend on prior interest or behavior. However, those who previously engaged in preventive behavior or who were less interested in COVID-19 exhibited more relief after exposure to wastewater surveillance-based information. Furthermore, this information could slightly influence online searches related to return travel modes, such as highways. In conclusion, information from wastewater surveillance effectively shapes individual perceptions of and responses to infections.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.20.23297297v1" target="_blank">Perceptions and responses to COVID-19 through wastewater surveillance information and online search behavior: A randomized controlled trial</a>
</div></li>
<li><strong>Reduced risk of SARS-CoV-2 infection among household contacts with recent vaccination and past COVID-19 infection: results from two multi-site case-ascertained household transmission studies</strong> -
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Background COVID-19 vaccines reduce the risk of severe disease, but it is less clear what effect vaccines have on reducing the risk of infection in high contact settings like households, alone or in combination with prior infection. Methods Households with an individual who tested positive for SARS-CoV-2 during Sep 2021-May 2023 were screened nationwide and at 7 sentinel sites and enrolled if the index cases illness onset was ≤6 days prior. Household members had daily self-collected nasal swabs tested by RT-PCR for SARS-CoV-2. COVID-19 vaccination status was assessed by plausible self-report (with date) or vaccination records. Prior infection was assessed by self-reported prior testing and by anti-nucleocapsid antibodies presence at enrollment. The effects of prior immunity, including vaccination, prior infection, or hybrid immunity (both vaccination and prior infection) on SARS-CoV-2 infection risk among household contacts were assessed by robust, clustered multivariable Poisson regression. Findings There were 1,532 contacts from 905 households included in this analysis. Of these, 67% were enrolled May-November 2022, when Omicron BA.4/5 predominated. Most contacts (89%) had some immunity to SARS-CoV-2 at the time of household exposure: 8% had immunity from prior infection alone, 51% from vaccination alone, and 29% had hybrid immunity. Sixty percent of contacts tested SARS-CoV-2-positive during follow-up. The risk of SARS-CoV-2 infection was not significantly reduced by vaccination but was reduced among those with prior infection considering such immunity separately (adjusted relative risk 0.83; 95% confidence interval: 0.77, 0.90); however, when accounting for both sources of immunity, only contacts with vaccination and prior infection had significantly reduced risk of infection (aRR: 0.81, 95% CI: 0.70, 0.93). The risk of infection was lower when the last immunizing event (vaccination or infection) occurred ≤6 months before COVID-19 affected the household (aRR: 0.69, 95% CI: 0.57, 0.83). Interpretation Immunity from COVID-19 vaccination and prior infection was synergistic in protecting household contacts from SARS-CoV-2 infection. These data support COVID-19 vaccination, even for those who have been previously infected.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.20.23297317v1" target="_blank">Reduced risk of SARS-CoV-2 infection among household contacts with recent vaccination and past COVID-19 infection: results from two multi-site case-ascertained household transmission studies</a>
</div></li>
<li><strong>Postacute Sequelae SARS-CoV-2 Infection by Vaccination Status: A Six-Month Latent Class Analysis</strong> -
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Symptoms post- SARS-CoV-2 infection may persist for months and cause significant impairment and impact to quality of life. Acute symptoms of SARS-CoV-2 infection are well studied, yet data on clusters of symptoms over time, or postacute sequelae of SARS-CoV-2 infection (PASC), are limited. We aim to characterize PASC phenotypes by identifying symptom clusters over a six-month period following infection in individuals vaccinated (boosted and not) and those unvaccinated. Subjects with ≥1 self-reported symptom and positive RT-PCR for SARS-CoV-2 at CVS Health US test sites were recruited between January and April 2022. Patient-reported outcomes symptoms, heath-related quality of life (QoL), work productivity and activity impairment (WPAI) were captured at 1 month, 3 months, and 6 months post-acute infection. Logistic regression and latent class analysis (LCA) were performed on 20 symptoms using baseline socio-demographic, clinical characteristics, and vaccination status as well as EQ-5and WPAI results as covariables. Subjects with more symptoms were associated with lower health-related quality of life, and worse WPAI scores. LCA identified three phenotypes that are primarily differentiated by number of symptoms. These three phenotypes remained consistent across time periods. Vaccinated individuals were more likely to be in the low symptom burden latent classes at all time points compared to unvaccinated individuals.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.20.23297332v1" target="_blank">Postacute Sequelae SARS-CoV-2 Infection by Vaccination Status: A Six-Month Latent Class Analysis</a>
</div></li>
<li><strong>Is Recovery Just the Beginning? Persistent Symptoms and Health and Performance Deterioration in Post-COVID-19, non-hospitalised University Students - A Cross-Sectional Study</strong> -
<div>
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Many individuals experience persistent symptoms such as deteriorated physical and mental health, increased fatigue, and reduced cognitive performance months after recovering from COVID-19. Current data are limited on the long-term trajectory of these symptoms and their prevalence in milder cases. Our study aimed to assess the persistent effects of COVID-19 on physical and mental health, fatigue, and cognitive performance in a cohort of 214 students, averaging 21.8 years of age. Of these, 148 had contracted COVID-19 but were not hospitalized, with the time since infection ranging from 1 to 39 months. We utilized a comprehensive panel of cognitive tests to measure intelligence, memory, and psychomotor skills, and a detailed anamnestic questionnaire to evaluate physical and mental health. While contracting COVID-19 did not significantly impact overall health and performance, it was associated with increased reports of fatigue. However, the reported severity of the disease had a pronounced negative influence on physical health, mental well-being, fatigue, and reaction time. Trends of improvement in physical and mental health, as well as error rate, were observed within the first two years post-infection. However, fatigue and reaction time showed a trend of deterioration. Beyond the two-year mark, physical health and error rate continued to improve, while mental health began to deteriorate. Fatigue and reaction time continued to decline. Overall, our findings suggest that some effects of contracting COVID-19 can persist or even deteriorate over time, even in younger individuals who had mild cases that did not require hospitalization.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.20.23297203v1" target="_blank">Is Recovery Just the Beginning? Persistent Symptoms and Health and Performance Deterioration in Post-COVID-19, non-hospitalised University Students - A Cross-Sectional Study</a>
</div></li>
<li><strong>Factors Influencing the Trajectory of COVID-19 Evolution: A Longitudinal Study of 12 Asian Countries</strong> -
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Summary Background The effectiveness of different strategies in addressing the COVID-19 pandemic has been assessed, but there is still not enough evidence in Asian countries. This study aims to examine the factors influencing the trajectory of COVID-19 evolution in Asia, to provide insights for optimizing public health policies. Methods In this longitudinal analysis, we combined COVID-19 cases and vaccination percentages from Our Word in Data with the policy stringency index from the Oxford COVID-19 Government Response Tracker for 12 Asian countries between January 1, 2021, and September 30, 2022. An agglomerative hierarchical cluster analysis (HCA) was conducted to identify countries with similar COVID-19 evolution trajectories. We also investigated the potential impact of seasonal variations on the virus9 trajectory. The relationship between the level of policy response, vaccination coverage, and COVID-19 cases was explored using Generalized Additive Models (GAMs). Findings There were noticeable differences in the evolution trajectory of COVID-19 among the countries. The 12 Asian countries were grouped into two clusters based on evolutionary similarities. Cluster 1 consisted of West Asian countries (Azerbaijan, Turkey, Bahrain, Israel and Lebanon); while Cluster 2 included Japan, South Korea, Singapore, Malaysia, Thailand, Cambodia and Indonesia. The analysis revealed that the stringency index and vaccination coverage were associated with a statistically significant impact (both P values &lt; 0.0001) on the evolution trajectory of COVID-19 (adjR2=0.54). The dose-response relationships demonstrated that the continuous high levels of stringency index (≥87.6) or vaccination coverage (≥ 42.0%) have led to a decrease in COVID-19 infection rates. In early 2021, the adjR2 increased to 0.93 for all countries. Furthermore, the adjR2 for Cluster 1 and Cluster 2 were 0.86 and 0.90 respectively. All GAMs models have significantly improved compared to null model (P values &lt;0.0001). Interpretation By strengthening vaccination ahead of susceptible seasons and enhancing personal self-protection measures, the transmission of COVID-19 among the population can be reduced even during the highly infectious Omicron era.
</p>
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.20.23297319v1" target="_blank">Factors Influencing the Trajectory of COVID-19 Evolution: A Longitudinal Study of 12 Asian Countries</a>
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<li><strong>Dynamics of SARS-CoV-2 Seroprevalence in a Large US population Over a Period of 12 Months</strong> -
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Due to a combination of asymptomatic or undiagnosed infections, the proportion of the United States population infected with SARS-CoV-2 was unclear from the beginning of the pandemic. We previously established a platform to screen for SARS-CoV-2 positivity across a representative proportion of the US population, from which we reported that almost 17 million Americans were estimated to have had undocumented infections in the Spring of 2020. Since then, vaccine rollout and prevalence of different SARS-CoV-2 variants have further altered seropositivity trends within the United States population. To explore the longitudinal impacts of the pandemic and vaccine responses on seropositivity, we re-enrolled participants from our baseline study in a 6- and 12- month follow-up study to develop a longitudinal antibody profile capable of representing seropositivity within the United States during a critical period just prior to and during the initiation of vaccine rollout. Initial measurements showed that, since July 2020, seropositivity elevated within this population from 4.8% at baseline to 36.2% and 89.3% at 6 and 12 months, respectively. We also evaluated nucleocapsid seropositivity and compared to spike seropositivity to identify trends in infection versus vaccination relative to baseline. These data serve as a window into a critical timeframe within the COVID-19 pandemic response and serve as a resource that could be used in subsequent respiratory illness outbreaks.
</p>
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.20.23297329v1" target="_blank">Dynamics of SARS-CoV-2 Seroprevalence in a Large US population Over a Period of 12 Months</a>
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<li><strong>FAKHRAVAC and BBIBP-CorV vaccine seeds’ binding to angiotensin-converting enzyme 2: A comparative molecular dynamics study</strong> -
<div>
Background: Safety and efficacy of the SARS-CoV-2 inactivated vaccines have been question since the emergence of SARS-CoV-2 variants of concern (VOCs). Using residue fluctuations and statistically comparing RMSF values, have escalated the understanding of the binding dynamics of the viral proteins to their receptors and here in this study, we compared the interaction between inactivated spike proteins (representing FAKHRAVAC and BBIBP-CorV vaccines seed) and the human Angiotensin-Converting Enzyme 2 (hACE2) receptor. Methodology: Through 100 set of accelerated 1 ns comparative molecular dynamics simulations, we analyze the binding dynamics and energy components of these interactions and compared residue backbone fluctuations using entropy and statistics including KL-Divergence and KS-test. Principal Findings: Our results reveal that FAKHRAVAC and Sinopharm exhibit similar binding dynamics and affinity to hACE2. Further examination of residue-wise fluctuations highlights the common behavior of binding key residues and mutation sites between the two vaccines. However, subtle differences in residue fluctuations, especially at critical sites like Q24, Y435, L455, S477, Y505, and F486, raise the possibility of distinct efficacy profiles. Conclusion: These variations may influence vaccine immunogenicity and safety in response to evolving SARS-CoV-2 variants. The study underscores the importance of considering residue-wise fluctuations for understanding vaccine-pathogen interactions and their implications for vaccine design.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.19.563051v1" target="_blank">FAKHRAVAC and BBIBP-CorV vaccine seeds’ binding to angiotensin-converting enzyme 2: A comparative molecular dynamics study</a>
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<li><strong>Divergent spike mutations impact the activation of the fusion core in Delta and Omicronvariants of SARS-CoV-2</strong> -
<div>
SARS-CoV-2 infects host cells by binding the receptor-binding domain (RBD) of its spike protein to the receptor, ACE2. A subset of highly effective spike mutations plays critical roles in altering the conformational dynamics of spike protein. Here, we use molecular dynamics simulations to investigate how spike mutations affect the conformational dynamics of spike/ACE2 complex in the D614G, Delta (B.1.617.2) and Omicron (B.1.1.529) SARS-CoV-2 variants. We observe that the increased positive-charged mutations in the Omicron spike amplify its structural rigidity and reduce its structural flexibility. The mutations (P681R in Delta and P681H in Omicron) at the S1/S2 junction facilitate S1/S2 cleavage and aid the activation of the fusion core. We report that high structural flexibility in Delta lowers the barrier for the activation of the S2 core; however, high structural rigidity in Omicron enhances the barrier for the same. Our results also explain why Omicron requires the presence of a higher number of ACE2 to activate its fusion core than Delta.
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🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.19.563184v1" target="_blank">Divergent spike mutations impact the activation of the fusion core in Delta and Omicronvariants of SARS-CoV-2</a>
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<li><strong>Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by PBR28 PET correlates with vascular disease measures</strong> -
<div>
The COVID-19 pandemic caused by SARS-CoV-2 has triggered a consequential public health crisis of post-acute sequelae of COVID-19 (PASC), sometimes referred to as long COVID. The mechanisms of the heterogeneous persistent symptoms and signs that comprise PASC are under investigation, and several studies have pointed to the central nervous and vascular systems as being potential sites of dysfunction. In the current study, we recruited individuals with PASC with diverse symptoms, and examined the relationship between neuroinflammation and circulating markers of vascular dysfunction. We used [11C]PBR28 PET neuroimaging, a marker of neuroinflammation, to compare 12 PASC individuals versus 43 normative healthy controls. We found significantly increased neuroinflammation in PASC versus controls across a wide swath of brain regions including midcingulate and anterior cingulate cortex, corpus callosum, thalamus, basal ganglia, and at the boundaries of ventricles. We also collected and analyzed peripheral blood plasma from the PASC individuals and found significant positive correlations between neuroinflammation and several circulating analytes related to vascular dysfunction. These results suggest that an interaction between neuroinflammation and vascular health may contribute to common symptoms of PASC.
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🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.19.563117v1" target="_blank">Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by PBR28 PET correlates with vascular disease measures</a>
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<li><strong>Analysis of uptake, effectiveness and safety of COVID-19 vaccinations in pregnancy using the QResearch database: research protocol and statistical analysis plan</strong> -
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Background The COVID-19 pandemic has affected millions of people globally with major health, social and economic consequences, prompting development of vaccines for use in the general population. However, vaccination uptake is lower in some groups, including in pregnant women, because of concerns regarding vaccine safety. There is evidence of increased risk of adverse pregnancy and neonatal outcomes associated with SARS-CoV-2 infection, but fear of vaccine-associated adverse events on the baby both in short and longer term is one of the main drivers of low uptake for this group. Other vaccines commonly used in pregnancy include influenza and pertussis. These both have reportedly higher uptake compared with COVID-19 vaccination, which may be because they are perceived to be safer. In this study, we will undertake an independent evaluation of the uptake, effectiveness and safety of COVID-19 vaccinations in pregnant women using the QResearch primary care database in England. Objectives A. To determine COVID-19 vaccine uptake in pregnant women compared to uptake of influenza and pertussis vaccinations. B. To estimate COVID-19 vaccine effectiveness in pregnant women by evaluating the risk of severe COVID-19 outcomes following vaccination. C. To assess the safety of COVID-19 vaccination in pregnancy by evaluating the risks of adverse pregnancy and perinatal outcomes and adverse events of special interest for vaccine safety after COVID-19 vaccination compared with influenza and pertussis vaccinations. Methods This population-based study uses the QResearch database of primary health care records, linked to individual-level data on hospital admissions, mortality, COVID-19 vaccination, SARS-CoV-2 testing data and congenital anomalies. We will include women aged 16 to 49 years with at least one pregnancy during the study period of 30th December 2020 to the latest date available. Babies born during the study period will be identified and linked to the mothers record, where possible. We will describe vaccine uptake in pregnant women by trimester and population subgroups defined by demographics and other characteristics. Cox proportional hazards multivariable regression will be used to identify factors associated with vaccine uptake. The effectiveness of COVID-19 vaccines in pregnant women will be assessed using time varying Royston-Palmar regression analyses to determine unadjusted and adjusted hazard ratios for the occurrence of severe COVID-19 outcomes after each vaccine dose compared with unvaccinated individuals. For the safety analysis, we will we use logistic regression analyses to determine unadjusted and adjusted odds ratios for the occurrence of maternal (e.g. miscarriage, ectopic pregnancy and gestational diabetes) and perinatal outcomes (e.g. stillbirth, small for gestational age and congenital anomalies) by vaccination status compared to unvaccinated individuals. For the adverse events of special interest for vaccine safety (e.g. venous thromboembolism, myocarditis and Guillain Barre syndrome), we will use time varying Royston-Palmar regression analyses to determine unadjusted and adjusted hazard ratios for the occurrence of each outcome by vaccination status to unvaccinated individuals. Ethics and dissemination QResearch is a Research Ethics Approved Research Database with ongoing approval from the East Midlands Multi-Centre Research Ethics Committee (Ref: 18/EM/0400). This study was approved by the QResearch Scientific Committee on 9th June 2022. This research protocol has been developed with support from a patient and public involvement panel, who will continue to provide input throughout the duration of the study. Research findings will be submitted to pre-print servers such as MedRxIv, academic publication and disseminated more broadly through media releases and community groups and conference presentations.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.12.19.22283660v2" target="_blank">Analysis of uptake, effectiveness and safety of COVID-19 vaccinations in pregnancy using the QResearch database: research protocol and statistical analysis plan</a>
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<li><strong>Influence of age, sex, body habitus, vaccine type and anti-S serostatus on cellular and humoral responses to SARS-CoV-2 vaccination</strong> -
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Vaccine development targeting SARS-CoV-2 in 2020 was of critical importance in reducing COVID-19 severity and mortality. In the U.K. during the initial roll-out most individuals either received two doses of Pfizer COVID-19 vaccine (BNT162b2) or the adenovirus-based vaccine from Oxford/AstraZeneca (ChAdOx1-nCoV-19). There are conflicting data as to the impact of age, sex and body habitus on cellular and humoral responses to vaccination, and most studies in this area have focused on determinants of mRNA vaccine immunogenicity. Here we studied a cohort of participants in a population-based longitudinal study (COVIDENCE UK) to determine the influence of age, sex, body mass index (BMI) and pre-vaccination anti-Spike (anti-S) antibody status on vaccine-induced humoral and cellular immune responses to two doses of BNT162b2 or ChAdOx-n-CoV-19 vaccination. Younger age and pre-vaccination anti-S seropositivity were both associated with stronger antibody responses to vaccination. BNT162b2 generated higher neutralising and anti-S antibody titres to vaccination than ChAdOx1-nCoV-19, but cellular responses to the two vaccines were no different. Irrespective of vaccine type, increasing age was also associated with decreased frequency of cytokine double-positive CD4+ T cells. Increasing BMI was associated with reduced frequency of SARS-CoV-2-specific TNF+ CD8% T cells for both vaccines. Together, our findings demonstrate that increasing age and BMI associate with attenuated cellular and humoral responses to SARS-CoV-2 vaccination. Whilst both vaccines induced T cell responses, BNT162b2 induced significantly elevated humoral immune response as compared to ChAdOx-n-CoV-19.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.09.29.23296222v2" target="_blank">Influence of age, sex, body habitus, vaccine type and anti-S serostatus on cellular and humoral responses to SARS-CoV-2 vaccination</a>
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<li><strong>The gravity of the status quo: the response of research governance to system-level shocks</strong> -
<div>
Using semi-structured interviews with n=69 global research stakeholders, , this research explores the ways in which stakeholders within system-level research governance organisations conceptualised, responded to, and reasoned the realities of disruption caused by the COVID-19 pandemic, and how they positioned procedural changes to their governance mechanisms. Given that shocks to systems present critical challenges to established practices and embedded institutional norms, we use neo-institutional theory as a heuristic device to examine the relationship between the exogenous shock of COVID-19, trajectories of institutional norms and cultures, and the role institutional stakeholders play in managing responses. Across all the research systems studied (with particular focus on the UK, Australia, Norway, New Zealand, Hong Kong SAR and Italy), participants were concerned about how the shock provided by COVID-19 had both revealed and entrenched deep inequalities (between individuals and between organisations) inherent in their research systems and globally. There were tensions in how participants centralised the concept of the ‘normal’ as part of a process of recovery permeating all system-level responses, often with a sense of nostalgia for past structures (a pre-pandemic ‘golden age’ of research), modes of operation, and embedded norms. Aspirations for short-, medium- and long-term plans for research change echoed a dependency on returning to ‘normal’ and reflected an inevitable pull of the norms of the pre-pandemic status quo. Despite the desire of individuals involved in research governance to ‘build back better’, the pull of institutional norms and the gravitational force of the status quo appears too strong for meaningful change to happen in recovering research systems.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/socarxiv/3wfcb/" target="_blank">The gravity of the status quo: the response of research governance to system-level shocks</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>Immunogenicity of Concomitant Administration of COVID-19 Vaccines With Influenza Vaccines</strong> - <b>Conditions</b>: COVID-19; Influenza; Vaccine Reaction; Contaminant Injected <br/><b>Interventions</b>: Biological: Omicron-containing COVID-19 vaccine; Biological: influenza vaccine <br/><b>Sponsors</b>: Catholic Kwandong University; Korea University Guro Hospital <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>Narrative Intervention for Long COVID-19 (NICO)</strong> - <b>Conditions</b>: Long COVID; Long Covid19 <br/><b>Interventions</b>: Behavioral: Narrative Intervention for Long COVID-19 (NICO) <br/><b>Sponsors</b>: University of Colorado, Denver <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>Inspiratory Muscle Training in People With Long COVID- A Pilot Investigation.</strong> - <b>Conditions</b>: Long COVID <br/><b>Interventions</b>: Device: PrO2 <br/><b>Sponsors</b>: University of Bath; Swansea University <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>Home-Based Respiratory Muscle Strength Training Program for Individuals With Post-COVID-19 Persistent Dyspnea</strong> - <b>Conditions</b>: Post-COVID-19 Syndrome; Dyspnea <br/><b>Interventions</b>: Device: Respiratory Muscle Strength Trainers <br/><b>Sponsors</b>: University of South Florida <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>Inspiratory Muscle Strength Training in Post-Covid Syndrome</strong> - <b>Conditions</b>: Cardiovascular Abnormalities; Post-COVID-19 Syndrome; Physical Exercise <br/><b>Interventions</b>: Other: Inspiratory muscle strength training <br/><b>Sponsors</b>: D’Or Institute for Research and Education <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>Rural Tailored Communication to Promote SARS-CoV-2 Antibody Testing in Saliva</strong> - <b>Conditions</b>: SARS-CoV2 Infection <br/><b>Interventions</b>: Behavioral: General SARS-CoV-2 Communication; Behavioral: Rural-Targeted SARS-CoV-2 Communication <br/><b>Sponsors</b>: Michigan State University; National Cancer Institute (NCI); Johns Hopkins 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>Cognitive Rehabilitation Therapy for COVID-19</strong> - <b>Conditions</b>: Post-Acute COVID-19 Syndrome <br/><b>Interventions</b>: Behavioral: Compensatory Cognitive Training for COVID-19; Behavioral: Holistic Cognitive Education <br/><b>Sponsors</b>: VA Office of Research and Development <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 Rehabilitation</strong> - <b>Conditions</b>: Rehabilitation; Post-Acute COVID-19 Syndrome; Post-Infectious Disorders <br/><b>Interventions</b>: Behavioral: One day course; Behavioral: Individual follow-ups <br/><b>Sponsors</b>: University Hospital of North Norway; University of Bergen; Oslo University Hospital; Norwegian University of Science and Technology <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 3 Open-Label Controlled Trial of Convalescent Plasma in Early COVID-19 Infection</strong> - <b>Conditions</b>: Covid19 <br/><b>Interventions</b>: Drug: Convalescent Plasma; Other: Standard of Care <br/><b>Sponsors</b>: Larkin Community Hospital <br/><b>Withdrawn</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>Food Effects of GST-HG171 Tablets Combined With Ritonavir in Healthy Chinese Participants</strong> - <b>Conditions</b>: COVID-19 Respiratory Infection <br/><b>Interventions</b>: Drug: GST-HG171/ritonavir; Drug: ritonavir <br/><b>Sponsors</b>: Fujian Akeylink Biotechnology Co., Ltd. <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>Improving Post COVID-19 Syndrome With Hyperbaric Oxygen Treatments</strong> - <b>Conditions</b>: Post COVID-19 Condition; Post-COVID-19 Syndrome; Post-COVID Syndrome; COVID-19; Fatigue; Fatigue Syndrome, Chronic <br/><b>Interventions</b>: Device: Monoplace Hyperbaric Chamber (Class III medical device). <br/><b>Sponsors</b>: Sunnybrook Health Sciences Centre <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>Education of Medical Staff to Post Acute Covid susTained sYmptoms</strong> - <b>Conditions</b>: Post-acute COVID-19 Syndrome <br/><b>Interventions</b>: Other: Training in the management of functional disorders; Other: Reimbursement of 3 long consultations <br/><b>Sponsors</b>: Assistance Publique - Hôpitaux de Paris; ANRS, Emerging Infectious Diseases <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>Pharmacist Management of Paxlovid eVisits</strong> - <b>Conditions</b>: COVID-19; Quality of Care <br/><b>Interventions</b>: Other: Pharmacist Care; Other: AFM Pool Care <br/><b>Sponsors</b>: Kaiser Permanente <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>tDCS in the Management of Post-COVID Disorders</strong> - <b>Conditions</b>: Long COVID <br/><b>Interventions</b>: Device: Transcranial Direct Current Stimulation (tDCS); Behavioral: Motor Training; Behavioral: Cognitive Training <br/><b>Sponsors</b>: Universidade Federal de Pernambuco; São Paulo State 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>Equity Evaluation of Fact Boxes on Informed COVID-19 and Influenza Vaccination Decisions - Study Protocol</strong> - <b>Conditions</b>: COVID-19; Influenza <br/><b>Interventions</b>: Other: Fact box <br/><b>Sponsors</b>: Harding Center for Risk Literacy <br/><b>Not yet recruiting</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>Evaluation of Potential Peptide-Based Inhibitors against SARS-CoV-2 and Variants of Concern</strong> - The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has greatly affected all aspect of life. Although several vaccines and pharmaceuticals have been developed against SARS-CoV-2, the emergence of mutated variants has raised several concerns. The angiotensin-converting enzyme (ACE2) receptor cell entry mechanism of this virus has not changed despite the vast mutation in emerging variants. Inhibiting the spike protein by which the virus identifies the host ACE2 receptor is a…</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>Some novel bioactivities of <em>Virgibacillus halodenitrificans</em> carotenoids, isolated from Wadi El-Natrun lakes</strong> - Carotenoids come in second among the most frequent natural pigments and are utilized in medications, nutraceuticals, cosmetics, food pigments, and feed supplements. Based on recent complementary work, Virgibacillus was announced for the first time as a member of Wadi El-Natrun salt and soda lakes microbiota, identified as Virgibacillus halodenitrificans, and named V. halodenitrificans DASH; hence, this work aimed to investigate several in vitro medicinal bioactivities of V. halodenitrificans…</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>Clinical and pulmonary function analysis in long-COVID revealed that long-term pulmonary dysfunction is associated with vascular inflammation pathways and metabolic syndrome</strong> - INTRODUCTION: Long-term pulmonary dysfunction (L-TPD) is one of the most critical manifestations of long-COVID. This lung affection has been associated with disease severity during the acute phase and the presence of previous comorbidities, however, the clinical manifestations, the concomitant consequences and the molecular pathways supporting this clinical condition remain unknown. The aim of this study was to identify and characterize L-TPD in patients with long-COVID and elucidate the main…</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 Naïve Phage Display Library-Derived Nanobody Neutralizes SARS-CoV-2 and Three Variants of Concern</strong> - CONCLUSION: Our study highlights a novel nanobody, Nb-H6, that may be useful therapeutically in SARS-CoV-2 and VOC outbreaks and pandemics. These findings also provide a molecular foundation for further studies into how nanobodies neutralize SARS-CoV-2 and variants and imply potential therapeutic targets for the treatment of COVID-19.</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>Macromolecules: Synthesis, antimicrobial, POM analysis and computational approaches of some glucoside derivatives bearing acyl moieties</strong> - Macromolecules i.e., carbohydrate derivatives are crucial to biochemical and medical research. Herein, we designed and synthesized eight methyl α-D-glucopyranoside (MGP) derivatives (2-8) in good yields following the regioselective direct acylation method. The structural configurations of the synthesized MGP derivatives were analyzed and verified using multiple physicochemical and spectroscopic techniques. Antimicrobial experiments revealed that almost all derivatives demonstrated noticeable…</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>Synthesis, structural characterization, antioxidant, cytotoxic activities and docking studies of schiff base Cu(II) complexes</strong> - By combining hydrazide with 2-Acetylpyridine, a hydrazone ligand (HL) was successfully created. Several copper (II) salts have been used to create three copper (II) hydrazone complexes (acetate, sulphate, and chloride). The hydrazide ligand and its copper (II) complexes (1-3) were studied via variety of analytical techniques, including elemental analysis, electronic, infrared, UV-vis Spectrum, XRD study, thermal analysis, also molar conductivity amounts. The spectrum results indicate that in all…</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>Pyrazolidinone-Based Peptidomimetic SARS-CoV-2 M<sup>pro</sup> inhibitors</strong> - The main protease (M^(pro)) of SARS-CoV-2 is an attractive drug target for COVID-19 treatment as it plays an integral role in the proliferation of coronavirus. Herein, we describe the investigation of β- and γ-lactams as electrophilic “warheads” for covalent binding to Cys145 of the M^(pro) active site. The highest inhibitory activity (IC(50) = 45 ± 3 μM) was achieved using a pyrazolidinone warhead attached to the targeting dipeptide. Importantly, the synergy of the warhead and the targeting…</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>In vitro testing of host-targeting small molecule antiviral matriptase/TMPRSS2 inhibitors in 2D and 3D cell-based assays</strong> - The outbreak of coronavirus disease 2019 (COVID-19) pandemic strongly stimulated the development of small molecule antivirals selectively targeting type II transmembrane serine proteases (TTSP), required for the host-cell entry of numerous viruses. A set of 3-amidinophenylalanine derivatives (MI-21, MI-472, MI-477, MI-485, MI-1903 and MI-1904), which inhibit the cleavage of certain viral glycoproteins was characterized in 2D and 3D primary human hepatocyte models on collagen- and…</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>Humoral immune response to SARS-CoV-2 and endemic coronaviruses in urban and indigenous children in Colombia</strong> - CONCLUSIONS: Overall, antibody titers, but in particular ACE2 binding inhibition are low within Colombian samples, requiring further investigation to determine any potential clinical significance.</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>ASK1 inhibitors are potential pan-antiviral drugs, which dampen replication of diverse viruses including SARS-CoV2</strong> - Apoptosis signal-regulating kinase 1 (ASK1)/MAP3K5 is a stress response kinase that is activated by various stimuli. It is known as an upstream activator of p38- Mitogen-activated protein kinase (p38MAPK) and c-Jun N-terminal kinase (JNK) that are reactive oxygen species (ROS)-induced kinases. Accumulating evidence show that ROS accumulate in virus-infected cells. Here, we investigated the relationship between viruses and ASK1/p38MAPK or ASK1/JNK pathways. Our findings suggest that virus…</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>Analysis of blood and nasal epithelial transcriptomes to identify mechanisms associated with control of SARS-CoV-2 viral load in the upper respiratory tract</strong> - CONCLUSIONS: Correlations between the transcriptional host response and inter-individual variations in SARS-CoV-2 URT viral load, revealed many molecular mechanisms plausibly favouring or constraining viral replication. Existing evidence corroborates many of these mechanisms, including likely roles for NK cells, granulysin, prostanoids and interferon alpha-14. Inhibition of prostanoid production, and administration of interferon alpha-14 may be attractive transmission-blocking interventions.</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>Assembly of SARS-CoV-2 ribonucleosomes by truncated N* variant of the nucleocapsid protein</strong> - The Nucleocapsid (N) protein of SARS-CoV-2 compacts the RNA genome into viral ribonucleoprotein (vRNP) complexes within virions. Assembly of vRNPs is inhibited by phosphorylation of the N protein SR region. Several SARS-CoV-2 variants of concern carry N protein mutations that reduce phosphorylation and enhance the efficiency of viral packaging. Variants of the dominant B.1.1 viral lineage also encode a truncated N protein, termed N* or Δ(1-209), that mediates genome packaging despite lacking 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>Update on fungal lipid biosynthesis inhibitors as antifungal agents</strong> - Fungal diseases today represent a world-wide problem. Poor hygiene and decreased immunity are the main reasons behind the manifestation of this disease. After COVID-19, an increase in the rate of fungal infection has been observed in different countries. Different classes of antifungal agents, such as polyenes, azoles, echinocandins, and anti-metabolites, as well as their combinations, are currently employed to treat fungal diseases; these drugs are effective but can cause some side effects and…</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>Assessment of virus and Leptospira carriage in bats in France</strong> - With over 1,400 species worldwide, bats represent the second largest order of mammals after rodents, and are known to host major zoonotic pathogens. Here, we estimate the presence of pathogens in autochthonous bat populations. First, we set out to check our samples for PCR amplification efficiency by assessing the occurrence of inhibited PCR reactions from different types of bat samples with amplifying the housekeeping gene β-actin. Second, we investigated the presence of five targeted pathogens…</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>Blocking of doublecortin-like kinase 1-regulated SARS-CoV-2 replication cycle restores cell signaling network</strong> - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to fatal outcomes for subgroups of patients with pre-existing co-morbidities. We previously reported a significant association between high expression levels of a cancer stem cell protein, doublecortin-like kinase 1 (DCLK1), in the lungs and macrophages of SARS-CoV-2-infected patients and the severity of coronavirus disease 2019 (COVID-19). Herein, we demonstrate a pivotal role of DCLK1 in the viral replication cycle…</p></li>
</ul>
<h1 data-aos="fade-right" id="from-patent-search">From Patent Search</h1>
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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>The View from My Window in Gaza</strong> - Two days before Israel escalated attacks in the Gaza Strip, my family bought some bread. After we evacuated, I biked home to get it. - <a href="https://www.newyorker.com/news/the-weekend-essay/the-view-from-my-window-in-gaza">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Week When Biden Hugged Bibi</strong> - The President, fresh off a grim trip to the Middle East, makes the case for funding Israel’s war—and Ukraine’s, too. - <a href="https://www.newyorker.com/news/letter-from-bidens-washington/the-week-when-biden-hugged-bibi">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Anguished Fallout from a Pro-Palestinian Letter at Harvard</strong> - Students issued a statement blaming Israel for the Hamas attacks. Then a doxing campaign tested the courage of their conviction. - <a href="https://www.newyorker.com/news/dispatch/the-anguished-fallout-from-a-pro-palestinian-letter-at-harvard">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Simmering Lebanese Front in Israel’s War</strong> - A series of tit-for-tat exchanges between Hezbollah fighters and the Israeli Army risks blowing the Gaza offensive into a regional conflict. - <a href="https://www.newyorker.com/news/dispatch/the-simmering-lebanese-front-in-israels-war">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ibram X. Kendi’s Anti-Racism</strong> - The historian espoused grand ambitions to dismantle American racism, but the crisis at his research center suggests that he always had a more limited view of change. - <a href="https://www.newyorker.com/news/our-columnists/ibram-x-kendis-anti-racism">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>A simple checklist to plan for your old age, today</strong> -
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<img alt="A cartoon of a woman reading a long list while looking at a giant hourglass." src="https://cdn.vox-cdn.com/thumbor/keZ-2qY6ROcz-eo9mZtqPG3g3XE=/365x0:6200x4376/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72784095/GettyImages_1307620247.0.jpg"/>
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We’re all getting older. It’s time to have a plan. | Ponomariova_Maria via Getty Images/iStockphoto
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Four not-so-scary steps to take to give yourself peace of mind.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SjbirS">
None of us is getting any younger, yet many of us prefer to ignore that fact.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PI8D83">
“We tend to think of aging as something sad that old people do, when in fact we are aging from the minute we are born,” says Ashton Applewhite, author of the book <a href="https://bookshop.org/p/books/this-chair-rocks-a-manifesto-against-ageism-ashton-applewhite/6986118"><em>This Chair Rocks: A Manifesto Against Ageism</em></a>.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ATnUCc">
As a result, many of us don’t prepare for the realities of getting old: <a href="https://news.gallup.com/poll/351500/how-many-americans-have-will.aspx">Less than half of American adults</a> have a will, and many underestimate both the cost of long-term care and the likelihood that they’ll need it. About <a href="https://www.aarp.org/caregiving/financial-legal/info-2022/planning-for-long-term-care.html">seven in 10 people</a> need care at some point as they age, and that care is expensive: <a href="https://www.nytimes.com/2021/08/09/opinion/aging-nursing-home-medicare.html">$50,000 a year for a full-time home health aide</a>, or $93,000 for a semi-private room in a nursing home. Moreover, falling birth rates mean that, in the years to come, America’s elderly will have <a href="https://www.aarp.org/home-family/caregiving/info-08-2013/the-aging-of-the-baby-boom-and-the-growing-care-gap-AARP-ppi-ltc.html">fewer family members than ever</a> to help them, making advance planning all the more important.
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Experts suggest that people get legal documents like a <a href="https://www.vox.com/e/23675310">power of attorney and living will in place</a> by their 50s, but it’s never too early to start thinking about your later years, or to make preparations so your loved ones can follow your wishes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BEDyOK">
Below are a few steps you can take whether you’re 25 or 95 to make it more likely that you can grow old the way you want to. You don’t have to have all of these items in place right away, but getting started can give you peace of mind about the future and <a href="https://www.vox.com/e/23675310">make life easier</a> for you and your loved ones later on. “Aging is living,” Applewhite says; the sooner we embrace that, the better off we’ll be.
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<h3 id="AhrBOn">
Talk to your loved ones
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZLAAdB">
Planning for aging isn’t just an individual task. Experts and current and former caregivers agree it’s important to involve your loved ones — children, partners, friends, and anyone who might be part of your support team as you get older. “Talk about how you envision wanting to age,” says Susan Sterner, a caregiver whose father has dementia. “How do you want to be taken care of? Who do you want to be near?”
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Sterner and her husband have already talked to their children, who are young adults, about their advance directives. “We actually had a little dinner with our kids where we dressed up and made fancy food and we talked about things like wills,” Sterner said. She also advises having “an open, honest conversation about health and <a href="https://www.vox.com/health-care">health care</a> with your kids as you’re raising them, so they feel like they can also bring it up.”
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Frank conversations are especially important if you think you might need or want your loved ones to help with your long-term care — a likely scenario, given that <a href="https://www.prb.org/resources/family-caregiving-for-older-people/">the majority of elder care</a> is provided by family members. Sometimes people worry that they will be a burden on their family members by asking for help, says Regina Koepp, a clinical geropsychologist and the founder of the Center for Mental Health &amp; Aging. But “if you get your care needs met in a timely fashion and well enough,” she says, “it actually reduces more care needs down the road” because chronic conditions can become worse if they’re not properly treated.
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Another way to reduce feelings of guilt around asking for help is “to find ways to contribute even when you’re receiving care,” Koepp says. This could be as simple as being clear with your loved ones about your medical conditions. “There’s a lot of strained family relationships because family members don’t have all of the information that the older person has about their medical needs.”
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You can also remind yourself that needing support is by no means unique to older ages. “We are interdependent from birth to death,” says Applewhite. “If you get sick, whatever age you happen to be, you’re going to need help. If I have a baby, I need help. If I break my foot, I need help. If I go broke, I need help. We need help lifelong.”
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Set up advance directives
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Advance directives are legal documents that allow you to set forth your wishes in case you become incapacitated. The following four types are especially important, says Eric Einhart, treasurer of the Executive Committee of the National Academy of Elder Law Attorneys:
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<strong>A power of attorney</strong> allows you to name someone else, such as a family member or friend, to handle your legal and financial affairs if you become incapacitated. You can give that person as much or as little authority as you want — for example, you could grant them the ability to do a specific task, like selling your home. However, Einhart suggests that you make the power of attorney as broad as possible to cover any circumstances that might come up, and choose someone you trust. A power of attorney should also be updated regularly because banks and brokerage firms won’t necessarily recognize the document’s validity if it’s several decades old. “You want the latest and the greatest,” Einhart says.
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<strong>A health care proxy</strong> allows you to name someone to make medical decisions on your behalf if you can no longer do so. That person should be acting on your wishes, Einhart said, so it’s important to talk beforehand about any health care decisions you feel strongly about, including your preferences around palliative and end-of-life care. It’s important to choose someone who has “the time, energy, and the wherewithal to handle the job” in the event it’s necessary, Einhart says.
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<strong>A HIPAA authorization </strong>allows someone else to access your medical records. This document can be helpful if a family member or another trusted person needs to handle your medical care or deal with your health insurance, Einhart says.
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<strong>A living will</strong> spells out your wishes around the end of your life, including whether or not you want to be on life support, and what treatments you want or don’t want <a href="https://www.nia.nih.gov/health/preparing-living-will">in an emergency situation</a> if you can’t communicate. Uncomfortable as it may be, it’s helpful to consider the different circumstances under which someone might have to consult your living will. The way we view medical decisions might change depending on the context and depending on how much and what quality of life we might expect.
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All of these documents should be prepared by a professional; you can find one through the <a href="https://www.naela.org/">National Academy of Elder Law Attorneys</a> (NAELA). That preparation can cost anywhere from hundreds to thousands of dollars, but you can also find pro bono legal services through your state or local bar association.
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However you get it done, having advance directives can ensure your wishes are respected and help you and your loved ones avoid a stressful situation in the future. “If you don’t have those documents in place, you don’t have the legal structures that would allow someone else that you choose to make decisions for you,” Einhart said. “You can have a judge who you’ve never met before appoint somebody that is a complete stranger to make a decision for you.”
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Make a will
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Unlike a living will, a last will and testament (often simply called <a href="https://www.ncoa.org/adviser/estate-planning/living-trust-vs-will/">a will</a>) spells out what you want to happen to your assets after you die. State laws typically establish defaults for how property is distributed after death, but “you may have different ideas in mind of who should get what,” Einhart says, and a will is crucial for making sure those are honored.
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You need a will even if you don’t have a lot of money, Einhart says. The document allows you to designate who you want to be in charge of handling your affairs when you die and how any debts will be paid back. If you have children, it also allows you to appoint a guardian for them in the event of your death.
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You can find an attorney to prepare a will through NAELA, or, if your finances are simple, you can use an <a href="https://www.ncoa.org/adviser/estate-planning/best-online-will-makers/">online will maker</a>, which can range in cost from free to $299, according to the National Council on Aging.
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In addition to a will and advance directives, some experts recommend you put together a “life file” that also contains important passwords, banking information, and instructions for your possessions. The advocacy group Death With Dignity has <a href="https://deathwithdignity.org/resources/life-file/">a checklist</a> for assembling a life file containing these items and more.
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Make a financial plan for long-term care
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Medicare doesn’t pay for most long-term care, and Medicaid only covers such care once you’ve exhausted all your assets. That means that most people who need assistance as they age will have to pay for at least some of it out of pocket. Even if you hope to be cared for by family members, there are expenses attached — as of 2021, family caregivers spent <a href="https://www.aarp.org/research/topics/care/info-2016/family-caregivers-cost-survey.html">an average of $7,242</a> per year on costs related to care.
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Buying <a href="https://www.aarp.org/caregiving/financial-legal/info-2021/understanding-long-term-care-insurance.html">long-term care insurance</a> is one option, but it can be very expensive; some states have established or are <a href="https://www.nytimes.com/2023/06/16/business/retirement-long-term-care-insurance.html">looking to start public programs</a> to lower the cost. You can also contact your local <a href="https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx">area agency on aging</a>, a county-level organization that can help you determine what types of assistance you might qualify for. Your primary care doctor, if you have one, may also be able to put you in touch with a social worker who can help. If talking to your loved ones about money and long-term care is difficult or awkward, a social worker can also help facilitate those conversations, Koepp says.
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An elder law attorney can also often share information about long-term care and other services, because they have experience helping clients age “in a position where they are comfortable and have maintained their dignity,” Einhart said. “We’re all going to get old — you just want to do it with a plan.”
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<li><strong>Six questions to ask that will make caring for older relatives much easier</strong> -
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<img alt="A woman cooks on a stove while talking to an older woman sitting down." src="https://cdn.vox-cdn.com/thumbor/_If0Xl1Gbm6c07CKdC6bjDKfKXw=/586x0:7253x5000/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72784078/GettyImages_1388281348__1_.0.jpg"/>
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Talking about aging can be difficult — but it can also bring peace of mind. | invincible_bulldog via Getty Images
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Your parents or other loved ones could need you one day. Here’s how to get ready.
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The women in Loretta Woodward Veney’s family are known for their longevity. Her grandmother died in her late 90s; her great-grandmother lived alone until she was 101, and only agreed to move into a nursing home “when we told her there were men,” Veney jokes. So when Veney’s mother was diagnosed with dementia at age 77, Veney, then 47, was shocked — and unprepared for the financial and logistical realities of caregiving.
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Many millennial and Gen Z Americans will be faced with difficult decisions about elder care in the near future, if they aren’t grappling with it already. Baby boomers are reaching the age when they’re more likely to need support with medical care and daily tasks, and the ones providing that support are typically family members, often adult children. <a href="https://www.nytimes.com/2023/03/28/magazine/elder-child-care-millennials.html">More than 40 million Americans</a> today are caring for an older relative or friend, according to AARP, and many caregivers and former caregivers, like Veney, describe being taken by surprise when a loved one needed help, and feeling isolated by the lack of public discussion around aging and disability.
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Now an author and speaker on caregiving issues, one of Veney’s biggest pieces of advice for younger people: Don’t wait for a crisis to talk to your parents or other older relatives about what they want their later years to look like — where they want to live as they age, who they want to care for them, and what steps (if any) they’ve taken to prepare. “You do not want to be making these kinds of decisions when somebody’s lying in a hospital bed,” Veney says.
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It’s not always an easy conversation to have. Adult children often “don’t want to impose or catastrophize the older adult’s experience,” says <a href="https://drreginakoepp.com">Regina Koepp</a>, a clinical geropsychologist and the founder of the Center for Mental Health &amp; Aging. Older people, meanwhile, may worry that talking about their own future needs may unduly burden their kids. It’s difficult for most people to talk about getting older in a culture that automatically equates aging with disability — and that too often subjects people with disabilities to stigma and discrimination. We “live in a deeply ageist and ableist culture which drowns out all but the negatives about getting older,” says Ashton Applewhite, author of <a href="https://bookshop.org/p/books/this-chair-rocks-a-manifesto-against-ageism-ashton-applewhite/6986118?ean=9781250297259"><em>This Chair Rocks: A Manifesto Against Aging</em></a>. “We don’t talk about it for reasons that are human and reasons that are deeply culturally embedded.”
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By cutting through the silence around aging and addressing these topics head-on, families can replace anxiety and uncertainty with a concrete plan. Older years can bring with them specific needs, such as rides to doctor’s appointments, help applying for aid programs, and even assistance with basics like bathing or eating. Discussing them can make caregiving less daunting and help make sure an older person’s wishes are respected. Below are six questions that can help you get started.
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How is your living situation working for you?
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Approach the conversation with respect and caring, says <a href="https://roybal.usc.edu/our_team/maria-p-aranda/">María P. Aranda</a>, director of the University of Southern California’s Edward R. Roybal Institute on Aging. Older adults are “independent, and they have their own notions about how they want to live.”
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Any dialogue needs to center them, their needs, and their wishes. To that end, when Aranda’s parents were getting older, she and her family asked them, “How is this living arrangement working for you?” This kind of open-ended question can start a conversation whether elders are living in their own home, with family, or somewhere else, and can open the door to talk about the future. You can follow up with questions like “Are you comfortable?” and “Are your needs being met?”
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Where do you want to live if you start to need more help?
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After Susan Sterner’s father was diagnosed with dementia and started becoming physically weaker, she feared her parents could no longer safely live in their home, which had no first-floor bathroom. Talking to them about moving out was mentally and emotionally wrenching, Sterner says. As an adult child, it’s difficult “to launch the conversations about the decreasing in their independence, and to have those conversations while still supporting their agency,” she says.
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Having the conversation proactively, before someone is severely ill, can help family members prepare to honor a loved one’s wishes. For instance, according to one AARP survey, the majority of people over 50 want to “<a href="http://aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html">age in place</a>,” staying in their homes as long as possible rather than moving into an assisted living facility or nursing home. To make that feasible, a home may need modifications like <a href="https://www.nytimes.com/2021/04/23/health/elderly-medical-equipment.html">grab bars or a shower chair</a> in the bathroom, or a <a href="https://www.nytimes.com/2017/05/19/health/aging-in-place-contractors.html">lift</a> to help someone get upstairs.
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For some, however, aging in place may become impossible, often because of medical or care needs that can’t be managed at home. It’s helpful to know and consider a loved one’s preferences if that happens. Veney, for example, knew her mother “never liked people as much as I did.” So when she could no longer safely live in her home, Veney avoided larger facilities with “everybody playing bingo on Tuesday nights,” says Veney. Instead, she found her mom a small group home with six other seniors. “She loved it,” she says.
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In other families, an older loved one may want or need to move in with adult children or other relatives. Multigenerational living is <a href="https://www.pewresearch.org/social-trends/2022/03/24/the-demographics-of-multigenerational-households/">on the rise</a> in the US, with 20 percent of women and 15 percent of men over 65 living in multigenerational homes. A growing number of families are even pooling their resources with an older relative and <a href="https://www.nytimes.com/2021/07/09/realestate/multigenerational-living.html">buying a home together</a>, as Andrea Catlett did when she and her husband and kids combined households with her mother several years ago. Catlett told Vox she loves being able to share meals with so many loved ones, but also says the arrangement “takes a lot of patience and a lot of grace” — and tools like Bluetooth headphones that let her hard-of-hearing mom blast the TV without bothering the rest of the family.
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Knowing if this kind of arrangement might be in your future can help you make a plan. And whether it’s modifying a home or finding another place to live, planning for the future almost always means talking about money.
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What should I know about your finances?
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With the median cost of a full-time <a href="https://www.vox.com/the-highlight/2019/8/21/20694768/home-health-aides-elder-care">home health aide</a> reaching <a href="https://www.nytimes.com/2021/08/09/opinion/aging-nursing-home-medicare.html">$50,000 in 2021</a>, and a semi-private room in a nursing home nearly twice that, it’s crucial to ask this question to learn what financial resources your loved one has to help provide for any care they might need, and what gaps your family may need to help make up.
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If your loved ones are open to sharing the information, it’s helpful to find out their net worth, whether they own any property, such as real estate, and whether they owe any debts. If you do need to manage their finances, you’ll need to know what creditors need to be paid. Veney recalls a friend who “just found out that her parents have a second mortgage on their house that she didn’t know anything about.” Having a financial conversation early on can help you avoid such surprises.
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This conversation can be incredibly difficult. “It can sound very intrusive for an older person to all of a sudden have an adult child question them about money,” Koepp says. An older person may worry that a child is trying to control them or even fishing for information about an inheritance. Beyond being open and honest about why you’re bringing this up, you can also enlist a third party to help with the conversation.
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Each county in the US has an <a href="https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx">area agency on aging</a>, which often employs resource counselors who can walk families through programs they might qualify for to help with care and other expenses, Koepp says. Reaching out to such an agency together can be a way to start a conversation around finances. If your loved one has a primary care doctor, the medical practice may be able to put you in touch with a social worker who can also help discuss programs. If talking about finances directly is too challenging, “Maybe the adult child says, ‘Would you be willing to talk with a social worker about what you can afford?’” Koepp suggests.
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However the conversation happens, knowing about your loved one’s financial situation is also important so you understand what you’ll be managing if you ever need to take over their affairs, either while they are living or after they die, says Eric Einhart, treasurer of the executive committee of the National Academy of Elder Law Attorneys. “Understanding the size, scope, and title of their assets certainly would be very helpful for anybody who’s going to be put in the position of potentially managing those resources at some point.”
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Do you have any advance directives set up?
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<a href="https://www.nia.nih.gov/health/advance-care-planning-advance-directives-health-care">Advance directives</a> are documents that set forth instructions for medical care and other personal affairs in the event that someone can no longer communicate. Without such documents, it can be very difficult for family members to make medical decisions — or even do basic things like pay bills — if an elder becomes incapacitated because of a stroke, dementia, or another condition. When Amanda Singleton’s mother became sick with brain cancer, for example, she had few advance directives in place, Singleton says. “I ran into so many brick walls trying to get things done for her.”
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To avoid such situations, the following four documents are especially crucial, Einhart says:
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<strong>A power of attorney</strong>, which allows a person to name someone else who can handle their legal and financial needs if they can no longer do so themselves. Such a document could allow you to do tasks like banking, filing taxes, and picking up mail for an older relative, should they become unable to do so.
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<strong>A </strong><a href="https://www.vox.com/health-care"><strong>health care</strong></a><strong> proxy</strong>, which allows one party to name another to act as their surrogate if they’re unable to make medical decisions.
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<strong>A HIPAA authorization</strong>, which allows caregivers or other designated parties to access someone’s medical records.
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<strong>A living will,</strong> which spells out a person’s wishes for the end of life, including decisions around life support.
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“It is really, really important to seek the services of a qualified professional” in drafting the above documents, Einhart says. You can find a qualified attorney in your area through the <a href="https://naela.org//">National Academy of Elder Law Attorneys</a>. Preparing the documents can cost anywhere from a few hundred to a few thousand dollars, but if that’s a financial hardship, you can also seek out pro bono legal services through your local bar association.
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Figuring out when to ask older relatives about these directives and other long-term plans is “an art, not a science,” Einhart says, though he recommends people start getting their own documents in order in their 50s. He advises families to avoid starting conversations about care and end-of-life wishes right after a health incident, but instead to wait until the immediate crisis passes and remember to take a soft approach. “Reassure them that you’re not looking to take over anything,” Einhart says. “You just want to have this conversation with them because you’re concerned about the future and you love them.”
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Who do you want to support you as you get older, and how?
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Beyond where and how a person wants to age, there’s also the question of who will be there to help, and in what capacity. The majority of people will need some kind of support in their later years, whether that’s assistance with daily tasks like bathing or dressing, driving to doctor’s appointments or social engagements, or more involved medical care. Part of planning for the future is figuring out who’s going to provide that support.
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Most elder care in America is provided by family members, and that family care needs to be planned. When Veney’s grandmother was aging, all of her grandchildren had a family meeting to discuss who was going to do what when, Veney recalls. If you’re having such a meeting, you can also include your spouse or partner, family friends, and anyone else who is going to be supporting you or your loved one. The <a href="https://www.cdc.gov/aging/publications/features/caregivers-month.html">CDC</a> and <a href="https://www.aarp.org/caregiving/prepare-to-care-planning-guide/?cmp=RDRCT-P2C-CAREGIVING-VANITY">AARP</a> both have resources that can help with making a written care plan, which can be helpful, especially if your loved one has medical needs or if you’re coordinating with multiple caregivers.
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If you think you might be a caregiver in the future, it’s also important to know what your capacities and limits are. “If you know that you are not the person who can go over and change Dad,” for example, find out if there’s another family member who can, Veney advises. “When the different care things are divided among available family members, then everybody builds to their strengths.”
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However, not everyone has multiple relatives who can step in, especially in <a href="https://www.vox.com/e/23614623">an age of smaller families</a>. If the responsibilities of care are likely to fall solely on your shoulders, you can look to various resources for information and support. In addition to area agencies on aging, <a href="https://www.aarp.org/caregiving/">AARP</a> and the <a href="https://www.caregiving.org/">National Alliance for Caregiving</a> are good places to start, Aranda says.
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If a loved one has the resources to hire a <a href="https://www.vox.com/the-highlight/2019/8/21/20694768/home-health-aides-elder-care">home health aide</a> or another paid caregiver, it can be helpful for the family to research options together ahead of time, Veney says. In the process, family members can learn if an elder has any <a href="https://www.aarp.org/caregiving/home-care/info-2018/hiring-caregiver.html?intcmp=AE-CAR-CAH-SRVCS-IL">preferences about future caregivers</a>, like wanting someone of the same gender or someone who speaks their language. Many families also use a combination of family caregiving and paid support; even if you and other family members provide most of the care, you can still look for assistance on a <a href="https://www.aarp.org/caregiving/home-care/in-home-care-services/">part-time</a> or <a href="https://aging.ny.gov/respite-program#:~:text=Supporting%20Materials-,Program%20Description,them%20maintain%20a%20normal%20life.">substitute</a> basis.
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What brings you joy?
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Long-term care, powers of attorney, and living wills are heavy topics that can be anxiety-provoking for a lot of people. Current and former caregivers say it’s important to also make space to discuss what makes senior family members happy in their day-to-day lives.
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“I’ve been really trying to ask my parents and listen hard to what are the small things that matter, that make them feel like their life is theirs,” Sterner says. “How can we help my parents feel like their life is still their life when things are getting smaller and harder?”
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For Veney’s mother, that was Legos. The two had always built with the blocks together, and “when the disease progressed and she couldn’t find the words, Lego kept her calm,” Veney recalls. They brought them to doctor’s offices and used them to help Veney’s mother with behaviors related to dementia, like compulsively reading everything aloud.
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Veney ultimately got trained in <a href="https://www.lego.com/en-us/themes/serious-play">Lego Serious Play</a>, a program for adults meant to encourage problem-solving and critical thinking, and today she gives Lego presentations for people with dementia, inviting them to build items on their bucket lists, among other activities. “Families are shocked by what their parents can still do,” Veney says.
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It’s a reminder that older adults, like people of any age, deserve to have their wishes and best interests centered in how they live their lives. “Everyone is aging,” Applewhite says. “Let’s think about how we can support each other and inform each other’s journeys.”
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<li><strong>Baby boomers are aging. Their kids aren’t ready.</strong> -
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<img alt="A family with aging parents are facing a treacherous, cracked landscape with melting clocks under a hot sun." src="https://cdn.vox-cdn.com/thumbor/wpSo9efNedyGKdXUallIluisOsw=/240x0:1680x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72634311/PeteGamlen_Vox_AgingParents.0.jpg"/>
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Pete Gamlen for Vox
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Millennials are facing an elder care crisis nobody prepared them for.
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Amanda Singleton had just gotten married and bought her first home when her mom was diagnosed with brain cancer. Essentially overnight, she went from being a 30-year-old just starting a new phase of her life to being a 24-hour caregiver. “My mom couldn’t walk, she couldn’t talk, she couldn’t eat,” Singleton said.
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Singleton spent her days driving hours between her home in St. Petersburg, Florida, clinics for her mom’s chemo and radiation treatments, and her job as an attorney. The stress was constant. “As soon as you think you have a handle on what’s happening, things can change,” she said. “Medications can change, symptoms can pop up, there’s another specialist to see, there’s another thing to do. I felt like this conductor of a runaway train.”
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The experience of taking care of a parent while still in her 30s “was very isolating,” she said. Her new husband was supportive, but his main role was “to really try to keep his job” because her caregiving responsibilities put hers in jeopardy. Most of her peers didn’t yet understand what she was going through, and she had no script for handling the logistical obstacles she would face. “I felt so very unprepared for it.”
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As the baby boomer generation, born between 1946 and 1964, enters the period of life when, statistically, most people need some form of care, experts say that more millennials — as well as Gen X and Gen Z Americans — will find themselves in a position similar to Singleton’s, supporting an older relative with everything from specialized medical care to handling paperwork to daily tasks such as bathing and eating.
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For many, taking on the affairs of a parent or senior relative will add pressure on top of pressure. Americans are <a href="https://www.nytimes.com/2021/06/16/us/declining-birthrate-motherhood.html">having kids later in life</a>, meaning they’re more likely to find themselves in a “sandwich generation,” caring for elderly parents and young kids at the same time. Nearly 25 percent of American adults and more than half of people in their 40s <a href="https://www.pewtrusts.org/en/trust/archive/fall-2022/more-than-half-of-americans-in-their-40s-are-sandwiched">are “sandwiched,”</a> with at least one child to support and at least one parent over 65.
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Tomorrow’s caregivers will also face unprecedented career and financial challenges. Women, who have historically done the bulk of both elder and <a href="https://www.vox.com/child-care">child care</a>, are more likely than ever to <a href="https://www.americanprogress.org/article/breadwinning-mothers-continue-u-s-norm/">have careers and be breadwinners</a>. Many won’t be able to get time off work to provide the complex, ongoing assistance that many boomers will require. And they can’t afford to quit — faced with the Great Recession followed by the pandemic, younger workers, especially <a href="https://www.npr.org/sections/money/2021/04/27/990770599/there-is-growing-segregation-in-millennial-wealth">Black and non-college-educated millennials</a>, don’t have the accumulated wealth necessary to cushion any prolonged period of unemployment or to shoulder a relative’s expenses.
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“We are in a crisis of care,” said Carlene Davis, co-founder of the nonprofit Sistahs Aging With Grace &amp; Elegance (SAGE). It’s a crisis that American society, with no paid leave, a fragmented care system, and minimal public discussion around aging and disability, is woefully ill-equipped to handle.
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It’s a crisis that many people are finding themselves facing alone, with little support from policymakers, and little public conversation to tell them what to expect.
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As Singleton put it: “I felt like I was on my own.”
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The baby boomers are <a href="https://www.pewresearch.org/short-reads/2020/04/28/millennials-overtake-baby-boomers-as-americas-largest-generation/">a huge generation</a>. By 2030, the US will for the first time have <a href="https://www.aarp.org/home-family/friends-family/info-2018/census-baby-boomers-fd.html">more residents over 65</a> than children. Someone turning 65 today has a <a href="https://acl.gov/ltc/basic-needs/how-much-care-will-you-need#:~:text=Someone%20turning%20age%2065%20today,for%20longer%20than%205%20years">70 percent chance of needing long-term care</a> at some point, and 20 percent will need it for more than five years. Boomers are also living longer — <a href="https://www.prb.org/resources/aging-baby-boomers-to-face-caregiving-obesity-inequality-challenges/">life expectancy increased</a> from 68 years in 1950 to about <a href="https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220831.htm">76 years in 2021</a> — but are still vulnerable to conditions like Alzheimer’s disease, meaning they will need care for more years than previous generations.
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Elder care in America is a patchwork. <a href="https://www.medicare.gov/coverage/long-term-care">Medicare doesn’t cover</a> most long-term care, and seniors only become eligible for care through Medicaid when they have <a href="https://www.nytimes.com/2021/08/09/opinion/aging-nursing-home-medicare.html">almost no assets left</a>. Paying for professional care out of pocket can be <a href="https://www.nytimes.com/2021/08/09/opinion/aging-nursing-home-medicare.html">ruinously expensive</a> — the median annual cost of a full-time <a href="https://www.vox.com/the-highlight/2019/8/21/20694768/home-health-aides-elder-care">home health aide</a> was nearly <a href="https://www.genworth.com/aging-and-you/finances/cost-of-care.html">$60,000 in 2021</a>, while a semi-private room in a nursing home ran $94,000 per year or more. Those costs are out of reach for most boomers, more than 40 percent of whom have <a href="https://www.census.gov/library/stories/2022/08/who-has-retirement-accounts.html#:~:text=Demographics%20of%20Ownership&amp;text=About%20half%20(49.5%25)%20of,23%20owned%20a%20retirement%20account">no retirement savings</a>.
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That leaves family members to provide care themselves, reckon with mounting bills, or both. “Family caregivers are the backbone of the long-term care system,” says <a href="https://www.aarp.org/caregiving/experts/info-2019/amy-goyer.html">Amy Goyer</a>, the national family and caregiving expert at AARP.
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Boomers themselves have driven tectonic shifts in American cultural norms and family structures — a revolution in divorce, along with a trend toward smaller families and away from multigenerational living — that could make that backbone weaker. Compared to their elders, boomers will have fewer people in their lives able to step in and care for them as they age, says <a href="https://sociology.uwo.ca/people/profiles/margolis.html">Rachel Margolis</a>, a demographer and sociologist at the University of Western Ontario. In 2010, there were more than seven potential family caregivers for every person over 80; by 2030, that ratio is expected to fall to 4:1, and by 2050, it will be less than 3:1, <a href="https://www.aarp.org/home-family/caregiving/info-08-2013/the-aging-of-the-baby-boom-and-the-growing-care-gap-AARP-ppi-ltc.html">according to AARP</a>. More care responsibilities will fall on fewer family members, most of them adult children, who may find themselves caring for loved ones alone or with little help, sometimes across two different households.
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Michelle, 35, who asked that her last name not be used to protect her family’s privacy, cared for both her mother and father, who are separated and in their mid-70s, at the height of the pandemic, while also working full-time. “It was really, really hard to juggle everything,” she said. “I literally felt like I was lighting myself on fire to keep other people warm.”
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For Michelle, mornings might start with helping her dad out of bed, then helping him shower and eat breakfast. “You can’t take your eye off them,” she said. “You’re constantly having to be there.”
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There was nonstop laundry, meal-planning, and grocery shopping for two additional households. Michelle says that she spent a lot of mental energy “thinking of ways to help them adapt to this new way of life. If they’re struggling with taking their pills, or they’re struggling with eating, what kind of adaptive devices can I get for them?”
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Beyond the physical care, the difficulty of handling mountains of medical bills and logistics can be a shock to younger people who aren’t used to dealing with complex health situations, said Andrea Catlett, 45, who cares for and lives with her mother, who is legally blind, in Colorado. “It’s not just the actual care,” she said. “It’s the paperwork. It’s the calling. It’s the driving.”
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Michelle has struggled with “jealousy for my other friends that could lead a normal life, or they could pick up and move where they wanted.” She’s put her career aspirations on hold because of her caregiving responsibilities, and at this point, she can’t imagine having children. “I put that part of my life off because I was so burnt out with already being a caregiver for them that I could not fathom taking on anything else,” she said. (Her family ultimately got full-time care for her father.)
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Other adults are taking on elder care responsibilities while raising their own kids, and managing the overlapping needs is a unique challenge. John Adeniran, 26, and his wife take care of his mom, who has Alzheimer’s disease, alongside their 5-month-old daughter, and John works full time remotely as a data analyst. “The most difficult part right now is that my mom and my baby both need continuous care, and really at the same points in time,” he said.
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Sometimes, he says, the most he can do is “making sure that everybody’s well-fed, everybody’s clean, everybody’s taken care of, and everybody gets a walk in.” Often what suffers is his sleep. “My uninterrupted time is really the dead of night,” he says. “There are a lot of days where I’m pulling all-nighters.”
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During the day, he and his wife switch off with tasks like bathing his mom and helping her eat. He helps her up the stairs at night; his wife braids her hair. They’ve been taking care of his mom together since they got married last year so they “never really had that honeymoon phase,” Adeniran said. Despite the hardship, he said, it has given them perspective. “It has made us less critical of things that are very minute and really insignificant.”
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Taking care of his family is a labor of love for Adeniran. “Looking at my mom’s condition and how she carries herself with such dignity brings me a lot of joy,” he says. At the same time, “there can be deep moments of sorrow.”
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That emotional strain of caring can add up, with <a href="https://www.caregiver.org/resource/caregiver-health/">caregivers facing elevated risks</a> of depression and anxiety, alongside physical ailments like heart disease. “I was willing to neglect myself,” Singleton said. “I knew that my stress level was absolutely beyond, but I was just going to press on.” Then, one day, she had a panic attack while she was driving. “I said, nothing’s gonna get done if this is happening,” she remembers. “That was the point for me that I recognized that I needed more help.”
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Singleton found a therapist who had experience as a hospice nurse. “She got it. She knew what it was like to be a cancer caregiver,” Singleton said.
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Her mother had been working three jobs when she got sick and received disability payments, so they were able to afford caregiving assistance, Singleton says. “But that’s not available to everyone.”
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There’s no magic bullet<strong> </strong>to fix the multifaceted problem of a society that doesn’t care for its elders or those who care for them, experts say. A solution, however, starts with recognizing that increasing numbers of young and middle-aged people will be caring for their elders in the years to come, a reality that still receives little acknowledgment or discussion.
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“We didn’t know we’re gonna be caring for everybody in our 30s and 40s,” Catlett said. “You think that this is going to be the time where I can start doing stuff, but you are not going to be doing stuff. You’re going to be caregiving, and it can be isolating and lonely and a lot of work.”
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Current caregivers Vox spoke with say they believe the first step is combating the silence around the topic and having conversations with your elders about aging and care before a crisis hits. “They are not fun conversations,” Singleton said. “But if you have someone in your life you love, this is going to be part of the deal.”
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Caregivers and experts also call for policy reforms, from paid leave to changes in Medicaid eligibility and reimbursements, that would help elders and their families.
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Most caregivers don’t stop working completely, said <a href="https://crr.bc.edu/person/gal-wettstein/">Gal Wettstein</a>, a senior research economist at the Center for Retirement Research at Boston College. Instead, they often have to reduce their hours or take a different, more flexible job, and their earnings typically take a hit. It’s a “similar set of issues that arises with child care, and we know people <a href="https://www.nytimes.com/2014/09/07/upshot/a-child-helps-your-career-if-youre-a-man.html">pay a penalty</a> for that,” Wettstein said. Additionally, family caregivers spend an average of $7,242 out of pocket every year on expenses from home modifications to medical equipment for their loved ones, <a href="https://www.aarp.org/research/topics/care/info-2016/family-caregivers-cost-survey.html">according to AARP</a>.
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To remedy the financial, mental, and physical health crisis facing boomers and their children, experts say improved paid leave is crucial. Caregivers can take unpaid time off under the Family Medical Leave Act, but without a salary, many can’t afford to. “We need extensive and broad paid family leave,” Davis, the SAGE co-founder, said. “There’s no other way around it.”
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Expanding Medicaid eligibility to allow people to get coverage before they’ve exhausted all their assets would help the many middle- and lower-middle-income families who currently don’t qualify but can’t afford to pay out of pocket for care.
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Changing what Medicaid pays for could help, too. Some states are already <a href="https://www.medicaidplanningassistance.org/medicaid-hcbs-waivers/">experimenting with programs</a> that allow Medicaid to cover more care at home and in the community rather than in nursing homes. A few, like New York, even allow family caregivers to be paid through Medicaid, “but it’s not the norm,” Wettstein said — and payments are often far too low to cover the cost of living.
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Washington state, meanwhile, is experimenting with a new <a href="https://www.nytimes.com/2023/06/16/business/retirement-long-term-care-insurance.html">long-term care insurance program</a>, funded by a payroll tax and designed to cover about a year of care at home. “It’s not a lot,” Davis said, “but every bit helps.”
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In the absence of large-scale policy reforms, individual communities are looking for ways to care for one another as they age. “Folks’ real lives are at stake,” Davis said. “We can’t wait for policy to do everything.”
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Davis was inspired to start Sistahs Aging With Grace &amp; Elegance after caring for both of her parents as an only child, unmarried and without children of her own. “If something happened, there’s not a mini-me,” she said. “What that meant is that it would be important to build a more intentional community of support.” Today, the organization does outreach, education, policy, and advocacy work on behalf of Black women in their 40s and beyond. She and her co-founder, Kiara Harris, “wanted to create these safe, culturally specific, and culturally affirming spaces for Black women to come together to think about and plan for their aging journeys,” Davis said.
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Singleton, for her part, found a new career after caring for her mom. After she lost her job as a litigator when her medical leave ran out, “I was like, I don’t want to go back to that,” she said. “I want to be the kind of lawyer that I need right now.” Today, she works as a caregiver advocate, as well as writing and speaking about caregiving for AARP.
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When her mother was alive, Singleton didn’t yet have children. Now she’s a mom and has a new perspective on her time with her mother, who died in 2011. “The way that I’ve cared for and loved my daughter, it is really reminiscent of the way I cared for and loved my mom,” she said. Taking care of her mom was “almost a return of maternal energy back to her.”
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Indeed, “It’s difficult, but it’s also good,” said Adeniran. Despite the sleepless nights, “there’s so much beauty that still comes from this experience.”
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<h1 data-aos="fade-right" id="from-the-hindu-sports">From The Hindu: Sports</h1>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Bishan Singh Bedi, former India captain and legendary spinner, passes away at 77</strong> - Bedi, a prominent part of India’s famous spin quartet claimed 266 wickets in 67 Test matches</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>Para Asian Games | Indians win three gold on opening day</strong> - Three Indians also finished 1-2-3 in the men’s high jump T63 category but only gold and silver were awarded under Asian Paralympic Committee rules</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>Morning Digest | Indian Army to begin phase-out of Cheetah, Chetak from 2027; Israel strikes Gaza, Syria and West Bank, and more</strong> - Here is a select list of stories to start the day</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>Verstappen holds off Hamilton to earn hard-fought 50th career F1 victory at the U.S. Grand Prix</strong> - Red Bull’s Max Verstappen charged to his 15th win of the season and the 50th of his Formula One career at the United States Grand Prix</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>Cricket World Cup 2023 | Spin test from Afghanistan trio awaits unstable Pakistan middle-order</strong> - That the pace attack at Babar’s disposal has tended to drift whenever Afridi failed to nail early wickets will be a cause for concern for the team; Shahidi’s men will have to improve their catching a lot if they want to make a match out of it</p></li>
</ul>
<h1 data-aos="fade-right" id="from-the-hindu-national-news">From The Hindu: National News</h1>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>In 2018 rerun, Bhupesh Baghel promises farm loan waiver if Congress wins Chhattisgarh Assembly polls</strong> - Congress has made four key announcements — caste census, procurement of 20 quintals of paddy per acre, houses for 17.5 lakh people and now a farm loan waiver.</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>India will remain fastest-growing major economy in FY’24: Finance Ministry report</strong> - India’s macroeconomic outlook for fiscal 2023-24 is bright and is solidly underpinned by strong domestic fundamentals. Alongside private consumption, investment demand is also firming up, the Finance Ministry’s report 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>West Bengal passport scam: CBI arrests four officials</strong> - The probe agency had earlier arrested two RPO officials and four agents in connection with the fake passport case</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>‘Why is he being a coward?’: Ashok Gehlot on Shekhawat approaching court over Sanjivani ‘scam’</strong> - Rajasthan CM Ashok Gehlot also slammed Union Jal Shakti Minister Gajendra Singh Shekhawat for failing to declare the East Rajasthan Canal Project (ERCP) as a national project</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>Even bad Constitution turns out to be good if those running it are good, says CJI; quotes Ambedkar</strong> - The CJI made the observations during his keynote address at the Sixth International Conference on the ‘Unfinished Legacy of Dr. B.R. Ambedkar’ at the Brandeis University, Waltham, Massachusetts, in the U.S. on October 22.</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>Billionaires should face a minimum tax rate, report says</strong> - A 2% rate on the world’s wealthy could raise as much as $250bn a year, a report suggests.</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>Olympiakos-Panathinaikos: Player struck by firecracker</strong> - Panathinaikos defender Juankar is taken to hospital after being struck by a firework in the club’s abandoned match with Olympiakos.</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>Ukraine war: Six postal workers killed in Kharkiv missile strike</strong> - The regional governor Oleh Syniehubov says a further 16 people have been taken to hospital with injuries.</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>Bobi, the world’s oldest dog ever, dies aged 31</strong> - The Guinness World Record holder, from Portugal, lived to be 31 years and 165 days old.</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>Ukraine fears drone shortages due to China restrictions</strong> - Volunteers in Ukraine say it is harder to access Chinese-made drone parts after Beijing clamped down.</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>Space is starting to look like the better mining operation</strong> - Mining in space might be less environmentally harmful than mining asteroids on Earth. - <a href="https://arstechnica.com/?p=1977659">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Space Wreck is a hardcore, combat-optional, break-the-game RPG that clicks</strong> - It’s a deep simulation, a retro throwback, and a funny few hours at a time. - <a href="https://arstechnica.com/?p=1977497">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Carbon capture pipeline nixed after widespread opposition</strong> - Navigator CO₂ says regulatory hurdles are too much to overcome. - <a href="https://arstechnica.com/?p=1977635">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Feel-good story of the week: 2 ransomware gangs meet their demise</strong> - One is fatally hacked, the other shut down in international police dragnet. - <a href="https://arstechnica.com/?p=1977607">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Okta says hackers breached its support system and viewed customer files</strong> - Hackers obtained valid credentials, but Okta doesn’t say how. - <a href="https://arstechnica.com/?p=1977688">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Seen on X. Credit to <span class="citation" data-cites="614clinton">@614clinton</span></strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
An elderly man rear-ended a guy driving an expensive sports car.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Enraged, the guy hops out and confronts the old man.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Look what you did to my car” he yells. “You’re going to give me $10,000 right now or I’m going to beat you to a pulp!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Oh my” says the old man, "I don’t have that kind of money.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Let me call my son, he trains dolphins and he will know what to do."
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Dolphins” the other driver huffs, while rolling his eyes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The old man pulls out his phone, dials his son and just as his son answered, the irate man snatches the phone away from the old man.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“So, YOU’RE a dolphin trainer, huh? Well, Your old man here just rear-ended my car and I need 10 grand right now or I’m going to beat you AND your old man to a pulp.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“I’ll be there in 10 minutes,” says the voice calmly on the other end.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Exactly 10 minutes later a Jeep pulls up and a guy hops out and proceeds to pulverize the bully, leaving him in a heap on the side of the road.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
When he finished, he walked over to his father and said….
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
"For the last time dad, I train Seals, Navy Seals…..
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
NOT dolphins!"
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Cowboy_Reaper"> /u/Cowboy_Reaper </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/17e33za/seen_on_x_credit_to_614clinton/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/17e33za/seen_on_x_credit_to_614clinton/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A man was riding on a bus minding his own business…</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
… when the gorgeous woman next to him started to breast-feed her baby.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The baby wouldn’t take it so she said, “Come on sweetie, eat it all up or I’ll have to give it to this nice man next to us.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Five minutes later the baby was still not feeding, so she said, “Come on, honey. Take it or I’ll give it to this nice man here.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
A few minutes later the anxious man blurted out, “Come on kid. Make up your mind! I was supposed to get off four stops ago!”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Spiritual_Ear_3456"> /u/Spiritual_Ear_3456 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/17e3fk4/a_man_was_riding_on_a_bus_minding_his_own_business/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/17e3fk4/a_man_was_riding_on_a_bus_minding_his_own_business/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A soldier ran up to a nun.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Out of breath he asked, “Please, may I hide under your skirt. I’ll explain later.” The nun agreed… A moment later two Military Police ran up and asked, “Sister, have you seen a soldier?” The nun replied, “He went that way.” After the MPs ran off, the soldier crawled out from under her skirt and said, “I can’t thank you enough, sister. You see, I don’t want to go to Syria.” The nun said, “I understand completely.” The soldier added, “I hope I’m not rude, but you have a great pair of legs!” The nun replied, “If you had looked a little higher, you would have seen a great pair of balls…. I don’t want to go to Syria either.”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/notyourregularninja"> /u/notyourregularninja </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/17egbrb/a_soldier_ran_up_to_a_nun/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/17egbrb/a_soldier_ran_up_to_a_nun/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>I met a beautiful, strong willed woman.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
When I introduced myself as Frank she said “I wouldn’t have pegged you as a Frank.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
So I asked “What if my name was Joe?”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Cowboy_Reaper"> /u/Cowboy_Reaper </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/17e5sbo/i_met_a_beautiful_strong_willed_woman/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/17e5sbo/i_met_a_beautiful_strong_willed_woman/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>My friend had recently lost it all and started giving blows behind Wendy’s.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He come to me so excited after a couple days and said he’d made $300.50.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Puzzled, I asked him “who gave you .50?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He replied, “They all did!”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Recidive"> /u/Recidive </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/17e4qb8/my_friend_had_recently_lost_it_all_and_started/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/17e4qb8/my_friend_had_recently_lost_it_all_and_started/">[comments]</a></span></p></li>
</ul>
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