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+ + + ++Biological evidence suggests ursodeoxycholic acid (UDCA) - a common treatment of cholestatic liver disease - may prevent severe COVID-19 outcomes. With the approval of NHS England, we conducted a population-based cohort study using primary care records, linked to death registration data and hospital records through the OpenSAFELY-TPP platform. We estimated the hazard of COVID-19 hospitalisation or death between 1 March 2020 and 31 December 2022, comparing UDCA treatment to no UDCA treatment in a population with indication. Of 11,320 eligible individuals, 642 were hospitalised or died with COVID-19 during follow-up, 402 (63%) events among UDCA users. After confounder adjustment, UDCA was associated with a 21% (95% CI 7%-33%) relative reduction in the hazard of COVID-19 hospitalisation or death, consistent with an absolute risk reduction of 1.3% (95% CI 1.0%-1.6%). Our findings support calls for clinical trials investigating UDCA as a preventative measure for severe COVID-19 outcomes. +
+Restoring Energy With Sub-symptom Threshold Optimized Rehabilitation Exercise for Long COVID - Conditions: Long Covid19; Exercise Intolerance, Riboflavin-Responsive
Interventions: Behavioral: Restoring Energy with Sub-symptom Threshold Aerobic Rehabilitation Exercise; Behavioral: Light Stretching/Breathing Exercises
Sponsors: Columbia University; New York University
Recruiting
A Pilot Study of Liraglutide (A Weight Loss Drug) in High Risk Obese Participants With Cognitive and Memory Issues - Conditions: Multiple Sclerosis; Long COVID; Long Covid19; Obese; Obesity; Obesity, Morbid; Acute Leukemia in Remission
Interventions: Drug: Liraglutide Pen Injector [Saxenda]; Other: Medication Diary
Sponsors: University of Chicago
Not yet recruiting
EXERCISE TRAINING USING AN APP ON PHYSICAL CARDIOVASCULAR FUNCTION INDIVIDUALS WITH POST-COVID-19 SYNDROME - Conditions: Post-Acute COVID-19 Syndrome
Interventions: Behavioral: Exercise; Behavioral: Control
Sponsors: University of Nove de Julho
Not yet recruiting
A Phase 1 Trial of Recombinant COVID-19 Trivalent Protein Vaccine ïŒCHO CellïŒLYB002V14 in Booster Vaccination - Conditions: SARS-CoV-2; COVID-19 Vaccine
Interventions: Biological: 30ÎŒg dose of LYB002V14; Biological: 60ÎŒg dose of LYB002V14; Biological: placebo
Sponsors: Guangzhou Patronus Biotech Co., Ltd.; Yantai Patronus Biotech Co., Ltd.
Not yet recruiting
COVID-19 Vaccine Effectiveness Against Recurrent Infection Among Lung Cancer Patients and Biomarker Research - Conditions: COVID-19 Recurrent; Lung Cancer; Vaccination; Antibody; Chemotherapy; Immune Checkpoint Inhibitor
Interventions: Biological: Any Chinese government-recommended COVID-19 booster vaccine
Sponsors: Peking Union Medical College Hospital
Recruiting
IMMUNERECOV CONTRIBUTES TO IMPROVEMENT OF RESPIRATORY AND IMMUNOLOGICAL RESPONSE IN POST-COVID-19 PATIENTS. - Conditions: Long Covid19; Dietary Supplements; Respiratory Tract Infections; Inflammation
Interventions: Dietary Supplement: Nutritional blend (ImmuneRecov).
Sponsors: Federal University of SĂŁo Paulo
Recruiting
Physical Activity Coaching in Patients With Post-COVID-19 - Conditions: Post-COVID-19 Syndrome
Interventions: Behavioral: Self-monitoring; Behavioral: Goal setting and review; Behavioral: Education; Behavioral: Feedback; Behavioral: Contact; Behavioral: Exercise; Behavioral: Report; Behavioral: Social support; Behavioral: Group activities; Behavioral: World Health Organization recommendations for being physically active
Sponsors: University of Alcala; Professional College of Physiotherapists of the Community of Madrid
Not yet recruiting
Study on Post-Acute COVID-19 Syndrome in Improvement of COVID-19 Rehabilitated Patients by Respiratory Training - Conditions: COVID-19, Post-Acute COVID-19 Syndrome, Dyspnea, Incentive Spirometer
Interventions: Device: breathing training
Sponsors: Tri-Service General Hospital
Active, not recruiting
Ensitrelvir for Viral Persistence and Inflammation in People Experiencing Long COVID - Conditions: Long COVID; Post Acute Sequelae of COVID-19; Post-Acute COVID-19
Interventions: Drug: Ensitrelvir; Other: Placebo
Sponsors: Timothy Henrich; Shionogi Inc.
Not yet recruiting
Low-intensity Aerobic Training Associated With Global Muscle Strengthening in Post-COVID-19 - Conditions: COVID-19
Interventions: Procedure: muscle strengthening
Sponsors: Centro UniversitĂĄrio Augusto Motta
Completed
Intravenous Immunoglobulin Replacement Therapy for Persistent COVID-19 in Patients With B-cell Impairment - Conditions: COVID-19
Interventions: Drug: Immunoglobulins
Sponsors: Jaehoon Ko
Not yet recruiting
Effect of Inhaled Hydroxy Gas on Long COVID Symptoms - Conditions: Post-Acute COVID-19 Syndrome
Interventions: Device: Hydroxy gas
Sponsors: Oxford Brookes University
Recruiting
Community Care Intervention to Decrease COVID-19 Vaccination Inequities - Conditions: COVID-19 Vaccination
Interventions: Behavioral: Community Health Worker Intervention to Enhance Vaccination Behavior (CHW-VB)
Sponsors: RAND; Clinical Directors Network; National Institute on Minority Health and Health Disparities (NIMHD)
Recruiting
PROmotion of COVID-19 BOOSTer VA(X)Ccination in the Emergency Department - PROBOOSTVAXED - Conditions: COVID-19
Interventions: Behavioral: Vaccine Messaging; Behavioral: Vaccine Acceptance Question
Sponsors: University of California, San Francisco; National Institute of Allergy and Infectious Diseases (NIAID); Pfizer; Duke University; Baylor College of Medicine; Thomas Jefferson University
Not yet recruiting
Pursuing Reduction in Fatigue After COVID-19 Via Exercise and Rehabilitation (PREFACER): A Randomized Feasibility Trial - Conditions: Long-COVID; Long Covid19; Post-COVID-19 Syndrome; Post-COVID Syndrome; Fatigue
Interventions: Other: COVIDEx
Sponsors: Lawson Health Research Institute; Western University
Not yet recruiting
Decoy peptides effectively inhibit the binding of SARS-CoV-2 to ACE2 on oral epithelial cells - The entry of SARS-CoV-2 into host cells involves the interaction between the viral spike protein and the human angiotensin-converting enzyme 2 (ACE2) receptor. Given that the spike protein evolves rapidly to evade host immunity, therapeutics that block ACE2 accessibility, such as spike decoys, could serve as an alternative strategy for attenuating viral infection. Here, we constructed a drug screening platform based on oral epithelial cells to rapidly identify peptides or compounds capable ofâŠ
Efficacy and safety of zapnometinib in hospitalised adult patients with COVID-19 (RESPIRE): a randomised, double-blind, placebo-controlled, multicentre, proof-of-concept, phase 2 trial - BACKGROUND: Zapnometinib is an oral, non-ATP-competitive, small-molecule inhibitor of MEK1/MEK2 with immunomodulatory and antiviral properties. We aimed to investigate the safety and efficacy of zapnometinib in patients with COVID-19.
Design, synthesis and biological evaluation of betulinic acid derivatives as potential inhibitors of 3CL-protease of SARS-CoV-2 - During the coronavirus reproduction process, 3-chymotrypsin-like protease (3CLpro) and papain-like protease (PLpro) are accountable for the fragmentation of two polyprotein precursors (pp1a/pp1ab) into substructural proteins. These two proteins are vital for the replication and transcription of the viral genome. Therefore, 3CLpro is a key protein and target for the design of coronavirus inhibitors. In previous studies, we found that betulinic acid has an inhibitory effect on 3CLpro, with 51.5 %âŠ
Chlorogenic acid inhibits porcine deltacoronavirus release by targeting apoptosis - Porcine deltacoronavirus (PDCoV), belonging to family Coronaviridae, genus Deltacoronavirus, can cause acute diarrhea in piglets, and also possesses cross-species transmission potential, leading to severe economic losses and threatening public health. However, no approved drug against PDCoV infection is available. Here, we investigated the antiviral effect of chlorogenic acid (CGA), the main active component of Lonicerae Japonicae Flos, against PDCoV infection. The results showed that CGAâŠ
Protective Efficacy of Novel Engineered Human ACE2-Fc Fusion Protein Against Pan-SARS-CoV-2 Infection In Vitro and in Vivo - Enduring occurrence of severe COVID-19 for unvaccinated, aged, or immunocompromised individuals remains an urgent need. Soluble human angiotensin-converting enzyme 2 (ACE2) has been used as a decoy receptor to inhibit SARS-CoV-2 infection, which is limited by moderate affinity. We describe an engineered, high-affinity ACE2 that is consistently effective in tissue cultures in neutralizing all strains tested, including Delta and Omicron. We also found that treatment of AC70 hACE2 transgenic miceâŠ
C60 -based Multivalent Glycoporphyrins Inhibit SARS-CoV-2 Specific Interaction with the DC-SIGN Transmembrane Receptor - Since WHO has declared the COVID-19 outbreak a global pandemic, nearly seven million deaths have been reported. This efficient spread of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is facilitated by the ability of the spike glycoprotein to bind multiple cell membrane receptors. Although ACE2 is identified as the main receptor for SARS-CoV-2, other receptors could play a role in viral entry. Among others, C-type lectins such as DC-SIGN are identified as efficient trans-receptorâŠ
DYRK1A is a multifunctional host factor that regulates coronavirus replication in a kinase-independent manner - Coronaviruses, like other positive-sense RNA viruses, can remodel the host membrane to form double-membrane vesicles (DMVs) as their replication organelles. Currently, host factors involved in DMV formation are not well defined. In this study, we used transmissible gastroenteritis virus (TGEV) as a virus model to investigate the regulatory mechanism of dual-specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A) on coronavirus. Results showed that DYRK1A significantly inhibited TGEVâŠ
Phase I study, and dosing regimen selection for a pivotal COVID-19 trial of GST-HG171 - This study is aimed to evaluate the safety, tolerability, and pharmacokinetics (PK), as well as to select an appropriate dosing regimen for the pivotal clinical trial of GST-HG171, an orally bioavailable, potent, and selective 3CL protease inhibitor by a randomized, double-blind, and placebo-controlled phase I trial in healthy subjects. We conducted a Ph1 study involving 78 healthy subjects to assess the safety, tolerability, and PK of single ascending doses (150-900 mg) as well as multipleâŠ
Promises and Pitfalls of Calcineurin Inhibitors in COVID-19: A Systematic Review and Meta-analysis of Controlled Trials - CONCLUSION: CIs are able to inhibit the virus nucleocapsid protein so that they can prevent replication and respiratory tract tissue damage caused by SARS-CoV-2. Based on the characteristics mentioned in detail, CIs can play a potential therapeutic role for COVID-19 patients.
An overview of the role of Niemann-pick C1 (NPC1) in viral infections and inhibition of viral infections through NPC1 inhibitor - Viruses communicate with their hosts through interactions with proteins, lipids, and carbohydrate moieties on the plasma membrane (PM), often resulting in viral absorption via receptor-mediated endocytosis. Many viruses cannot multiply unless the hostâs cholesterol level remains steady. The large endo/lysosomal membrane protein (MP) Niemann-Pick C1 (NPC1), which is involved in cellular cholesterol transport, is a crucial intracellular receptor for viral infection. NPC1 is a ubiquitousâŠ
Acarbose reduces Pseudomonas aeruginosa respiratory tract infection in type 2 diabetic mice - CONCLUSIONS: This study confirmed the attenuating effect of acarbose on P. aeruginosa RTIs in T2DM and nondiabetic mice and investigated its mechanism, providing novel support for its clinical application in related diseases.
An exonuclease-resistant chain-terminating nucleotide analogue targeting the SARS-CoV-2 replicase complex - Nucleotide analogues (NA) are currently employed for treatment of several viral diseases, including COVID-19. NA prodrugs are intracellularly activated to the 5â-triphosphate form. They are incorporated into the viral RNA by the viral polymerase (SARS-CoV-2 nsp12), terminating or corrupting RNA synthesis. For Coronaviruses, natural resistance to NAs is provided by a viral 3â-to-5â exonuclease heterodimer nsp14/nsp10, which can remove terminal analogues. Here, we show that the replacement of theâŠ
Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts: a retrospective observational study in the Omicron era - CONCLUSION: Ongoing SARS-CoV-2 replication in the lower respiratory tract is a relevant differential diagnosis in patients with severe immunosuppression and continuous cough, fever or dyspnoea even if nasopharyngeal swabs test negative for SARS-CoV-2. Especially in B cell-depleted patients, this may lead to inflammatory or fibrotic-like pulmonary changes, which are partially reversible after inhibition of viral replication. Antiviral therapy seems to be most effective in combination and over aâŠ
Inhibitory effect of napabucasin on arbidol metabolism and its mechanism research - As a broad-spectrum antiviral, and especially as a popular drug for treating coronavirus disease 2019 (COVID-19) today, arbidol often involves drug-drug interactions (DDI) when treating critical patients. This study established a rapid and effective ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method to detect arbidol and its metabolite arbidol sulfoxide (M6-1) levels in vivo and in vitro. In this study, a 200 ÎŒL incubation system was used to study the inhibitoryâŠ
Tumor Treating Fields (TTFields) demonstrate antiviral functions in vitro, and safety for application to COVID-19 patients in a pilot clinical study - Coronaviruses are the causative agents of several recent outbreaks, including the COVID-19 pandemic. One therapeutic approach is blocking viral binding to the host receptor. As binding largely depends on electrostatic interactions, we hypothesized possible inhibition of viral infection through application of electric fields, and tested the effectiveness of Tumor Treating Fields (TTFields), a clinically approved cancer treatment based on delivery of electric fields. In preclinical models,âŠ
The Chancellor of Berkeley Weighs In - Carol Christ reflects on campus protests, then and now. - link
Watching Rudy Giuliani Self-Destruct at a Defamation Trial in Washington - A jury decided that Giuliani owes two election workers whom he defamed nearly a hundred and fifty million dollars. Even his lawyer suggested he âhasnât been so great lately.â - link
The Federal Reserve Is Trying to Catch Up with Falling Inflation - With price increases having greatly moderated, Jay Powell and his colleagues are trying to stick a âsoft landingâ for the economy. - link
A Harrowing Detention in Gaza - A Palestinian writer is mistaken for a Hamas activist by Israeli forces while he tries to flee Gaza with his family. Plus, a story of Christmas at the U.S. Embassy in Tehran. - link
The U.N. Human-Rights Chief and the Fugitive Princess of Dubai - Michelle Bacheletâs private meeting with Sheikha Latifa bint Mohammed Al Maktoum was viewed as proof that a long-imprisoned royal was finally free. In her first interview about the encounter, Bachelet reveals her doubts. - link
+Good God, give this US agency a few more dollars to stop a mass extinction. +
++Exactly five decades ago, Congress did what would be unimaginable today: It passed a powerful environmental law with almost unanimous support. In 1973, the House voted in favor of the Endangered Species Act, 390 to 12. +
++âNothing is more priceless and more worthy of preservation than the rich array of animal life with which our country has been blessed,â Republican President Richard Nixon said upon signing the act into law. +
++Among the most comprehensive environmental laws worldwide, the Endangered Species Act (ESA) was set up to protect the nationâs many plants and animals that are at risk of extinction. It makes it a federal crime to harm species that it deems endangered, with some exceptions. The act also requires that government agencies, such as the Army or the Federal Aviation Administration, try to avoid jeopardizing endangered species or the habitat they need to survive. +
++Over the last five decades, the law has undoubtedly helped save dozens of creatures from extinction, from American alligators to black-footed ferrets. Each is a success. Yet as the ESA heads into its next era â a period that will bring profound environmental change â its ability to stem the extinction crisis warrants a closer look. +
++At the core of the ESA is a list. On it are plants and animals that the US Fish and Wildlife Service (FWS) and the National Marine Fisheries Service (NMFS) â agencies that oversee the act on land and at sea, respectively â determine are at risk of extinction, or will be soon. Species in the former category are classified as âendangered,â and those in the latter are classified as âthreatened.â Typically, the government makes those determinations after environmental groups present it with overwhelming evidence, in the form of a petition, that a certain species is in peril. +
++As of late 2023, there are roughly 1,670 species on this list, according to a Vox analysis of data from the FWS and NMFS. Three-quarters of them are classified as endangered, while the rest are threatened. A little more than half of these threatened and endangered species are plants. (The endangered species list, and the numbers that appear in the graphic below, includes not only species but subspecies and certain populations within a species that the government determines are important on their own and at risk.) +
++Simply put, species that are on this list are protected. From here, things get a bit more complicated. +
++The Endangered Species Act makes it illegal to kill, harm, or capture endangered animals. The law refers to these actions collectively as âtake.â You canât, say, bring an endangered Florida panther home as a pet, or hunt one down. Plants and species classified as threatened are treated somewhat differently under the law, but in many cases the same rule applies, according to Daniel Rohlf, a law professor at Lewis and Clark Law School. On nonfederal lands, for example, itâs not illegal to harm endangered plants as long as itâs not in violation of any state laws. +
++Under the ESA, all government agencies are supposed to make sure that their activities minimize harm to endangered species and the habitat they need. That includes granting federal permits to private landowners and corporations for something like road construction. If those actions are likely to kill wildlife, the government agency in question essentially has to get sign-off from the FWS or NMFS before moving forward. That sign-off is typically contingent on the agency trying to minimize âtakeâ of the listed species or offering a less harmful alternative (such as a different route for the road). +
++While private companies and citizens typically canât harm endangered species either, there is an important exception. Companies can essentially get a permit to legally kill listed species if they submit to the government a plan to minimize harm and offset some of the impacts on those animals, such as by funding wildlife conservation. (In Hawaii, for example, some companies that inadvertently kill endangered seabirds with infrastructure like power lines and bright hotel lights have helped fund avian conservation.) +
+ ++The act does a number of other things for endangered species, such as requiring that the government craft a plan to restore these speciesâ populations. (If you want to learn more, the Congressional Research Service has a great primer.) +
++Among environmental advocates, the Endangered Species Act is widely considered the nationâs strongest conservation law. âItâs really one of the most successful land conservation efforts in US history,â said Noah Greenwald, endangered species director at the Center for Biological Diversity, an environmental advocacy group. +
++One of the most compelling lines of evidence that it works is that most species listed as endangered or threatened have not gone extinct. Theyâre still on Earth. +
++Since 1973, only around 32 listed species â less than 2 percent â have gone extinct. The list of the lost includes birds like the Bachmanâs warbler, mammals like the little Mariana fruit bat, and several species of freshwater mussels (one of the most imperiled groups of organisms nationwide). +
++Black-footed ferrets are among the species arguably saved from extinction by the ESA. In 1980, these cute, carnivorous mammals had vanished from the Great Plains and were presumed extinct. But one morning the following year, a ranch dog in the small town of Meeteetse, Wyoming, brought its owners a dead animal that looked like a mink, with some noticeable exceptions: It had black feet and a black mask. The owners brought the carcass to a local taxidermist, who recognized it as an endangered species. +
++The dogâs discovery helped lead researchers to an unknown population of black-footed ferrets. And animals from that population formed the basis of a successful captive breeding effort â which was bankrolled, in part, by the ESA. The breeding program has since introduced thousands of ferrets back to the wild across eight states, Canada, and Mexico. +
++In the last five decades, the government has removed more than 60 species from the endangered species list because, according to its assessment, theyâve recovered. (What it means for a species to have ârecoveredâ is hotly debated and doesnât always mean that the species is found throughout its historic range.) Among them: the American alligator, the peregrine falcon, three subspecies of Channel Island foxes, and a plant called the golden paintbrush. Each has its own success story. +
++Critics of the ESA, including Republican lawmakers, see that number of âdelistedâ species â which is obviously not enormous â as an indication that the law doesnât work. If the ESA were successful, they say, the government would have delisted more species by now. Theyâve used what some lawmakers have called a âdisappointing track recordâ to justify reforms that seek to weaken the actâs regulatory power. (Studies that examine whether or not species are recovering under the act show mixed results; some indicate that tools under the ESA are linked to population recovery, whereas others suggest those links are weak or undetectable.) +
++Environmental advocates like Greenwald see it differently. Recovery is a tall order, they say, especially for species that were on the brink of extinction when they were first listed, which is often the case. The number of species taken off the list is âa poor measure of the success of the ESA,â Greenwald and his colleagues at the Center for Biological Diversity wrote in a 2019 study. âMost species have not been protected for sufficient time such that they would be expected to have recovered.â +
++But even staunch defenders of the ESA say it could be doing much more. For one, the act protects only a fraction of the species that are slipping away. In the US, more than 5,300 plant and animal species are at a âhigh riskâ of extinction, according to NatureServe, a nonprofit data organization. These include species like the Bethany Beach firefly, a lightning bug native to coastal Delaware that scientists say is imperiled yet remains unprotected under the ESA. (Again, the act protects only about 1,670 species.) +
++âThere are hundreds and hundreds of species that need consideration for protection that the Fish and Wildlife Service isnât doing anything about,â Greenwald said. +
++Part of the problem, environmental groups say, is that the FWS is failing to work through a backlog of species that are in desperate need of protection. âUnder the ESA, decisions about protection for species are supposed to take two years, but on average, it has taken the Fish and Wildlife Service 12 years,â wrote researchers, including Greenwald, in a 2016 study. âSuch lengthy wait times are certain to result in loss of further species.â (A more recent assessment indicates that wait times between 2010 and 2020 were shorter, likely because the FWS received fewer petitions to list species during that time.) +
++The Fish and Wildlife Service is aware of these delays. Gary Frazer, the agencyâs assistant director for ecological services, which administers the act, blames them on funding and staff shortages. The process to formally declare a species endangered, which requires an extensive review, is expensive. +
++This is something that everyone seems to agree on: The FWS needs a lot more money from Congress to do its job. âCurrently, the Service only receives around 50% of the funding required to properly implement the Act,â as more than 120 environmental groups wrote in a letter to Congress in March 2023, urging the government to ramp up spending by hundreds of millions of dollars. (That may sound like a lot, but itâs a tiny, nearly imperceivable fraction of what the US spends on, say, national defense, or fails to recoup in fossil fuel subsidies.) +
++â[The ESA] isnât broken, itâs starving,â said Jamie Rappaport Clark, CEO and president of Defenders of Wildlife, a conservation group. (Sheâs stepping down from her role at Defenders next year.) âIt can do its job if itâs supported,â said Clark, who formerly led the FWS. âBut itâs not.â +
++Hereâs whatâs strange: Even though the FWS acknowledges there is a resource shortage, the agency doesnât ask Congress for more money outside of relatively modest budget increases, according to Brett Hartl, government affairs director at the Center for Biological Diversity. Whatâs more, the FWS actually asks Congress to restrict the amount it can spend to list species as threatened or endangered. According to Frazer, thatâs because the agency receives an enormous number of petitions. If it were to address all of them, he said, it would have to pull resources away from other important activities under the act. +
++(When asked why the FWS wouldnât just request more money overall for the ESA, a spokesperson for the agency said that âfederal funding decisions are complexâ and pointed me to the agencyâs recent budget justification. Hartl suspects the FWS doesnât ask for more funding because Frazer is highly risk averse and doesnât want to come under scrutiny for putting forward a more substantial budget request. There are also pro-industry ESA critics who say the law is already too restrictive, even in its underfunded state.) +
++Limited funding has forced officials and environmental advocates to prioritize efforts to save species in the most critical conditions â the ones that are about to blink out. And that leads to another criticism of the ESA: The law is reactive, helping species only when theyâre on the edge of extinction. It fails to address more fundamental problems that are driving wildlife declines in the first place. +
++In search of a more proactive approach, some policymakers have been trying to pass another environmental law, known as Recovering Americaâs Wildlife Act (RAWA). The act, as it was envisioned a few years ago, would funnel roughly $1.4 billion to states and Indigenous tribes to restore ailing animals, even before theyâre listed as endangered. But it has run into similar problems as the ESA â namely, policymakers canât figure out how to pay for it. Now the RAWA, at least as it was originally drafted, seems all but dead. +
+ ++Itâs not that the US government canât afford to fund conservation, said Ken Hayes, a conservation biologist at Hawaiiâs Bishop Museum, who has studied endangered species for more than two decades. The problem, he said, is that we, as a society, donât value biodiversity nearly as much as we should. âWe donât have a money problem,â he said. âWe have a prioritization problem.â +
+America rarely has its financial ducks in a row. Does it finally matter? +
++As though there were not enough things in the world to worry about at the moment, a perennial issue has once again been percolating: Is the United Statesâ financial house in order? Talk about the federal governmentâs deficit â meaning the difference between what it spends and what it collects in taxes â has started to pick back up. The same goes for chatter about the countryâs debt. Deficits are a gamble â a wager that the government paying out more than itâs taking in, especially as time goes on, is worth the risk. Not everyone thinks itâs such a good bet. +
++Some prominent economists who were once pretty laid back on the matter have started to change their tune. Not everyone is setting their hair on fire, but it has been a bit of a âWait, what?â moment in terms of deciphering just how much to worry, or whether to worry at all. +
++The federal deficit officially clocked in at $1.7 trillion in fiscal year 2023 (the governmentâs fiscal year runs from October 1 to September 30), up from almost $1.4 trillion in 2022. Thanks to some wonkiness around the Supreme Court-thwarted attempt to cancel student loan debt, it was actually likely closer to $2 trillion for 2023 and $1 trillion for 2022. In other words, the gap between what the government spends and what it makes is a big one â and about doubled from one year to the next. +
++There are some 2023-specific reasons that the deficit was particularly high; namely, the government saw a big dip in tax revenue. However, there are plenty of trends that arenât limited to this specific year. +
++Whatâs further spooked onlookers are higher interest rates, which have made the countryâs debt more expensive because of higher interest costs. Interest rates on US Treasury bonds started to climb over the summer and into the fall, and while they have come down from some of the highs they were at in October, they remain elevated overall, making people a little more nervous. +
++âYou know the meme thatâs like mess around and find out? Thatâs a little what happened here,â said Marc Goldwein, senior vice president and senior policy director for the Committee for a Responsible Federal Budget, a think tank focused on fiscal responsibility. Years of low interest rates, low inflation, and strong global savings, among other factors, made deficits palatable and easy to ignore in practice on both the right and the left (except when politically convenient). Now, the landscape has shifted. +
++Lawmakers have made the bet that deficits are worth the trade-off and the debt is manageable, and these soaring rates and their attendant anxiety show just how high the stakes of that gamble are. That risk also calls attention to how difficult the issue is, politically. While many experts say thereâs next to no chance of balancing the budget, getting revenue and spending back in line would require compromises few people on Capitol Hill are willing to make. Republicans donât want to raise taxes and keep cutting them instead, seemingly worrying about deficits largely only when theyâre not in office. Democrats donât want to curb spending, and raising taxes isnât easy. Itâs not clear what, if anything, would make anyone budge. +
++âI donât think youâre going to get a solution to this [deficit] until it really is something quite salient to the public, to politicians, and the thing that Iâve been saying for years is ⊠that will happen when markets start to care, when interest rates start to rise,â said Louise Sheiner, a senior fellow at the Brookings Institution and policy director of the Hutchins Center on Fiscal and Monetary Policy. Despite high interest rates, sheâs still not sure if this will prove to matter now. âThis may be just this little head-fake where interest rates went up and then they came back down and it was no big deal, or we may turn around and may look back at this moment in 10 years and say, âThat was the moment when people did start to worry about the deficit again and we started doing stuff.â I donât know which one it will be.â +
++The 2023 deficit wasnât necessarily outlandishly high. The deficit also topped $1 trillion in the years following the Great Recession. It was over $3 trillion in 2020 and more than $2 trillion in 2021 because of the pandemic and related spending under Presidents Donald Trump and Joe Biden. âYou had Donald Trump go on a huge tax cut and spending spree, and then Joe Biden went on a spending spree,â said Brian Riedl, senior fellow at the Manhattan Institute. +
++But the deficit being so high in a relatively normal period in 2023 â no recession, no war the US is fighting â is a bit different. What exactly were we spending money on, and why didnât we have the funds to cover it? +
++The main culprit this year is taxes (spending was only slightly higher than where it was in 2022). As Jim Tankersley at the New York Times explains, the government brought in an especially low amount of revenue. The IRS extended tax-filing deadlines for people because of natural disasters, including for most people in California, the countryâs most populous state. A lot of firms took advantage of a pandemic-era tax credit for retaining workers â some of those claims may be fraud. Capital gains taxes, which come when an asset, like a stock, is sold, also fell from 2022, when they were abnormally high. The decline in capital gains taxes is an effect of high interest rates from the Federal Reserve, which contributed to stock market declines and a downturn in companies going public. (This is a big issue in Californiaâs budget.) +
++âThe 2023 deficit was certainly anomalous, and I think people are using a âthatâs weirdâ as a point of proof, but I donât think it actually has much to do with genuine concern over fiscal risk,â said Michael Linden, senior policy fellow at the Washington Center for Equitable Growth. âThe trajectory of debt has not fundamentally shifted in the last few years.â +
++Still, the trajectory is one that some people find to be uncomfortable. +
++Tax revenue as a percentage of GDP was abnormally high in 2022 and in 2023, it reverted closer to what it was pre-pandemic. Tax cuts, including those put in place by George W. Bush (and made permanent under Barack Obama) and Donald Trump, are taking a bite out of revenue and will continue to do so. The Trump tax cuts are set to expire in 2025, and itâs not clear whether they might be extended. +
++At the same time, government spending is on track to continue growing. As baby boomers age, programs like Social Security and Medicare are getting costlier. Defense is always an expensive line item, and thereâs demand for more in order to help Israel and Ukraine. And thereâs the question of interest costs, too. +
++âPeople have changed their views because the aging population is starting to hit â the pre-programmed rise in Social Security and Medicare is happening, and people are looking at it in 10-year projections where it wasnât before, because baby boomers are retiring. The second issue is interest costs,â said Danny Yagan, an economics professor at the University of California, Berkeley. âThe truth is that the interest costs are a much smaller deal now than people think they are, because economic growth has edged out interest rates for years and is generally projected to for some time.â +
++Americaâs debt and the potential implications of high deficits were pretty easy to ignore in the lower interest rate environment the country has been in for the last several years. As borrowing costs rise, paying interest on Americaâs debt load becomes pricier, especially if those higher costs persist. +
++âThe debt used to appear costless, because the interest rates were, in many cases, below inflation and almost always, for the last 15 years, below economic growth,â Goldwein said. The debt issued when borrowing that was more or less free is now being rolled over, meaning renewed, at higher interest rates, he said. The Center for a Responsible Federal Budget notes that more than half of the countryâs debt matures over the next three years. +
++There are a number of factors potentially playing into interest rate increases on Treasury bonds in the financial markets, but thereâs no one single factor to pinpoint. The Federal Reserve has hiked interest rates to fight inflation and is expected to perhaps keep them there for a while. The New York Times points out strong growth, fewer buyers of American debt from abroad, and overall worries about debt sustainability as contributing factors. Sheiner, from the Brookings Institution, said brinkmanship over the debt ceiling, threats of a government shutdown, the overall political environment, and a downgrade on US credit could be part of it as well. âMarkets arenât always 100 percent rational, and you canât predict every day why itâs doing stuff,â Sheiner said. +
++âWhy did we see a spike of interest rates on federal debt over the last six months, and why is it coming down now? I donât think itâs obvious what the right answer is,â Linden said. +
++If the economy grows faster than interest rates, the general line is that running a deficit is more or less okay, because the debt-to-GDP ratio, an indicator of the countryâs ability to pay back its debts, doesnât increase. The problem would come if interest rates outpace economic growth. +
++Many economists and experts say itâs not time to panic â interest rates have come back down. âGrowth is definitely still higher than interest rates, but itâs closer than it was in the past,â Linden said. âIf the 10-year Treasuries were sustained at 5, 6, 7 percent for more than six months or something like that, I would start to be like, âOkay, is there something really going on here?â Especially if that happened at the same time as a Fed cut.â +
++Bobby Kogan, senior director of federal budget policy at the Center for American Progress, a progressive think tank, emphasized that itâs also important to take a look at what a high deficit is paying for. Kogan â who is in the camp that believes the Bush and Trump tax cuts are largely responsible for the issues of today â pointed out that the spending side of the equation is one that is popular. Most people donât want cuts to Social Security and Medicare. âAll else being equal, lower debt is better, but all else is never equal,â he said. âAll else being equal, we probably would want lower debt, but if you gave me an option between the current path and eviscerating the social safety net, thatâs a different question.â +
++The country isnât necessarily careening toward financial ruin because of its deficits and debt. To quote Kogan, âour current level of debt is manageable because weâre managing it.â But itâs something that probably has to be addressed eventually. +
++The worst-case scenario here would be something like a debt spiral, where higher interest rates and a growing debt mean the costs of servicing the debt get higher and higher, eventually spinning out of control and pushing deficits up more and more. But the worst-case scenario isnât the only undesirable one. There could be other consequences around slowing economic growth or âcrowding outâ investment, meaning the governmentâs needs on borrowing and spending impact borrowing and investing in the private sector. âYou donât need a crisis for debt to be bad,â Goldwein said. +
++Given the landscape, one might find themselves asking why the government doesnât take a look at the deficit before it gets out of hand. Thatâs where thereâs an awkward standoff. The GOP generally wants to cut taxes, and certainly not raise them, and would rather cut spending instead. Democrats do not want to cut spending, especially on vital programs such as Social Security and Medicare. Many Democrats would be into raising taxes, especially on corporations and the wealthy. They havenât had the numbers to do so in a big enough way, though the Biden administration has implemented some tax changes on corporate minimum tax and stock buyback tax, and is pushing for more funding for the IRS to collect more of whatâs owed. +
++âNeither party is remotely serious about either spending cuts or tax increases,â Reidl said. âThe momentum has shifted that people are at least talking about the deficit and theyâre not proposing a big expansion, but theyâre nowhere close to actually solving the deficit.â +
++âNot only do you not have to balance the budget, but itâs not clear that you could,â Goldwein said. Even if there were a âstaunch Paul Ryan-type figure,â referring to the former budget hawk Speaker of the House, who was looking to go after spending, itâs unlikely the issue could be addressed without looking at revenue, he added. âThe bottom line is either the middle class is going to have to contribute ⊠on the tax side or on the spending side,â he said. âThere really is no path if theyâre not part of it and realistically even that, I think, would be very hard.â +
++The runway isnât endless. The Social Security trust fund is expected to run out of money in about a decade, which means taxes or benefits would need to be cut or the government would have to find money somewhere else. +
++Republicans often claim that theyâre serious about addressing the deficit. This year, some hardline members of the House GOP have been fighting for spending cuts, proclaiming concerns for the budget. But when in power, the GOP has slashed taxes. Efforts even now seem insincere â many Republicans are also pushing to take funding away from the IRS, which would lower revenue, not increase it. +
++Democrats have taken a more complex approach to deficits. Thereâs an argument to be made that during the Obama years, Democrats were too worried about them. That resulted in a reluctance to spend and ultimately dampened the recovery from the Great Recession. +
++Part of whatâs disturbing about the situation is that nobody really knows the answer to what level of deficit is truly sustainable, what level of debt would be completely destabilizing, and if or when that day will arrive. Nobody can really predict the future here. +
++âWe will have to do something eventually. What does that mean? Nobody really knows what [that] eventually means, the longer you wait, the more you are shifting costs onto the future generation,â Sheiner said. âItâs always about intergenerational equity.â +
+Could it work in the US? +
++A massive social policy experiment is unfolding in Canada to provide families throughout the country with child care for an average of $10 a day. The plan, which was introduced in 2021 amid the turmoil of the pandemic, aims to spend up to 30 billion Canadian dollars by 2026 to bring down child-care costs for parents and to create 250,000 new slots. +
++The federally backed effort brings Canadaâs safety net closer to that of other Western democracies that have stepped up on child care, including Finland, Sweden, France, Germany, and Australia â and it could prove an inspiration to other countries whose systems still lag, like the United States. +
++Almost three years in, Canadian families are already seeing a significant drop in price, paying hundreds of dollars less for care each month than they were prior to 2021. Canada is making âsolid progress in offering more affordable child care,â concluded a think tank report issued in October. Five of Canadaâs 13 provinces and territories have already reached the $10-a-day child-care goal ahead of schedule, while others have reduced their fees by over 50 percent. ($10 in Canadian currency is roughly $7.50 in US dollars.) +
++In addition to reducing costs for parents, the plan has created about 52,000 new child-care spots, and in some provinces, like Nova Scotia, federal funding has helped boost the wages of early-childhood educators. +
++âThis is social infrastructure that will drive jobs and growth,â Canadaâs deputy prime minister, Chrystia Freeland, said of the policy in a 2021 budget speech. âThis is feminist economic policy. This is smart economic policy.â +
++Canada is a less populous country than the United States (about 40 million people to the USâs 340 million), and while it has never previously had a national child-care policy, it has long embraced a more sturdy safety net than the US, providing its citizens with universal health care and annual family allowances to parents. Moreover, Canada provides parents who want to stay home with their infants partial paid leave for up to 18 months. +
++Still, the two countries arenât âradically different,â Elliot Haspel, the author of Crawling Behind: Americaâs Child Care Crisis and How to Fix It, told Vox, âwhich is one reason [Canada is] an interesting near peer.â Like in the US, Canadian child-care advocates had been organizing with minimal success for decades prior to the pandemic â but unlike in the US, theyâre finally seeing meaningful progress. +
++Consequently, US activists and lawmakers are looking to this dramatic shift in Canadian child-care policy for inspiration, and leading congressional Democrats even began this year to incorporate the successful â$10 a dayâ idea into their own political messaging. The Child Care for Every Community Act, introduced in Congress in February, pledges to cap costs for all families and ensure that at least half of families nationwide pay no more than $10 a day. +
++The policy shift among Democratic lawmakers is backed by research from the progressive polling firm Data for Progress, which found that when it comes to building support for expanding food assistance, voters were more persuaded when presented with a dollar-per-meal framing compared with a dollar-per-month framing. This fact struck the pollsters, who soon realized the same concept held true when messaging on child care. +
++âItâs really about drilling down to the smallest dollar denominator that you can to get your point across,â Danielle Deiseroth, the executive director of Data for Progress, told Vox. âYou want to avoid having to do mental gymnastics to figure out how much things cost or youâll be spending. And for child care we found talking about the actual dollars and cents, especially given how top of mind inflation and high prices have been for voters, was particularly effective.â +
++Canadaâs national child-care plan is on a potentially transformative trajectory, but it didnât come out of nowhere; rather, years of locally driven organizing proved pivotal in finally moving the needle on the federal level. +
++Beginning in 1997, the province of Quebec invested in a universal and affordable child-care system with the goals of raising public revenue, helping more women join the labor force, and improving child development. While rollout of the effort has been uneven over the last 25 years, researchers found it has helped boost female workforce participation and that the public investments more than paid for themselves. Moreover, when child-care centers closed throughout Canada during the pandemic, the publicly subsidized centers in Quebec, which are less reliant on charging parents high fees to operate, were more able to stay open and bounce back to full enrollment. This comparative advantage was not lost on federal politicians struggling to lead Canada out of its economic downturn. +
++âIâve been defending private markets all my life. Iâm not an extreme leftist. But you also have to be pragmatic,â Pierre Fortin, an economist at the University of Quebec at Montreal, told Bloomberg in 2021. âChild care is an area where private markets donât do a very good job.â +
++Advocates in another Canadian province, British Columbia, began organizing for child care under the banner of $10 a day and, beginning in 2016, persuaded the provincial branch of Canadaâs New Democratic Party (NDP) to embrace the idea too. It became a central and popular legislative plank for the NDP, which identifies as a social democratic party, and helped propel it into government after British Columbiaâs 2017 provincial elections. +
++Carolyn Ferns, the policy coordinator at the Ontario Coalition for Better Child Care, said advocates in other provinces were wary at first about embracing the $10-a-day mantra pioneered in British Columbia, since for some low-income families, $10 a day is still too high. +
++âBut the simple language made a real difference in getting buy-in from the public and families, especially in terms of retail politics and just being able to explain to people on their doorstep what youâre doing,â Ferns told Vox. âThatâs what sold the federal government on it.â +
+ ++In the US, some advocates hope to chart a similar path by organizing landmark state-level child-care policy reforms. Earlier this year, Vermont legislators approved a first-of-its-kind package to pour tens of millions of new dollars into the stateâs child-care system, raising wages for child-care workers and reducing costs for families. The path to victory in Vermont involved a concerted 10-year advocacy effort backed by philanthropy and grassroots volunteers. +
++Similarly, in New Mexico, voters approved a historic ballot measure in 2022 to guarantee a constitutional right to early-childhood education, a political effort that came out of more than 10 years of organizing led by early-childhood educators and parents. National child-care advocates heralded the victories in both states and studied the campaigns, hoping to replicate them in other parts of the country. +
++In Canada, though, child-care advocates trace their efforts for a universal nationwide program back well beyond more recent grassroots efforts in the provinces, to the release of a federal report in 1970 that recommended steps to enhance equal opportunities for women throughout Canada. +
++Martha Friendly, who in 1982 founded the Childcare Resource and Research Unit, a small Toronto-based policy institute, has watched the social movement for child care grow in her country over 50 years. âA lot of the social infrastructure in Canada was developed postâWorld War II, and child care then wasnât viewed with a feminist lens, it was established before women were really entering the workforce in a large way,â she told Vox. âChild care was long conceived as a welfare program for the deserving poor, but in the 1980s and 1990s a real movement emerged to reframe child care as an important policy issue for women.â +
++Advocates like Friendly also credit feminist leaders like Freeland, who is also Canadaâs first female minister of finance, and former premier of Quebec Pauline Marois, who served as education minister between 1996 and 1998, with moving government-backed child care efforts forward. +
++Not everything has been smooth sailing in the implementation of Canadaâs child-care plan, especially in more densely populated provinces that have struggled to attract enough new workers to meet the demand for care. Most of the money thus far has gone into bringing down costs for families and not to recruiting and retaining more child-care workers. +
++âThe goal of offering child-care spaces at $10 a day is not the most difficult part. The difficult part is to create new child-care spaces, because it requires more people working in the sector,â Sophie Mathieu, an appointee on Canadaâs national advisory council on early learning and child care, told Vox. âCurrently child-care workers are not very well paid, even in Quebec.â +
++In November, child-care advocates across Canada organized a National Day of Action to demand further public investments. In Ontario, the most populous province, activists drew attention to the thousands of families stuck on waiting lists and the meager salaries of child-care workers. To address this, activists are calling for a clearer salary scale, beginning at $30 to $40 per hour for registered early childhood educators and $25 per hour for other staff. +
++A report issued by Torontoâs economic development committee in late November affirmed that in order to meet its 2017 goal of creating 30,000 new child-care slots by 2026, the city will need to add funding and raise wages and benefits âto levels comparable to positions in the public sector.â +
++Itâs not a new problem, even for countries that invest more heavily in their social safety nets; Haspel points to Germany, which is dealing with similar workforce issues. In 2013, Germany declared that all families have a legal right to child care, but then failed to invest enough in funding staff to meet demand. âIf you can get your kid into Kita [preschool] you are set, but itâs a huge scramble,â Haspel said. +
++Friendly, of the Childcare Resource and Research Unit, agrees that more investment into raising wages will be needed but said sheâs not too worried overall about Canadaâs efforts, as other countries have established comprehensive child-care systems through iterative progress over time. âI think building any kind of social program like this is push and pull,â she told Vox. âSo itâs not that Canadaâs effort is not successful, itâs that weâre in the first phase. In every country that is happy with their child-care system, it always took a lot of work.â +
++Canadaâs national child-care effort, which prioritizes nonprofit and public day cares, does have some critics, like Peter Jon Mitchell, of the conservative think tank Cardus, who would rather see the government just give families more money directly to spend. âThe federal government is trying to entrench an expensive but poor-quality program that serves a minority of programs and that only funds some forms of child care that parents use,â he told Vox. âAnd they really underestimate the cost and complexity of their plan.â +
++But Ferns, with the Ontario Coalition for Better Child Care, rejects this critique and argues itâs been tried before with little success. âWe had the conservative approach to child care for over a decade at the federal level under the [Stephen] Harper government, and it didnât make child care affordable,â she told Vox. âThey had universal child-care benefits, and child-care fees just went up. It didnât help improve accessibility, affordability, and quality.â +
++The $10-a-day effort in Canada offers a number of practical lessons that may aid child-care reformers in the United States. In addition to the value of working to seed local victories that can potentially be replicated nationally later on, and of simply not giving up, advocates praise Canadaâs savvy implementation and straightforward messaging on child-care reform. +
++One feature of the five-year child-care implementation plan that Haspel described as âreally smartâ is the federal governmentâs commitment to giving voters some immediate benefits as it works toward its larger affordability goal. As an interim step, provinces have already worked to bring average fees down by at least 50 percent. âSo you as a politician can say, âYou were paying $8,000, now youâre paying $4,000,â and weâre slowly continuing to build these new child-care sites online over time,â Haspel said. +
++Another possible lesson for the US â which, like Canada, faces a shortage of child-care workers â is Canadaâs openness to immigration. In addition to raising wages and benefits in the child-care sector, enlarging the workforce could help create new child-care slots. Mathieu told Vox itâs a âvery delicate issue,â but itâs one she and her colleagues on the national advisory council have been discussing. âItâs part of the solution,â she said. âItâs one solution among others.â +
++Advocates in the US also admit thereâs something fundamentally more appealing about Canadaâs $10-a-day concept than the more complicated advocacy language often used in the US about capping costs to a percentage of oneâs annual income. Democrats still use this more cumbersome messaging â it was included in Senate Democratsâ Child Care for Every Community Act, and the Biden administrationâs proposed child-care rule back in July. +
++âI like the simplicity of $10 a day,â said Marica Cox Mitchell, a leader with the Bainum Family Foundation, a Maryland-based philanthropy focused on early childhood. âItâs universal.â +
++Some, however, argue that implementing a Canada-style child-care plan pegged to a $10-a-day pledge isnât the best way to address family challenges in the US. Josh McCabe, the director of social policy at the DC-based Niskanen Center think tank, said he thinks the US would be better off focusing on prioritizing a paid leave policy similar to Canadaâs rather than trying to replicate the countryâs strategy around child care. +
++âCanada doesnât have to worry about supplying nearly as much infant care precisely because the majority of Canadian infants are being cared for at home by their parents for the first year of their life, when center-based care is at its most expensive,â he told Vox. âAnother reason to prioritize paid leave over child care is it reduces this problem.â +
++Many national advocacy groups in the US, including Moms First, Chamber of Mothers, and Moms Rising, reject the idea that politicians must choose one over the other and maintain that, like in Canada, activists in the United States can and should lay the political groundwork so leaders can capitalize on windows of opportunity when they arise. +
++âOur neighbors to the north have shown it is possible to cut across party lines and invest in a child-care system that works for more families,â said Jessica Sager, CEO of All Our Kin, a national group that trains and supports family child-care educators. âThe vision of a mixed-delivery system, which offers a variety of options to families, is already taking hold in parts of the US. While we can consider Canadaâs efforts, we can also find remarkable efforts across our own country.â +
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