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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>Early immune responses have long-term associations with clinical, virologic, and immunologic outcomes in patients with COVID-19</strong> -
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The great majority of SARS-CoV-2 infections are mild and uncomplicated, but some individuals with initially mild COVID-19 progressively develop more severe symptoms. Furthermore, mild to moderate infections are an important contributor to ongoing transmission. There remains a critical need to identify host immune biomarkers predictive of clinical and virologic outcomes in SARS-CoV-2-infected patients. Leveraging longitudinal samples and data from a clinical trial of Peginterferon Lambda for treatment of SARS-CoV-2 infected outpatients, we used host proteomics and transcriptomics to characterize the trajectory of the immune response in COVID-19 patients within the first 2 weeks of symptom onset. We define early immune signatures, including plasma levels of RIG-I and the CCR2 ligands (MCP1, MCP2 and MCP3), associated with control of oropharyngeal viral load, the degree of symptom severity, and immune memory (including SARS-CoV-2-specific T cell responses and spike (S) protein-binding IgG levels). We found that individuals receiving BNT162b2 (Pfizer-BioNTech) vaccine had similar early immune trajectories to those observed in this natural infection cohort, including the induction of both inflammatory cytokines (e.g. MCP1) and negative immune regulators (e.g. TWEAK). Finally, we demonstrate that machine learning models using 8-10 plasma protein markers measured early within the course of infection are able to accurately predict symptom severity, T cell memory, and the antibody response post- infection.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.27.21262687v1" target="_blank">Early immune responses have long- term associations with clinical, virologic, and immunologic outcomes in patients with COVID-19</a>
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<li><strong>Child and caregiver mental health during COVID-19</strong> -
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There are urgent calls for research into the mental health consequences of living through the COVID-19 pandemic. We describe caregiver and child mental health over 12 months using Australia9s only nationally representative, repeated cross-sectional survey of caregivers with children (0-17 years). N=2020 caregivers in June 2020, N=1434 in September 2020, and N=2508 in July 2021 provided data. Caregivers rated their mental health (Kessler-6), and impacts of the pandemic on their own and their children9s mental health. Data were weighted using national distribution of age, gender, number of children, state/territory and neighbourhood-level disadvantage. Mental health measures worsened over time. There was an unequal distribution of impacts based on caregiver gender, child age and family socioeconomic characteristics. Negative impacts were more common with current or cumulative lockdown. The indirect impacts of COVID-19 are real and concerning. Mental health must be central to the immediate and ongoing pandemic responses for families and children.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.26.21262708v1" target="_blank">Child and caregiver mental health during COVID-19</a>
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<li><strong>Previous Infection Combined with Vaccination Produces Neutralizing Antibodies With Potency Against SARS-CoV-2 Variants</strong> -
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SARS-CoV-2 continues to evolve in humans. Spike protein mutations increase transmission and potentially evade antibodies raised against the original sequence used in current vaccines. Our evaluation of serum neutralizing activity in both persons soon after SARS-CoV-2 infection (in April 2020 or earlier) or vaccination without prior infection confirmed that common spike mutations can reduce antibody antiviral activity. However, when the persons with prior infection were subsequently vaccinated, their antibodies attained an apparent biologic ceiling of neutralizing potency against all tested variants, equivalent to the original spike sequence. These findings indicate that additional antigenic exposure further improves antibody efficacy against variants.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.27.21262744v1" target="_blank">Previous Infection Combined with Vaccination Produces Neutralizing Antibodies With Potency Against SARS-CoV-2 Variants</a>
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<li><strong>Highly valued despite burdens: qualitative implementation research on rapid tests for hospital-based SARS-CoV-2 screening</strong> -
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Antigen-based rapid diagnostic tests (RDTs) for SARS-CoV-2 have good reliability and have been repeatedly implemented as part of pandemic response policies, especially for screening in high-risk settings (e.g., hospitals and care homes) where fast recognition of an infection is essential, but evidence from actual implementation efforts is lacking. We conducted a prospective qualitative study at a large tertiary care hospital in Germany where RDTs are used to screen incoming patients. We relied on semi-structured observations of the screening situation, as well as on 30 in- depth interviews with hospital staff (members of the regulatory body, department heads, staff working on the wards, staff training providers on how to perform RDTs, and providers performing RDTs as part of the screening) and patients being screened with RDTs. Despite some initial reservations, RDTs were rapidly accepted and adopted as the best available tool for accessible and reliable screening. Decentralized implementation efforts resulted in different procedures being operationalized across departments. Procedures were continuously refined based on initial experiences (e.g., infrastructural or scheduling constraints), pandemic dynamics (growing infection rates), and changing regulations (e.g., screening of all external personnel). To reduce interdepartmental tension, stakeholders recommended high-level, consistently communicated and enforced regulations. Despite challenges, RDT-based screening for all incoming patients was observed to be feasible and acceptable among implementers and patients, and merits continued consideration in the context of rising infections and stagnating vaccination rates.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.27.21262660v1" target="_blank">Highly valued despite burdens: qualitative implementation research on rapid tests for hospital-based SARS-CoV-2 screening</a>
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<li><strong>COVID-19 infection among health care workers: Experience in Base Hospital Wathupitiwala,Sri Lanka.</strong> -
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Abstract: Coronavirus disease 2019 (COVID-19) is a serious global health pandemic resulting in high mortality and morbidity. Frontline health care workers (HCWs) are at an increased risk of the acquisition of severe acute respiratory syndrome coronavirus-2 infection (SARS CoV-2) due to their close interaction with infected patients (1, 2). Also, HCWs can serve as reservoirs of SARS CoV-2 cross-transmission both in community and hospital settings (1). However, the extent of COVID-19 infection among HCWs in Sri Lanka is understudied. Objectives: This study determined the incidence, demographic characteristics, and risk exposure behavior of HCWs who tested positive for SARS CoV-2 at Base Hospital Wathupitiwala. Furthermore, the rate of acquisition of SARS CoV-2 following COVISHIELD/ChAdOx1 nCoV-19 and Sinopharm /BBIBP-CorV vaccines in HCWs were studied. Methods: A retrospective cross-sectional descriptive analysis was conducted from May 2021 to August 2021 for a total of 818 HCWs. Results: Hundred and twenty-four HCWs (15.16%) were tested positive for COVID-19. The mean age of infected HCWs was 46.27 years and the majority were females (74.19%). Among all infected persons, 54 (43.55%) were nurses/midwives, 39 (31.45%) were clinical supportive staff and 12(9.68%) were medical officers. The number of infected HCWs rapidly escalated and a total of 64(51.61%) HCWs got an infection during August/2021. No source was identified in most of them (34.68%) followed by community acquisition (33.87%). Thirty-five HCWs (28.23%) had acquired infection during a hospital setting or had a high-risk exposure in recent history. Among hospital-related infections, 37.91% of HCWs had shared meals or shared sleeping rooms with an infected workmate. The majority of the HCWs were tested by the infection control unit as symptomatic screening (70.16%) followed by contact tracing (20.16%). Fifty-six (45.16%) HCWs had a history of single or multiple comorbidities. The vast majority of HCWs (95.97%) presented as mild to asymptomatic disease that followed an uneventful recovery. Body aches, headache, fever, and sore throat were the most commonly reported symptoms among them. Among the five HCWs required therapeutic oxygen supplementation, two unvaccinated HCWs succumbed to the infection. The rate of breakthrough infection among HCWs was 8.93%. The acquisition of disease was significantly higher among unvaccinated HCWs than partially (p&lt;0.0001) or fully vaccinated (p&lt;0.0001) HCWs with either type of vaccine. Conclusions: Protecting HCWs remains a challenge in resource-poor settings. The risk of infection fueled by very contagious circulating variants is continuously high even though vaccination has shown clear benefits in preventing mortality and severe infection. Therefore, all healthcare workers should be vaccinated while ensuring continuous infection control measures in the hospital setting.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.28.21262733v1" target="_blank">COVID-19 infection among health care workers: Experience in Base Hospital Wathupitiwala,Sri Lanka.</a>
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<li><strong>Direct Comparison of Antibody Responses to Four SARS-CoV-2 Vaccines in Mongolia</strong> -
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Different vaccines for SARS-CoV-2 are approved in various countries, but few direct comparisons of the antibody responses they stimulate have been reported. We collected plasma specimens in July 2021 from 196 Mongolian participants fully vaccinated with one of four Covid vaccines: Pfizer/BioNTech, AstraZeneca, Sputnik V and Sinopharm. Functional antibody testing with a panel of nine SARS-CoV-2 viral variant RBD proteins reveal marked differences in the vaccine responses, with low antibody levels and RBD-ACE2 blocking activity stimulated by the Sinopharm and Sputnik V vaccines in comparison to the AstraZeneca or Pfizer/BioNTech vaccines. The Alpha variant caused 97% of infections in Mongolia in June and early July 2021. Individuals who recover from SARS-CoV-2 infection after vaccination achieve high antibody titers in most cases. These data suggest that public health interventions such as vaccine boosting, potentially with more potent vaccine types, may be needed to control the COVID-19 pandemic in Mongolia and worldwide.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.22.21262161v1" target="_blank">Direct Comparison of Antibody Responses to Four SARS-CoV-2 Vaccines in Mongolia</a>
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<li><strong>Behavioural barriers to COVID-19 testing in Australia: Two national surveys to identify barriers and estimate prevalence by health literacy level</strong> -
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Background: COVID-19 testing and contact tracing has been crucial in Australia9s prevention strategy. However, testing for COVID-19 is far from optimal, and behavioural barriers are unknown. Study 1 aimed to identify the range of barriers to testing. Study 2 aimed to estimate prevalence in a nationally relevant sample to target interventions. Methods: Study 1: National longitudinal COVID-19 survey from April-November 2020. Testing barriers were included in the June survey (n=1369). Open responses were coded using the COM-B framework (capability-opportunity-motivation). Study 2: Barriers from Study 1 were presented to a new nationally representative sample in November to estimate prevalence (n=2869). Barrier prevalence was analysed by health literacy level using Chi square tests. Results: Study 1: 49% strongly agreed to get tested for symptoms, and 69% would self-isolate. Concern about pain was the top barrier from a provided list (11%), but 32 additional barriers were identified from open responses and coded to the COM-B framework. Study 2: The most prevalent barriers were motivation issues (e.g. don9t believe symptoms are COVID-19: 28%, few local cases: 18%). Capability issues were also common (e.g. not sure symptoms are bad enough: 19%, not sure whether symptoms need testing: 15%). Many barriers were more prevalent amongst people with low compared to high health literacy, including motivation (preference to self isolate: 21% vs 12%, pain: 15% vs 9%) and capability (not sure symptom needs testing: 12% vs 8%, not sure how to test:11% vs 4%). Conclusion: Even in a health system with free and widespread access to COVID-19 testing, motivation and capability barriers were prevalent issues, particularly for people with lower health literacy. This study highlights the important of diagnosing behaviour barriers to target public health interventions for COVID-19 and future pandemics.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.26.21262649v1" target="_blank">Behavioural barriers to COVID-19 testing in Australia: Two national surveys to identify barriers and estimate prevalence by health literacy level</a>
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<li><strong>LESSONS FROM THE COVID-19 THIRD WAVE IN CANADA: THE IMPACT OF VARIANTS OF CONCERN AND SHIFTING DEMOGRAPHICS</strong> -
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Importance: With the emergence of more transmissible SARSCoV2 variants of concern (VOC), there is an urgent need for evidence about disease severity and the health care impacts of VOC in North America, particularly since a substantial proportion of the population have declined vaccination thus far. Objective: To examine 30day outcomes in Canadians infected with SARSCoV2 in the first year of the pandemic and to compare event rates in those with VOC versus wild type infection. Design: Retrospective cohort study using linked healthcare administrative datasets. Setting: Alberta and Ontario, the two Canadian provinces that experienced the largest third wave in the spring of 2021. Participants: All individuals with a positive SARSCoV2 reverse transcriptase polymerase chain reaction swab from March 1, 2020 until March 31, 2021, with genomic confirmation of VOC screen positive tests during February and March 2021 (wave 3). Exposure of Interest: VOC versus wild type SARSCoV2 Main Outcomes and Measures: All-cause hospitalizations or death within 30 days after a positive SARSCoV2 swab. Results: Compared to the 372,741 individuals with SARSCoV2 infection between March 2020 and January 2021 (waves 1 and 2 in Canada), there was a shift in transmission towards younger patients in the 104,232 COVID19 cases identified in wave 3. As a result, although third wave patients were more likely to be hospitalized (aOR 1.34 [1.29 to 1.39] in Ontario and aOR 1.53 [95%CI 1.41 to 1.65] in Alberta), they had shorter lengths of stay (median 5 vs. 7 days, p&lt;0.001) and were less likely to die within 30 days (aOR 0.66 [0.60 to 0.71] in Ontario and aOR 0.74 [0.62 to 0.89] in Alberta). However, within the third wave, patients infected with VOC (91% Alpha) exhibited higher risks of death (aOR 1.52 [1.27 to 1.81] in Ontario and aOR 1.67 [1.13 to 2.48] in Alberta) and hospitalization (aOR 1.57 [1.47 to 1.69] in Ontario and aOR 1.88 [1.74 to 2.02] in Alberta) than those with wild- type SARSCoV2 infections during the same timeframe. Conclusions and Relevance: On a population basis, the shift towards younger age groups as the COVID19 pandemic has evolved translates into more hospitalizations but shorter lengths of stay and lower mortality risk than seen in the first 10 months of the pandemic in Canada. However, on an individual basis, infection with a VOC is associated with a higher risk of hospitalization or death than the original wild type SARSCoV2; this is important information to address vaccine hesitancy given the increasing frequency of VOC infections now.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.27.21261857v1" target="_blank">LESSONS FROM THE COVID-19 THIRD WAVE IN CANADA: THE IMPACT OF VARIANTS OF CONCERN AND SHIFTING DEMOGRAPHICS</a>
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<li><strong>COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. PUBLISHED VERSION: https://doi.org/10.1186/s12879-021-06357-4</strong> -
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Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk (“Emmentaler cheese model”), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
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🖺 Full Text HTML: <a href="https://osf.io/k2d84/" target="_blank">COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. PUBLISHED VERSION: https://doi.org/10.1186/s12879-021-06357-4</a>
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<li><strong>Implementation of a Web-Based Symptom Checker to Manage the Quarantine of the USS Theodore Roosevelt Crew Following a Shipboard Outbreak of SARS-CoV-2</strong> -
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Introduction: In late March 2020, the USS Theodore Roosevelt (TR), a nuclear-powered aircraft carrier, pulled into port in the US territory of Guam to assess the severity of a developing outbreak of COVID-19 aboard the ship. A small staff contingent of 60 personnel from US Naval Hospital (USNH) Guam was tasked with the medical care of 4,079 sailors who were placed in single room quarantine amongst 11 hotels across the island of Guam. With the assistance of the Defense Digital Service, the USNH Guam staff implemented a web-based symptom checker, which allowed for monitoring of developing COVID symptoms, and selective testing of symptomatic individuals. Materials and Methods: Sailors from the TR were placed in quarantine or isolation cohorts upon debarking the ship. Sailors not positive for COVID-19 were quarantined amongst 11 hotels on Guam. Sailors positive for COVID-19 were isolated aboard Naval Base Guam (NBG). A retrospective cohort analysis and subgroup analyses were performed on symptom data obtained from sailors in quarantine. The sailors recorded their symptoms and temperature in a web-based symptom checker that assigned a symptom severity score (SSS). Sailors with a SSS &gt;50 were evaluated by a medical provider and re-tested. Data were collected from 4 April 2020 to 1 May 2020. Sailors required two negative tests to exit quarantine and re-embark the ship. The time course, and most common cluster of symptoms associated with a positive COVID-19 PCR test were determined retrospectively after data collection. Results: The web-based symptom checker was successful in establishing daily positive contact and symptom monitoring of susceptible individuals in quarantine. 4,079 sailors in quarantine maintained positive contact with medical staff via the symptom checker, with at least 81% of the sailors recording their symptoms on a daily basis. Individuals with high symptom scores were quickly identified and underwent further evaluation and repeat COVID-19 testing. A cohort of 331 sailors tested positive for COVID-19 while in quarantine and recorded symptoms in the symptom checker before and after a positive COVID-19 test. In this cohort, the most frequent symptoms reported prior to a positive test were headache, anosmia, followed by cough. The symptom of anosmia was reported more frequently in sailors positive for COVID-19, compared to a cohort of matched controls. A small medical staff was able to monitor developing symptoms in a large quarantined population, while efficiently allocating resources, preserving personal protective equipment (PPE), and maintaining isolation and social distancing protocols. Conclusions and Relevance: The application provided a tool for broad health surveillance over a large population while maintaining strict quarantine and social distancing protocols. Highly symptomatic sailors were quickly identified, triaged, and transferred to a higher level of care if indicated. The symptom checker and predictive model generated from the data can be utilized by military and civilian public health officials to triage large populations and make rapid decisions on isolation measures, resource allocation, selective testing.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.25.21254738v1" target="_blank">Implementation of a Web-Based Symptom Checker to Manage the Quarantine of the USS Theodore Roosevelt Crew Following a Shipboard Outbreak of SARS- CoV-2</a>
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<li><strong>Effectiveness of vaccination against symptomatic and asymptomatic SARS-CoV-2 infection: a systematic review and meta-analysis</strong> -
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OBJECTIVE: To assess the effectiveness of SARS-CoV-2 vaccines in terms of prevention of disease and transmission. The evaluation was narrowed to two mRNA vaccines and two modified adenovirus vectored vaccines. METHODS: A frequentist random effects meta-analysis was carried out after data extraction. Risk of bias of the included studies was assessed using New-Castle-Ottawa Scale. The overall risk of SARS-CoV-2 infection confirmed by real time Polymerase Chain Reaction (PCR) was estimated in partially and fully vaccinated individuals. The effect size was expressed as Relative Risk (RR) and RRR (RR reduction) of SARS-CoV-2 infection after vaccination. Potential sources of heterogeneity were investigated through between-study heterogeneity analysis and subgroup meta-analysis. RESULTS: The systematic review identified 27 studies eligible for the quantitative synthesis. Partially vaccinated individuals presented a RRR=73% (95%CI=59%-83%) for any positive SARS-CoV-2 PCR (RR=0.27) and a RRR=79% (95%CI=30%-93%) for symptomatic SARS-CoV-2 PCR (RR=0.21). Fully vaccinated individuals showed a RRR=94% (95%CI=88%-98%) for any SARS-CoV-2 positive PCR (RR=0.06) compared to unvaccinated. According to the subgroup meta-analysis, full BNT162b2 vaccination protocol achieved a RRR=84%-94% against any SARS-CoV-2 positive PCR and a RRR=68%-84% against symptomatic positive PCR. The RR for any SARS-CoV-2 positive PCR remained higher within elderly groups aged ≥69 years (RR=0.12-0.15) compared to younger individuals (RR=0.05-0.12). The RR against B.1.351 infection approached 0.40 for any positive PCR and 0.36 for symptomatic SARS-COV-2 while the RR of any B.1.1.7 infection was 0.14. CONCLUSION: The current licensed vaccines may be transmission blocking, especially after full vaccination protocol. Given the substantial heterogeneity, results should be interpreted with caution. Subgroups meta-analyses suggested that the risk of any SARS-CoV-2 infection may be higher for non-B.1.1.7 variants and individuals aged ≥69 years. Further data and longer follow-up are required to investigate additional sources of heterogeneity and the effectiveness of SARS-CoV-2 vaccination within population subgroups.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.25.21262529v1" target="_blank">Effectiveness of vaccination against symptomatic and asymptomatic SARS-CoV-2 infection: a systematic review and meta-analysis</a>
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<li><strong>Socioeconomic and comorbid factors affecting mortality and length of stay in COVID-19</strong> -
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Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic exposed and exacerbated health disparities between socioeconomic groups. Our purpose was to determine which disparities are most prevalent and their impact on length of stay (LoS) and in hospital mortality in patients diagnosed with Covid-19. Methods De- Identified data for patients who tested positive for COVID-19 was abstracted from the HCA enterprise database. Data was binned into summary tables. A negative binomial regression with LoS as the dependent variable and a logistic regression of in-hospital mortality data, using age, insurance status, sex, comorbidities as the dependent variables, were performed. Results From March 1, 2020 to August 23, 2020, of 111,849 covid testing patient records, excluding those with missing data (n=7), without confirmed COVID-19 (n=27,225), and those from a carceral environment (n=1,861), left 84,624 eligible patients. Compared to the US population, the covid cohort had more black patients (23.17% vs 13.4%). Compared to the white cohort, the black cohort had higher private insurance rates (28.52% vs. 23.68%), shorter LoS (IRR=0.97 CI=0.95-0.99, P&lt;0.01) and lower adjusted mortality (OR 0.81, 95% CI 0.75-0.97). Increasing age was associated with increased mortality and LoS. Patients with Medicare or Medicaid had longer LoS (IRR=1.07, 95% CI=1.04-1.09) and higher adjusted mortality rates (OR=1.11, 95% CI=1-1.23) than those with private insurance Conclusion Conclusions We found that when blacks have higher rates of private insurance, they have shorter hospitalizations and lower mortality than whites, when diagnosed with Covid-19. Some other psychiatric and medical conditions also significantly impacted outcomes in patients with Covid-19.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.26.21262693v1" target="_blank">Socioeconomic and comorbid factors affecting mortality and length of stay in COVID-19</a>
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<li><strong>Association between tocilizumab, sarilumab and all-cause mortality at 28 days in hospitalized patients with COVID-19: A network meta-analysis</strong> -
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Objective: To estimate pairwise associations between administration of tocilizumab, sarilumab and usual care or placebo with 28-day mortality, in COVID-19 patients receiving concomitant corticosteroids and non-invasive or mechanical ventilation, based on all available direct and indirect evidence. Methods: Eligible trials randomized hospitalized patients with COVID-19 that compared either interleukin-6 receptor antagonist with usual care or placebo in a recent prospective meta-analysis (27 trials, 10930 patients) or that directly compared tocilizumab with sarilumab. Data were restricted to patients receiving corticosteroids and either non-invasive or invasive ventilation at randomization. Pairwise associations between tocilizumab, sarilumab and usual care or placebo for all-cause mortality 28 days after randomization were estimated using a frequentist contrast-based network meta-analysis of odds ratios (ORs), implementing multivariate fixed-effects models that assume consistency between the direct and indirect evidence. Results: One trial (REMAP-CAP) was identified that directly compared tocilizumab with sarilumab and supplied results on all-cause mortality at 28-days. This network meta-analysis was based on 898 eligible patients (278 deaths) from REMAP-CAP and 3710 eligible patients from 18 trials (1278 deaths) from the prospective meta-analysis. Summary ORs were similar for tocilizumab [0.82 [0.71-0.95, P=0.008]] and sarilumab [0.80 [0.61-1.04, P=0.09]] compared with usual care or placebo. The summary OR for 28-day mortality comparing tocilizumab with sarilumab was 1.03 [95%CI 0.81-1.32, P=0.80]. The P value for the global test for inconsistency was 0.28. Conclusion: Administration of either tocilizumab or sarilumab was associated with lower 28-day all-cause mortality compared with usual care or placebo. The association is not dependent on the choice of interleukin-6 receptor antagonist.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.26.21262523v1" target="_blank">Association between tocilizumab, sarilumab and all-cause mortality at 28 days in hospitalized patients with COVID-19: A network meta- analysis</a>
</div></li>
<li><strong>Profile of Mucormycosis Cases from a Network of Hospitals in North India Amidst COVID-19 Pandemic</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Incidence of mucormycosis suddenly surged in India after the second wave of COVID-19. This is a crippling disease and needs to be studied in detail to understand the disease, its course, and the outcomes. Between 1st March and 15th July 2021, our network of hospitals in North India received a total of 155 cases of COVID-associated mucormycosis cases as all of them reported affliction by COVID-19 earlier or concurrent. Their records were retrieved from the Electronic Health Records system of the hospitals and their demographics, clinical features, treatments, and outcomes were studied. More than 80% (125 cases) had proven disease and the remaining 30 were categorized as possible mucormycosis as per the EORTC criteria. More than two-thirds (69.0%) of the cases were males and the mean age was 53 years for either sex. Nearly two-thirds (64.5%) had symptoms of nose and jaws and 42.6% had eye involvement. Some had multiple symptoms. As many as 78.7% had diabetes and 91.6% gave history of use of steroids during COVID-19 treatment. The primary surgery was functional endoscopic sinus surgery (FESS) (83.9%). Overall mortality was 16.8%, which is one- and-a-half times the mortality in hospitalized COVID-19 patients in the corresponding population. Occurrence of mucormycosis was associated with diabetes and use of steroids, but mortality was not associated with either of them. Cases undergoing surgery and on antifungal had steeply lower mortality (11.9% vs. 50.0%, P &lt; 0.001) than those who were exclusively on antifungal drugs. Treatment by different drugs did not make much of a difference in mortality.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.25.21262404v1" target="_blank">Profile of Mucormycosis Cases from a Network of Hospitals in North India Amidst COVID-19 Pandemic</a>
</div></li>
<li><strong>Clinical Evaluation of the Novel Rapid Nucleic Acid Amplification Point-of-Care Test (Smart Gene SARS-CoV-2) in the analysis of Nasopharyngeal and Anterior Nasal samples.</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Introduction Smart Gene is a point-of-care (POC)-type automated molecular testing platform that can be performed with 1 minute of hands-on-time. Smart Gene SARS-CoV-2 is a newly developed Smart Gene molecular assay for the detection of SARS-CoV-2. The analytical and clinical performance of Smart Gene SARS-CoV-2 has not been evaluated. Methods Nasopharyngeal and anterior nasal samples were prospectively collected from subjects referred to the local PCR center from March 25 to July 5, 2021. Two swabs were simultaneously obtained for the Smart Gene SARS-CoV-2 assay and the reference real-time RT-PCR assay, and the results of Smart Gene SARS-CoV-2 were compared to the reference real-time RT- PCR assay. Results Among a total of 1150 samples, 68 of 791 nasopharyngeal samples and 51 of 359 anterior nasal samples were positive for SARS-CoV-2 in the reference real-time RT-PCR assay. In the testing of nasopharyngeal samples, Smart Gene SARS-CoV-2 showed the total, positive and negative concordance of 99.2% (95% confidence interval [CI]: 98.4–99.7%), 94.1% (95% CI: 85.6–98.4%) and 99.7% (95% CI: 99.0–100%), respectively. For anterior nasal samples, Smart Gene SARS- CoV-2 showed the total, positive and negative concordance of 98.9% (95% CI: 97.2–99.7%), 98.0% (95% CI: 89.6–100%) and 99.0% (95% CI: 97.2–99.8%), respectively. In total, 5 samples were positive in the reference real-time RT-PCR and negative in Smart Gene SARS-CoV-2, whereas 5 samples were negative in the reference real-time RT-PCR and positive in Smart Gene SARS-CoV-2. Conclusion Smart Gene SARS-CoV-2 showed sufficient analytical performance for the detection of SARS-CoV-2 in nasopharyngeal and anterior nasal samples.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2021.08.25.21262583v1" target="_blank">Clinical Evaluation of the Novel Rapid Nucleic Acid Amplification Point-of-Care Test (Smart Gene SARS-CoV-2) in the analysis of Nasopharyngeal and Anterior Nasal samples.</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>A Phase III Study to Evaluate the Efficacy and Safety of Proxalutamide (GT0918) in Hospitalized Subjects With COVID-19</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Drug: GT0918;   Drug: Standard of care;   Drug: Matching placebo<br/><b>Sponsor</b>:   Suzhou Kintor Pharmaceutical Inc,<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Study of PF-07321332/Ritonavir in Non-hospitalized Low-Risk Adult Participants With COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: PF-07321332;   Drug: Ritonavir;   Drug: Placebo<br/><b>Sponsor</b>:   Pfizer<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Targeting de Novo Pyrimidine Biosynthesis by Leflunomide for the Treatment of COVID-19 Virus Disease</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Drug: leflunomide<br/><b>Sponsor</b>:  <br/>
Ashford and St. Peter’s Hospitals NHS Trust<br/><b>Active, not recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Andrographis Paniculata vs Boesenbergia Rotunda vs Control in Asymptomatic COVID-19</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Drug: Andrographis Paniculata;   Drug: Boesenbergia;   Other: Standard supportive treatment<br/><b>Sponsors</b>:   Mahidol University;   Ministry of Health, Thailand<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Efficacy of PJS-539 for Adult Patients With COVID-19.</strong> - <b>Conditions</b>:   Covid19;   COVID-19 Pneumonia<br/><b>Interventions</b>:   Drug: PJS-539 Dose 1;   Drug: PJS-539 Dose 2;   Drug: Placebo<br/><b>Sponsors</b>:   Hospital do Coracao;   Covicept<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Enhancing COVID Rehabilitation With Technology</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Behavioral: NexJ Connected Wellness;   Other: Usual Care<br/><b>Sponsors</b>:   University of Ottawa;   Canadian Institutes of Health Research (CIHR);   Ottawa Hospital Research Institute<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Phase I/II Clinical Trial of Recombinant COVID-19 Vaccine (Sf9 Cells) in Children and Adolescents</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Biological: Recombinant COVID-19 vaccine (Sf9 cells);   Other: Placebo control<br/><b>Sponsors</b>:   WestVac Biopharma Co., Ltd.;   West China Hospital<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Treatment of Covid-19 With a Herbal Compound, Xagrotin</strong> - <b>Condition</b>:   Covid19<br/><b>Intervention</b>:   Combination Product: Xagrotin<br/><b>Sponsors</b>:  <br/>
Biomad AS;   Directorate of health of Sulaimani, Iraq -KRG<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Philippine Trial to Determine Efficacy and Safety of Favipiravir for COVID-19</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Combination Product: Favipiravir + Standard of Care;   Procedure: Standard of Care<br/><b>Sponsors</b>:   University of the Philippines;   Department of Health, Philippines<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Evaluation of the Effects of Bradykinin Antagonists on Pulmonary Manifestations of COVID-19 Infections (AntagoBrad- Cov Study).</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Drug: C1 Inhibitor Human;   Drug: Icatibant Injection;   Other: Placebo<br/><b>Sponsor</b>:   GCS Ramsay Santé pour l’Enseignement et la Recherche<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Combination of Dietary Supplements Curcumin, Quercetin and Vitamin D for Early Symptoms of COVID-19</strong> - <b>Condition</b>:   Covid19<br/><b>Interventions</b>:   Drug: Standard of care;   Dietary Supplement: combination of curcumin, quercetin and Vitamin D<br/><b>Sponsor</b>:   Ayub Teaching Hospital<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Evaluation of Safety and Immunogenicity of a Novel Vaccine for Prevention of Covid-19 in Adults Previously Immunized</strong> - <b>Condition</b>:   Covid19<br/><b>Intervention</b>:   Biological: A vaccine composed of a recombinant S1 antigen<br/><b>Sponsors</b>:   Hospital do Coracao;   Farmacore Biotecnologia Ltda<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>Preventive Dendritic Cell Vaccine, AV-COVID-19, in Subjects Not Actively Infected With COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Biological: AV-COVID-19<br/><b>Sponsors</b>:  <br/>
Aivita Biomedical, Inc.;   PT AIVITA Biomedika Indonesia;   Kariadi Hospital;   Central Army Hospital RSPAD Gatot Soebroto<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Phase 3 Clinical Study Evaluating Nitric Oxide Nasal Spray (NONS) Efficacy To Treat and Prevent the Exacerbation of Infection in Individuals With Documented Asymptomatic or Mild COVID-19</strong> - <b>Condition</b>:   Covid19<br/><b>Intervention</b>:   Drug: to be given as a treatment<br/><b>Sponsor</b>:  <br/>
Salmaniya Medical Complex<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>A Phase I Study to Determine Safety and Immunogenicity of the Candidate COVID-19 Vaccine AZD1222 Delivered by Aerosol in Healthy Adult Volunteers</strong> - <b>Conditions</b>:   Covid19;   SARS-CoV-2 Infection<br/><b>Interventions</b>:   Biological: 1x10^9 vp AZD1222;   Biological: 5x10^9 vp AZD1222;   Biological: 1x10^10 vp AZD1222<br/><b>Sponsors</b>:   Imperial College London;   University of Oxford;   AstraZeneca<br/><b>Not yet recruiting</b></p></li>
</ul>
<h1 data-aos="fade-right" id="from-pubmed">From PubMed</h1>
<h1 data-aos="fade-right" id="from-patent-search">From Patent Search</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Anti-Sars-Cov-2 Neutralizing Antibodies</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857732">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Expression Vector for Anti-Sars-Cov-2 Neutralizing Antibodies</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857737">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>DEVELOPMENT OF CNN SCHEME FOR COVID-19 DISEASE DETECTION USING CHEST RADIOGRAPH</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857177">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>SARS-COV-2 BINDING PROTEINS</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333402004">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A PROCESS FOR PREPARING MONTELUKAST SODIUM FOR TREATING COVID 19 PATIENTS</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857132">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>IDENTIFICATION OF ANTI-COVID 19 AGENT SOMNIFERINE AS INHIBITOR OF MPRO &amp; ACE2-RBD INTERACTION</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857079">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Deep Learning Based System For Detection of Covid-19 Disease of Patient At Infection Risk.</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333857030">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>자외선살균등</strong> - 본 발명은 사람의 의복이나 사용한 마스크 등에 부착하여 있다 호흡기로 유입되어 감염을 유발할 수 있는 COVID-19와 같은 유해균류를 간편하게 살균하기 위한 휴대용 자와선살균등에 관한 것이다. 반감기가 길고 인체에 유해한 오존을 발생하지 않으면서 탁월한 살균능력이 있는 250~265nm(최적은 253.7nm) 파장의 자외선을 발광하는 자외선램프를 본 발명의 막대형의 자외선살균등 광원으로 사용하고 비광원부를 손으로 잡고 의복이나 사용한 마스크 등 유해균류가 부착되었을 것으로 의심되는 곳에 자외선을 조사하여 간편하게 유해균류를 살균하므로써 감염을 예방하기 위한 휴대용 자외선살균등에 관함 것이다. - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=KR332958765">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Protein chip and kit for detecting the SARS-CoV-2 S antigen</strong> - - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=AU333400883">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>桑黄和百蕊草复方作为新型冠状病毒治疗药物或抗病毒制剂的用途</strong> - 本发明公开了桑黄和百蕊草复方作为新型冠状病毒治疗药物或抗病毒制剂的用途。本发明提供了桑黄和百蕊草的应用：在制备治疗新型冠状病毒所致疾病的药物中的应用；在制备治疗新型冠状病毒感染的药物中的应用；在制备预防新型冠状病毒所致疾病的药物中的应用；在制备预防新型冠状病毒感染的药物中的应用；在制备新型冠状病毒抑制剂中的应用。发明人在前期研究发现桑黄和百蕊草具有抗新冠病毒的作用效果。进一步的，将百蕊草提取物与桑黄提取物组合使用，组合药物的毒性并没有增加，同时百蕊草有很强的抗炎作用，桑黄具有调节人体免疫力作用，这种组合药物对于治疗新冠肺炎病人是理想的选择药物。 - <a href="https://patentscope.wipo.int/search/en/detail.jsf?docId=CN333965968">link</a></p></li>
</ul>
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<h1 data-aos="fade-down" id="daily-dose">Daily-Dose</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-new-yorker">From New Yorker</a></li>
<li><a href="#from-vox">From Vox</a></li>
<li><a href="#from-the-hindu-sports">From The Hindu: Sports</a></li>
<li><a href="#from-the-hindu-national-news">From The Hindu: National News</a></li>
<li><a href="#from-bbc-europe">From BBC: Europe</a></li>
<li><a href="#from-ars-technica">From Ars Technica</a></li>
<li><a href="#from-jokes-subreddit">From Jokes Subreddit</a></li>
</ul>
<h1 data-aos="fade-right" id="from-new-yorker">From New Yorker</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Afghanistan, Again, Becomes a Cradle for Jihadism—and Al Qaeda</strong> - The terrorist group has outlasted the trillion-dollar U.S. investment in Afghanistan since 9/11. - <a href="https://www.newyorker.com/news/daily-comment/afghanistan-again-becomes-a-cradle-for-jihadism-and-al-qaeda">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Have You Already Had a Breakthrough COVID Infection?</strong> - The question of what “infection” means is just one of the riddles posed by the late-stage pandemic. - <a href="https://www.newyorker.com/science/medical-dispatch/have-you-already-had-a-breakthrough-covid-infection">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Meeting “the Other Side”: Conversations with Men Accused of Sexual Assault</strong> - In 2011, I helped launch a movement to aid survivors on college campuses. That meant I also had to think hard about the rights of those under scrutiny. - <a href="https://www.newyorker.com/news/annals-of-activism/meeting-the-other-side-conversations-with-men-accused-of-%20sexual-assault">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>U.S. Retaliation for the Kabul Bombing Won’t Stop ISIS or End Terrorism</strong> - The central flaw in U.S. strategy is the belief that military force can eradicate extremist groups or radical ideologies. - <a href="https://www.newyorker.com/news/daily-comment/us-retaliation-for-the-kabul-bombing-wont-stop-isis-or-end-%20terrorism">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Mayoral Candidate with a Mouth That Roars</strong> - Curtis Sliwa, the Republican nominee, expects his opponent to paint him as racist, sexist, and homophobic. But he’s ready to strike back. - <a href="https://www.newyorker.com/news/our-local-correspondents/the-mayoral-candidate-with-a-mouth-that-roars">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>Hurricane Ida could ravage the Covid-strained Gulf Coast</strong> -
<figure>
<img alt="People in Baton Rouge, Louisiana, fill up sand bags as they prepare for Hurricane Ida making
landfall." src="https://cdn.vox-cdn.com/thumbor/l4qR4hEjHazifFCg2Ltzfi6k8OI=/0x0:2132x1599/1310x983/cdn.vox-
cdn.com/uploads/chorus_image/image/69788610/20210828_132054_hurricane_ida_prep.0.jpg"/>
<figcaption>
People in Baton Rouge, Louisiana, fill up sand bags as they prepare for Hurricane Ida making landfall. | Courtesy of Khalid Hudson
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Hospitals in the South are already stretched with coronavirus patients. The powerful storm could make things worse.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XNQHJ0">
Hurricane season brings a unique set of difficulties for the East Coast, and particularly the South. Like other natural disasters, hurricanes can lay bare inadequate infrastructure, political ineptitude, and stark racial and economic inequalities. For residents of the Gulf Coast region, Hurricane Ida comes 16 years — to the day — after <a href="http://britannica.com/event/Hurricane-Katrina">Hurricane Katrina</a> and its devastating aftermath killed more than 1,800 people.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yAF9wW">
Ida is scheduled to hit Louisiana <a href="https://apnews.com/article/new-orleans-storms-hurricanes-tropical-storms-science--
d4b3399437cc5ccb7e76aa270a63f724">Sunday night</a> as a Category 4 hurricane, with winds of up to 156 miles per hour. Storms of that caliber are expected to cause “catastrophic damage,” according to the <a href="https://www.nhc.noaa.gov/aboutsshws.php">National Hurricane Center</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cLqHTO">
But now, there’s the added strain of a Covid resurgence, which is hitting this region particularly hard; Louisiana’s intensive care units are almost full, <a href="https://www.insider.com/louisiana-hospitals-near-capacity-covid-hurricane-ida-
approaches-2021-8">Insider reports</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Un2I7O">
According to the <a href="https://www.ncbi.nlm.nih.gov/books/NBK54237/">National Academy of Sciences</a> (NAS), Louisiana evacuated around 1.5 million people in preparation for Hurricane Katrina; between 150,000 and 200,000 stayed put, either because they didn’t have the resources to leave or because they chose to remain. In the aftermath, several hospitals flooded and had to be evacuated.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gOU68d">
That was complicated enough without a global pandemic surging.
</p>
<figure class="e-image">
<img alt="The National Weather Service’s projection of Hurricane Ida’s path." src="https://cdn.vox-cdn.com/thumbor/fE0rY5lz1DQWBP2wO00uINk54wQ=/800x0/filters:no_upscale()/cdn.vox-
cdn.com/uploads/chorus_asset/file/22811811/nws_hurricane_ida.jpg"/> <cite>National Weather Service New Orleans</cite>
<figcaption>
The National Weather Service’s projection of Hurricane Ida’s path, as of Saturday at 2 p.m. Eastern.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4zRC27">
According to the NAS, “In the initial days following the storm flooding of Hurricane Katrina, the state evacuated approximately 12,000 caregivers and their patients from 25 hospitals. This was a slow process. In some cases, patients were evacuated one or two at a time by boat to a helipad where they were transferred to a helicopter that brought them to the airport, from which they were flown to other states.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VLsDs5">
Hospitals in neighboring <a href="https://msdh.ms.gov/msdhsite/_static/14,21994,420,873.html">Mississippi</a> and <a href="https://www.wsfa.com/2021/08/27/alabama-hospital-crisis-intensifies-66-now-waiting-icu-beds/">Alabama</a> — parts of which are also in the path of Ida — are already struggling with capacity because of the<strong> </strong>delta variant of Covid-19. <a href="http://cnn.com/2021/08/25/us/mississippi-covid-nurse-
strain/index.html?utm_content=2021-08-28T04%3A00%3A13&amp;utm_source=fbCNN&amp;utm_medium=social&amp;utm_term=link&amp;fbclid=IwAR2qtuvny3hThW6y2ncdjYNnajqzndmjCiJA1IJjmVokyuYj9R6yEOVF5H4">CNN</a> reports that around 2,000 Mississippi nurses have resigned during the pandemic.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TrN14f">
The pandemic has exposed the country’s systemic <a href="https://www.hsph.harvard.edu/news/hsph-in-the-news/covid-19-pandemic-highlights-
longstanding-health-inequities-in-u-s/">unequal access to health care</a>. In Baton Rouge, that divide is particularly stark, according to senior organizer for nonprofit<strong> </strong>Together Baton Rouge Khalid Hudson.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IidGVf">
“The biggest issue is the lack of equitable investment in predominantly Black areas,” he said, adding<strong> </strong>that all of the city’s hospitals are in the southern, predominantly white, part of the city.
</p></li>
</ul>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Oh4mQa">
“If there is flooding and people are getting hurt, where are they to go?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3TVwOx">
<a href="https://apnews.com/article/53e4d2566c75488a83a3a6cb82796a79">Unprecedented floods</a> devastated Baton Rouge just five years ago, the result of torrential rainfall in a slow-moving weather system. “2016 was a 100-year flood; five years later, we are having the same thing,” Hudson said.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="R06T8p">
“These things are happening more and more rapidly.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cyQL2H">
Climate change both <a href="https://www.vox.com/21452781/zogg-fire-glass-wildfire-
california-climate-change-hurricanes-attribution-2020-debate">contributes</a> to more, and stronger, natural disasters, and weakens a community’s ability to withstand those events. In Louisiana’s case, coastal land erosion contributes to the ability of a hurricane like Ida to wreak havoc inland.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rb5ve2">
“Having already lost nearly 2,000 square miles of land (approximately the size of Delaware), Louisiana desperately needs every tool at its disposal to build and maintain as much of our coastline as possible. Our natural defenses, such as barrier islands and wetlands, help reduce storm surge, offering protection for the people and infrastructure further inland,” the <a href="https://lawildlifefed.org/2020/08/katrina-15th-anniversary/">Louisiana Wildlife Federation</a> wrote on the 15th anniversary of Hurricane Katrina.
</p>
<figure class="e-image">
<img alt="Residents drive on Interstate
Highway 55 near Magnolia, Mississippi, as they evacuate away from New Orleans, before the arrival of Hurricane Ida." src="https://cdn.vox-cdn.com/thumbor/jz0UllSvzwZRmKtwfjLW3kT6prA=/800x0/filters:no_upscale()/cdn.vox-
cdn.com/uploads/chorus_asset/file/22811809/1234924039.jpg"/> <cite>Photo by PATRICK T. FALLON/AFP via Getty Images</cite>
<figcaption>
Residents drive on Interstate Highway 55 near Magnolia, Mississippi, as they evacuate away from New Orleans on Aug. 28, 2021, before the arrival of Hurricane Ida.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nkWgKj">
Hurricane Katrina registered as a <a href="https://www.weather.gov/mob/katrina">Category 3</a>, while Ida is expected to have more intense winds at landfall as a Category 4.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cY3fhG">
“This will be a life-altering storm for those who aren’t prepared,” according to National Weather Service meteorologist Benjamin Schott, who spoke during a <a href="https://apnews.com/article/new-orleans-storms-hurricanes-tropical-storms-science--
d4b3399437cc5ccb7e76aa270a63f724">press conference </a>Friday with Louisiana Gov. John Bel Edwards.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6PHmq7">
“This will be one of the strongest hurricanes to hit Louisiana since the 1850s,” <a href="https://www.wwltv.com/article/weather/severe-weather/liveblog-hurricane-ida-1-day-out-from-
landfall/289-04be2a13-8498-4c37-8cb6-bcaf4979df99">Edwards said</a>. Whether New Orleans’ infrastructure is up to the challenge remains to be seen. Officials warned of widespread power outages, and at a Friday press conference, New Orleans Sewerage and Water Board Executive Director Ghassan Korban discussed repairs to Turbine 4, one of the city’s power generators that’s been out of commission for the past several months, <a href="https://www.nola.com/news/politics/article_aacd543a-075e-11ec-b6f6-eb09c3a2f99d.amp.html">Nola.com</a> reports.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iPmwcF">
Those generators help run the city’s drainage system, which depends on pump stations. Turbine 4 repairs are expected to be completed Saturday, but three of the city’s pumps are still offline.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ch7Qyw">
“This is not an ideal situation but it’s also a very manageable situation,” Korban said Friday.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VgZ8K3">
New Orleans Mayor LaToya Cantrell issued a mandatory evacuation order for part of the city outside the levee system, the <a href="https://apnews.com/article/new-orleans-storms-hurricanes-tropical-storms-science--
d4b3399437cc5ccb7e76aa270a63f724">AP reported</a>, but declined to evacuate the whole city because the storm was intensifying too quickly.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JLPu2K">
This means that residents who stay behind might need to escape to a shelter — which could be a minefield during a global pandemic, <a href="https://www.cbsnews.com/news/hurricane-ida-new-orleans-
louisiana-braces-category-4-storm/">CBS News reports</a>. In addition to food, water, and other essentials, Hudson told Vox, Baton Rouge residents are being encouraged to stock up on face masks and hand sanitizer.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xIb4hy">
And while COVID cases are down 27 percent throughout the state in the past two weeks, according to <a href="https://www.nytimes.com/interactive/2021/us/louisiana-covid-cases.html">the New York Times</a>, only about half of Louisiana’s residents are vaccinated. Unvaccinated people account for 91 percent of current hospitalizations, according to the <a href="https://ldh.la.gov/Coronavirus/">Louisiana Department of Health</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="M7ktgZ">
Retired Army <a href="https://generalhonore.com/">Lt. Gen. Russel L. Honoré</a>, who coordinated the military’s relief operations after Hurricane Katrina, <a href="https://twitter.com/ltgrusselhonore/status/1431418432189239296?s=20">tweeted</a> Friday that local leaders should “think like it’s another #Katrina or #Gustav,” warning of flooding and power outages.
</p>
<figure class="e-image">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><img alt="People load a generator onto a pick-up truck, ahead of Hurricane Ida." src="https://cdn.vox-cdn.com/thumbor/DTa1B7-UrzIyXrJpRWqtcsYwDUw=/800x0/filters:no_upscale()/cdn.vox-
cdn.com/uploads/chorus_asset/file/22811823/1234923721.jpg"/> <cite>Photo by Patrick T. FALLON / AFP</cite></p>
<figcaption>
Home improvement store employees help a customer load a generator onto a pick-up truck in McComb, Mississippi, as residents prepare for Hurricane Ida, on Aug. 28, 2021.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hXNWxm">
Others who lived through Hurricane Katrina’s devastation are bracing for crisis yet again, as the Louisiana National Guard prepares to send in personnel and storm-ready equipment to assist in rescue and relief efforts.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="h8kRkV">
“Ida is supposed to make landfall on the anniversary of Katrina,” Mississippi educator George Stewart II <a href="https://twitter.com/gs2project/status/1431460041132056577">tweeted</a> Friday.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YO0BvI">
“Brings back memories. I was living in Gulfport when Katrina hit. People forget how bad we got slammed on the Mississippi Gulf Coast.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="aCzMhA">
Stewart’s tweet is a reminder that the destruction and havoc of Hurricane Katrina were widespread, affecting a far larger area than New Orleans alone. And the effects of that storm — and the compounding devastation of storms like Hurricane Rita and Hurricane Gustav — never fade completely.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="L2NHVh">
As Eric Gardner, a 54-year-old lifelong New Orleans resident whose family lived through Hurricane Katrina, <a href="https://www.wsj.com/articles/new-orleans-prepares-for-hurricane-ida-11630159086">told</a> the Wall Street Journal, “We’re on pins and needles.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PJlLpA">
While his family has evacuated, Gardner, who is a municipal worker, is staying behind as an essential worker.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="S0psiJ">
“There ain’t nothing we can do but try to survive.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7sb3lw">
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yZDe6d">
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="eZEq4e">
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pCwk7o">
</p>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The helplessness of being an Afghanistan War vet</strong> -
<figure>
<img alt="" src="https://cdn.vox-
cdn.com/thumbor/6fKNI2Jsf2dvMVrHJgT4tAPR36k=/0x0:2048x1536/1310x983/cdn.vox-
cdn.com/uploads/chorus_image/image/69787328/IMG_0627_2.0.jpg"/>
<figcaption>
Former Army Capt. Jackie Munn at Forward Operating Base Salerno, in Khost province, Afghanistan, in 2012. | Courtesy of Leigh Murchison
</figcaption></figure></li>
</ul>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
I helped Afghan women seek maternal care. I worry what will become of these mothers and children.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Asubhk">
Inside a clinic in eastern Afghanistan, a nine-months-pregnant Afghan woman shivered on an old metal bed as an Afghan midwife examined her. It was 2012, and the war in Afghanistan had already been going on for 11 years. The woman had just traveled from an outlying village along the Pakistan border, seeking a safe place to deliver her third child. After repeated miscarriages, her family was determined to make their way to the Afghan government’s sponsored clinic at the district’s center,<strong> </strong>where they had heard news about better maternal outcomes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CCX1yS">
Part of my job, as a Cultural Support Team (CST) leader with special operations in the US military, was to inform families like theirs about the clinic. The midwives there could facilitate a safer delivery that might not have happened otherwise, like when the Taliban was in power during the 1990s. The pregnant patient would spend several days at the clinic, waiting out her delivery and returning to her village after recovering from labor.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KMv79j">
When the Taliban entered Kabul and <a href="https://www.vox.com/2021/8/15/22626082/kabul-capital-fall-
afghanistan-government-taliban-forces-explained">reclaimed control over Afghanistan</a> earlier this month, I was at a baseball game with my son. I frantically scoured through news reports while fans cheered and my kid devoured ice cream. I worried about the many Afghans I worked alongside, like that mother and her family whom I had the honor of meeting. What will become of pregnant women and their children? What about the midwives, the clinic, and the district? Or the Afghan police and soldiers I served with? I felt simultaneously helpless, unable to do anything in the moment, and guilty for being at a ballgame with fans singing along to “God Bless America” while this other country I cared about was falling apart.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3mr9Wl">
For 10 months in 2012, I was stationed near the Afghan-Pakistan border as a CST — a program created when the military realized that after nearly a decade at war, it was a problem that all-male combat units were unable to interact with the Afghan female population. Our team did a number of things, but one of our aims was to make it safer for women to travel to and from the clinic. We also went from village to village, informing everyone about the clinic’s capabilities — like how it could provide medicines, immunizations, prenatal care, and a safe place to deliver their babies and recuperate under the watchful eye of trained medical professions.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iOAR8R">
Our CST was mostly<strong> </strong>met with curiosity, since almost none of the locals had ever seen an American woman before. Only when insurgents were nearby were the locals distant. As a tribal society, the Pashtuns prided themselves on their commitment to the Pashtunwali, an ethical code and way of life defined by laws, culture, and tradition, of which hospitality is deeply valued. When we met with midwives most weeks, we sat knee to knee on a red rug that covered the clinic’s cold tiles, discussing the stories of the pregnant patients over cups of chai.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4aHHmU">
Our CST’s relationship with the midwives was critical because they had daily interactions and access to the female population, and knew what type of support the women needed from the government. Together, we’d talk about villages they and the women avoided, or which villagers never came to the clinic because they were too fearful of reprisals from nearby insurgents, which helped us understand the threats facing the women in the district.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rdnv9W">
But now that the Taliban control the country, I worry about these women and what will become of these clinics. While the Taliban are saying that <a href="https://www.npr.org/2021/08/17/1028391403/afghanistan-women-taliban-
government">they’ll respect women’s rights (within the context of Islamic law</a>), their history of violence coupled with recent reports of <a href="https://www.wsj.com/articles/afghans-tell-of-executions-forced-marriages-in-taliban-
held-areas-11628780820">women being forced into marriages with Taliban fighters</a> and being <a href="https://inews.co.uk/news/world/taliban-attack-women-and-children-with-whips-as-they-desperately-try-to-reach-
kabul-airport-1156245">attacked for trying to flee the country at the airport</a> make me doubtful.
</p>
<aside id="3fNLA3">
<div>
</div>
</aside>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KYIxKv">
Like those of many citizens, veterans’ opinions about America’s involvement in Afghanistan vary. Many of my friends are upset about our rapid withdrawal and the lack of planning to evacuate those in need. Many of them have messaged me about how bleak and unreal the situation feels. Some feel utterly powerless. Their concerns echo my own frustrations and heartache. Since Biden announced the US was withdrawing from Afghanistan, I’ve been vested in helping our allies get out of the country. But once Kabul fell, I felt utterly dejected. I’ve found myself cycling through the various stages of grief: disbelief that the Taliban rose so quickly, anger in our nation’s lack of coordinated efforts to rescue and aid our Afghan allies, and depression at feeling like I’m too far away to actually effect change.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5lPHGC">
But I am choosing not to allow those feelings of hopelessness consume me. That evening, after holding back tears at the baseball game, I returned home, got on my laptop, and got back to work. For the past few weeks, I’ve partnered with an inspiring team of veterans and civilians to help our Afghan allies get evacuated. Together, we’ve filled out paperwork, applied for visas, and coordinated efforts to get people into Kabul airport and onto flights out of the country. There have been days I’ve broken down, crying at the sheer chaos of it all, like after hearing the news that <a href="https://www.wsj.com/articles/afghanistan-kabul-airport-
explosion-11629976397">13 US service members and at least 90 Afghans were killed </a>in a suicide bombing orchestrated by ISIS-K. Other times, I’ve been inspired by the work. All I can do is hope that our efforts ripple, reaching those who need it the most.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="aZgCY1">
<a href="https://twitter.com/munn_jackie"><em>Jackie Munn</em></a><em> is a West Point graduate and former Army captain who served in Iraq and Afghanistan. After her service, Jackie became a nurse practitioner and writer.</em>
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OSSYet">
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5Oj5DV">
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KKZ10Z">
</p>
<ul>
<li><strong>ISIS-K, explained by an expert</strong> -
<figure>
<img alt="" src="https://cdn.vox-cdn.com/thumbor/tzFmotRQ_-
HRq1B5p33peAraj3A=/333x0:3000x2000/1310x983/cdn.vox-
cdn.com/uploads/chorus_image/image/69785689/GettyImages_1234889239_copy.0.jpg"/>
<figcaption>
Relatives load into a car the coffin of a victim of the August 26 twin suicide bombs outside the Kabul airport. | Aamir Qureshi/AFP via Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
What to know about the Afghanistan offshoot of the group in Iraq and Syria that waged a deadly attack at the Kabul airport.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3Ks3Ah">
The United States issued a warning this week amid the crush and chaos at the Hamid Karzai International Airport in Kabul, Afghanistan: <a href="https://www.wsj.com/articles/u-s-warns-of-islamic-state-threat-to-americans-in-afghanistan-11629648314">Avoid the area because of a possible ISIS terror attack</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="eTSuBj">
On Thursday, the threat bore out. The full tragedy of the attack is still unclear, but <a href="https://www.npr.org/2021/08/27/1031649747/kabul-airport-explosions-
afghanistan-dead-evacuations">at least 170 Afghans</a> and 13 US service members were killed in an<strong> </strong>explosion around Kabul airport, <a href="https://twitter.com/wesleysmorgan/status/1430972012504231940?s=20">the deadliest day for American combat troops in Afghanistan in a decade</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cAL7KP">
The <a href="https://www.csis.org/programs/transnational-threats-project/past-projects/terrorism-backgrounders/islamic-state-
khorasan">Islamic State in Khorasan Province,</a> or ISIS-K, <a href="https://abcnews.go.com/US/isis-claims-
responsibility-explosions-kabuls-airport-agenda/story?id=79661533">claimed responsibility</a>. The organization is an offshoot of the original group<strong> </strong>in Iraq and Syria, and it emerged in 2015, <a href="https://www.wilsoncenter.org/article/timeline-the-rise-spread-and-fall-the-islamic-state">not long after ISIS had consolidated territory in Iraq and Syria</a>. In Afghanistan, ISIS is building toward its goal of establishing a global caliphate.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="11tTtX">
Ex-Taliban filled ISIS-K’s ranks early on, and the two groups have morphed into enemies, fighting each other and trying to sell their competing ideologies to recruits. The United States-led coalition in Afghanistan also battered ISIS-K in recent years — occasionally even <a href="https://www.washingtonpost.com/outlook/2020/10/22/taliban-isis-drones-afghanistan/">ending up on the Taliban’s side of the battle against the ISIS offshoot</a>.<strong> </strong>Those efforts weakened the group but never dismantled it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="axiRaL">
Thursday’s attack was a reminder of that ongoing presence — and a reminder of ISIS’s ability to sow chaos and confusion, says Andrew Mines, a research fellow at the Program on Extremism at George Washington University.
</p>
<figure class="e-image">
<img alt="Workers in the aftermath of the bombing of Kabul’s airport
wheel a gurney past a barricade." src="https://cdn.vox-cdn.com/thumbor/xN8qTX-
uywUJW8lTbvNGqHIxAnM=/800x0/filters:no_upscale()/cdn.vox-
cdn.com/uploads/chorus_asset/file/22809888/GettyImages_1234881175_copy.jpg"/> <cite>Sayed Khodaiberdi Sadat/Anadolu Agency via Getty Images</cite>
<figcaption>
The full tragedy of the attack is still unclear, but at least 170 Afghans and 13 US service members were killed in the<strong> </strong>explosion.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HzJOGb">
ISIS-K is doing this right as the US is leaving because, Mines says, facilitating “an increased US and international footprint” aligns with their bigger goal of discrediting the Taliban.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vuar9k">
“If ISIS-K can force that [international presence], it makes the Taliban both look as collaborators with the West — which is really good for ISIS-K messaging — but also like failed collaborators, right? ‘You can’t even provide security, you’re incapable of ruling this nation, we [ISIS] are the viable alternative,’” says Mines, who is co-authoring a book on the Islamic State Khorasan with <a href="https://twitter.com/AmiraJadoon/status/1430617225635979264?s=20">Amira Jadoon</a>, an expert on the group. “It is almost certainly to discredit the Taliban and their ability to hold power and deliver security.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cHgXOT">
Vox spoke to Mines about that rivalry with the Taliban, plus ISIS-K’s origins, the possible motivations behind Thursday’s attack, and what America’s withdrawal from Afghanistan might mean for the terror group.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CaK4Ua">
Our conversation, edited for length and clarity, is below.
</p>
<hr class="p-entry-hr" id="DtpR9y"/>
<h4 id="nhW33v">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TtVDhe">
Let’s start with the basics. Who, or what, is ISIS-K?
</p></li>
</ul>
<h4 id="kzn9ok">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rA6dDh">
Islamic State’s Khorasan Province — ISIS-K, IS-KP, IS-K, it goes by a bunch of different acronyms. It’s the official affiliate of the Islamic State group in Afghanistan. It was the official affiliate in Afghanistan and Pakistan, but in 2019, there was a split, and now it has distinct provinces for Afghanistan and Pakistan. So right now, ISIS-K is focused solely on Afghanistan. It’s been recognized by the Islamic State group leaders in Iraq and Syria and was officially founded in January 2015.
</p>
<h4 id="U53cEl">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jY4oVB">
What was the impetus for starting an ISIS offshoot in Afghanistan?
</p>
<h4 id="iz76x2">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DScMqV">
In 2014, there were all these background discussions going on across different local groups and emissaries on behalf of the core group in Iraq and Syria. They were traveling and reaching out to different groups that already existed in Afghanistan and Pakistan to see about exactly that — to see about establishing a local affiliate, an official beachhead for ISIS in Afghanistan and Pakistan. ISIS looks at that as the crux of its broader jihad in Central and South Asia. It really sees it as a beachhead to launch attacks and pursue the vision of the global caliphate.
</p>
<h4 id="atWeSk">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="22SJJm">
Does ISIS-K operate independently? Or do they report to — or have their activities coordinated by — ISIS in Iraq and Syria?
</p>
<h4 id="aBgz4C">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="U0YGgF">
It’s kind of a mixed bag. The leader of the group, the governor of the wilayat [the province, in this case Khorasan] is nominated by others in his organization and then approved and appointed by the <a href="https://www.nytimes.com/2019/10/27/world/middleeast/al-baghdadi-dead.html">caliph</a> and his delegating committee in Iraq and Syria. That nomination process means the group in Iraq and Syria, in theory, has control over the group in Afghanistan. But when it comes to the operational components, they’re pretty displaced from the day-to-day. There are core operators in Afghanistan — previously in Pakistan, not just Afghanistan — that are trying to figure out how to launch attacks and all this stuff by themselves.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ydpgcb">
At the strategic level, ISIS-K aims to implement much of the same the group in Iraq and Syria does. It pursues sectarian attacks against groups like the <a href="https://www.aljazeera.com/features/2016/6/27/afghanistan-who-are-the-hazaras">Hazaras</a> [a predominately Shia ethnic group in Afghanistan] and <a href="https://apnews.com/article/afghanistan-discrimination-islamic-state-group-
kabul-archive-b310aecece22454cc5918756e245810c">Sikhs</a>. It seeks to consolidate territorial control. In fact, that’s one of the qualifications that a group needs to hit to be acknowledged by the core group in Iraq and Syria — what it calls “territorial consolidation.” Once that happened, they were like, “Okay, check, you can be a province now.”
</p>
<div class="c-float-right c-float-hang">
<aside id="p4EKc2">
<q>“ISIS-K has ambitions beyond this evacuation timeline. We need to treat them with the seriousness of their ambitions.”</q>
</aside>
</div>
<h4 id="uf88U2">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ujqgsy">
You qualify, basically.
</p>
<h4 id="5fMK1E">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="givrED">
You qualify, right? There are a few others on that list, but that’s one of the big ones.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ye6953">
The other biggest one is coming forward with a leader that can be appointed by the delegating committee. It looks different in Somalia, it looks different in Yemen, it looks different in Afghanistan, but whichever groups or sets of individuals are coming together need to nominate a leader that the core leadership can vet first and then appoint.
</p>
<h4 id="lEGekL">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="l3LUF2">
This is probably not the best example for a terrorist organization, but it almost sounds like franchising? You have an ISIS branch in Afghanistan and then you have the corporate headquarters in Iraq and Syria.
</p>
<h4 id="kcVlX7">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="02nseJ">
I mean, that’s exactly it. One of my colleagues calls it the “<a href="https://www.hudson.org/research/16798-the-routinization-of-the-islamic-state-s-global-
enterprise">routinization</a>” of the Islamic State movement.
</p>
<h4 id="vdqMU2">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kkzTuJ">
So who is in charge of ISIS-K right now?
</p>
<h4 id="JoPssA">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YRvpIt">
There’s a great article by one of our colleagues, <a href="https://www.lawfareblog.com/who-new-leader-islamic-state-khorasan-province">Abdul Sayed, in Lawfare</a> that addresses this issue. Right now, it’s a man by the name of Shahab al-Muhajir. He’s <a href="https://www.nytimes.com/2021/08/25/us/politics/isis-terrorism-afghanistan-taliban.html">believed to be</a> a former and experienced <a href="https://www.dni.gov/nctc/groups/haqqani_network.html">Haqqani network</a> [an Islamist militant group affiliated with the Taliban] operative. He has a lot of experience with the makings of a terrorist organization, when it goes from a low-level insurgency, and it’s trying to pursue re-expansion. He’s a bit of an urban warfare expert.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="juXeZI">
He’s also reportedly appointed as <a href="https://www.lawfareblog.com/who-new-
leader-islamic-state-khorasan-province">the first non-Afghan or non-Pakistani national to head the group</a>. That’s pretty significant, to be headed by a non-Afghan, or non-Pakistani, or non-Pashtun is a pretty big deal. He’s tasked with overseeing the group through this period of relative decline and relative uncertainty.
</p>
<h4 id="yiddDm">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="w1q6rW">
What is Shahab al-Muhajir’s background?
</p>
<h4 id="fZ9tI2">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4i49K9">
Other ISIS-K leaders were super well-known, and through ISIS’s own propaganda, they did these backgrounds on the first governor [<a href="https://www.theguardian.com/world/2016/aug/12/isis-leader-pakistan-afghanistan-hafiz-
saeed-khan-killed">Hafiz Saeed Khan</a>]. They did this whole interview in ISIS’s main magazine with him.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ICbTkl">
This newest governor [Shahab al-Muhajir] was shrouded in a little bit of uncertainty. It took him a while to issue his first statement. There was confusion about whether they were trying to hide his accent because he’s not Afghani, not Pakistani. So there’s a lot of mystery when he was first announced as governor.
</p>
<h4 id="Iy0h3p">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="D7LqmB">
And Shahab al-Muhajir has been governor since when?
</p>
<h4 id="dLn7T3">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GlL842">
Since 2020.
</p>
<h4 id="d4fmnP">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="lHtAhF">
Okay, so he’s fairly new to the job then. But who exactly makes up ISIS-K’s ranks?
</p>
<h4 id="rpjN57">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cLoRJm">
ISIS-K starts in 2015 — and, obviously, those discussions [about its formation] were going on in the background in 2014. This was a time when there’s a little bit of disgruntlement with the Taliban as a movement — especially once news got out that [Taliban founder and leader] <a href="https://www.wsj.com/articles/the-last-days-of-taliban-head-mullah-omar-11552226401">Mullah Omar was dead and had been dead for some time</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tOReI2">
ISIS, as an entity, <a href="https://www.bbc.com/news/world-middle-east-28082962">had just established the global caliphate</a>, and that was a huge messaging boost. The Taliban, as an entity, their aspiration is for a government focused only on Afghanistan, within the boundaries of Afghanistan. When these guys get in fights with each other and when they diss each other in their propaganda and their narrative messaging in how they recruit people, that’s how ISIS-K brands the Taliban. They brand them as “filthy nationalists.”
</p>
<h4 id="Ldp9Nj">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xp7Kj2">
It’s like ISIS was the cool, new, hip group in town. The Taliban has been around for a while; it’s kind of fusty, and so ISIS-K was trying to capitalize on their success in Iraq and Syria to recruit in Afghanistan.
</p>
<h4 id="9baKhK">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Amu9qU">
Definitely. We’ve got founding members from the Pakistani Taliban. We’ve got founding members from the Afghan Taliban. We’ve got members from the <a href="https://cisac.fsi.stanford.edu/mappingmilitants/profiles/islamic-
movement-uzbekistan">Islamic movement of Uzbekistan</a>, and then over time, a bunch of other groups start to join them.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="z0DSGY">
But what kind of happens in these first few months and, then over time, is that the Taliban catch on to this really quickly, and they start to clamp down on all of their commanders and anybody who’s thinking about joining ISIS-K.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Le9HG6">
Really, 2015, was a pretty crazy year that saw, across Afghanistan, in different provinces, major Taliban commanders switching flags and joining ISIS-K. This is a huge pivotal moment because the Taliban realizes if the dominoes start to fall, ISIS-K becomes the preeminent jihadist organization in the country.
</p>
<h4 id="AwkiAD">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="s988oD">
I do want to talk more about the relationship with the Taliban, but when we talk about ISIS-K 2021, how big is it?
</p>
<h4 id="hzR87r">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Hiw2X9">
Starting in 2016 to 2018 is when the coalition really hammers down on ISIS-K. That piggybacks off the Taliban routing ISIS-K in different places. Sometimes they coincide. Sometimes it’s just the Taliban; sometimes it’s just the coalition.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UDYPAo">
In one sense or another, by 2019, the group is pretty decimated — <a href="https://www.aa.com.tr/en/asia-
pacific/over-1-400-daesh-affiliates-surrender-in-afghanistan/1666062">at the end of 2019, over 1,400 fighters and their families surrendered to government forces in northeast Afghanistan</a>. This is really where we start to see this messaging, especially by the Afghan government, that ISIS is defeated in the country, and that there’s no more ISIS here. That’s when we really see ISIS-K go back to this survival mode, like low-level insurgency.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bd3IJ0">
At that point, a lot of ISIS-K’s recruitment messaging is starting to localize. Historically, a lot of its rank-and-file members have come from across the border in Pakistan. More recently, there’s other good evidence <a href="https://www.usip.org/publications/2020/06/bourgeois-jihad-why-young-middle-class-afghans-join-islamic-state">of recruitment of young urban Afghans who have become disillusioned with the peace process</a> and just don’t think it’s going anywhere. So ISIS-K is really kind of a mix of the core hardened guys, who managed to survive the onslaught of coalition targeting, and then newer recruits, and then attack operation cells spread throughout different Afghan cities.
</p>
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/OkZil-4SfaCvCVrB3wE-
zFGkYxg=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22810168/GettyImages_1234889373_copy.jpg"/> <cite>Wakil Kohsar/AFP via Getty Images</cite>
<figcaption>
A Taliban fighter stands guard at the site of the August 26 twin suicide bombs.
</figcaption>
</figure>
<h4 id="Oy5fQj">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qt3Vro">
I do remember in 2017 when the <a href="https://www.nytimes.com/2017/04/13/world/asia/moab-mother-of-all-bombs-afghanistan.html">US dropped the “mother of all bombs”</a> on ISIS caves in Afghanistan, which stands out as the big example, in my mind, of that US-led campaign.
</p>
<h4 id="1DxL93">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4czR9G">
It was a big bomb. The purpose of it was to clear <a href="https://www.nytimes.com/2017/04/13/world/asia/moab-mother-of-all-bombs-afghanistan.html">this cave tunnel complex</a> to allow forces to get into a valley where they had been set up, basically, since their inception in 2015. But it’s also a messaging thing in its own right, which is, “this is what happens, and so be prepared, because we’re going to use this kind of ordnance on you guys.”
</p>
<h4 id="w9ht7v">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ceWiRG">
Let’s talk about this strategic rivalry. Why are ISIS-K and the Taliban enemies?
</p>
<h4 id="d57rz3">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="2Z5K28">
The biggest one is over the distinction between emirate and caliphate. This goes all the way back to 2015. There were actually talks between senior leadership in the Taliban and [ISIS leader Abu Bakr]<a href="https://www.nytimes.com/2019/10/27/world/middleeast/al-baghdadi-dead.html"> al-Baghdadi</a> himself and his delegating committee. [The Taliban is] basically like, “why are you instructing these guys to do this? Call your guys off.” And Baghdadi is like, “Well, recognize me as caliph and then we’ll be good, right?” So that beef goes back a long time. But the crux of it is really about emirate or caliphate — global movement or national confines.
</p>
<h4 id="QjPAO4">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hkfWRu">
The emirate is Taliban-style and caliphate is ISIS-style?
</p>
<h4 id="f04GBm">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hTfNhI">
Yes, exactly.
</p>
<h4 id="fVCsMy">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MO1xzr">
Okay, and during this past five-plus years, the United States was bombing ISIS-K targets, and the Taliban and ISIS-K were also fighting on the ground.
</p>
<h4 id="uzEiuq">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="E1j0Bg">
Yes, extensively.
</p>
<h4 id="XYyG4B">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="oAA9GN">
And what are the dynamics of that fighting between the Taliban and ISIS-K?
</p>
<h4 id="lT9Bgf">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5KzMkG">
The dynamics of that took a bunch of forms. It was really a bit more positional fighting, so the Taliban attacked ISIS-K positions. That went all the way down to skirmishes in the outskirts of districts and in rural areas, to targeted attacks against individual units and individual fighters.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="A3ppJj">
But the majority of ISIS-K attack campaigns, in late 2020 and throughout this year, have been focused on some of the same stuff that we saw in Iraq and Syria, which is called a <a href="https://www.wilsoncenter.org/article/timeline-the-rise-spread-and-fall-the-islamic-state">harvesting campaign</a> — which is a horrible name — but that’s how they view it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AqmP1d">
ISIS-K goes after journalists, they go after aid workers, they go after intelligence and security personnel that they can identify. They go after government facilities and government targets and anything they can do to prove that the governing power is not able to provide security to anybody, and to sow confusion and chaos.
</p>
<div class="c-float-right c-float-hang">
<aside id="XjtsBS">
<q>“But the crux of it is really about emirate or caliphate — global movement or national confines”</q>
</aside>
</div>
<h4 id="spVEwK">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="83ozoC">
The US and the Taliban both don’t want ISIS-K in Afghanistan. I’m wondering if there was any coordination or collaboration on ISIS targets during the war at all? Or do we just not know that information?
</p>
<h4 id="5qg9sb">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ytA0PP">
It’s actually a really difficult question. Wesley Morgan is really the guy on this one. He wrote <a href="https://www.washingtonpost.com/outlook/2020/10/22/taliban-isis-drones-afghanistan/">this piece in the Washington Post</a> about how there was unofficial coordination. It wasn’t cooperation, per se, but it’s basically, “we’re about to hit ISIS-K here, just so you know.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fJZPp8">
It falls very far short of strategic cooperation between the Afghan Taliban and the US armed forces and Afghan forces to root out ISIS. But it’s in both of their interests, and when made sense, it seems like there was kind of unofficial cooperation.
</p>
<h4 id="7bpUY5">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FvJwZm">
Now <a href="https://www.vox.com/22618215/afghanistan-news-taliban-advance">we just saw the Taliban go on this rout through Afghanistan</a>. What has ISIS-K been up to in the last few months as this was unfolding?
</p>
<h4 id="y9lxkE">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0hmwFX">
If you look at ISIS-K attack numbers, in terms of their operational tempo, it was a lot lower than 2020 and early 2021. A lot of people interpret that as they’re either lying low to see what happens, or they’re pooling their resources and just biding their time for what we saw at the Kabul airport on Thursday.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="53x82S">
The question becomes: What is their interest in conducting <a href="https://www.npr.org/2021/08/27/1031649747/kabul-airport-explosions-afghanistan-dead-evacuations">an attack like we saw Thursday</a>?
</p>
<h4 id="qMK29D">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nvSglH">
And so what is their interest in conducting that attack we saw?
</p>
<h4 id="lx0UPU">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uD3JqW">
The first is simply just do the same thing that’s coming out of the Iraq and Syria textbook, which is to sow chaos and confusion and create those conditions that insurgent groups like these try to fill.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3Ty1B0">
The second is to encourage and, in their view, hopefully facilitate an increased US and international footprint, which would be reneging on the withdrawal process.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9vkM4c">
If ISIS-K can force that, it makes the Taliban both look like collaborators with the West — which is really good for ISIS-K messaging — but also like failed collaborators, right? “You can’t even provide security, you’re incapable of ruling this nation, we [ISIS] are the viable alternative.” It is almost certainly to discredit the Taliban and their ability to hold power and deliver security.
</p>
<h4 id="nSxStt">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FWP2QD">
What does the attack say about the relative power of ISIS-K? I’m trying to understand if this was its coming-out party to say, “we’re back!” Or is the group still relatively weakened by years of US bombings and Taliban fighting? Or do we just not really know the answer to that question at this point?
</p>
<h4 id="WNaSEt">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="e3PPVI">
It’s certainly been weakened in 2019 and 2020. That’s why we see them really pursue these kinds of attack campaigns.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GM2nqU">
At the same time, some of the more credible estimates of the group’s force size show them gradually increasing; they are trying to continue recruiting, trying to reconsolidate some semblance of territory. Their attack cells are also carrying out these really vicious campaigns throughout last year and this year and so they maintain that capability.
</p>
<h4 id="ZTkXz5">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wN2UqN">
President Joe Biden <a href="https://www.nytimes.com/2021/08/26/world/biden-afghanistan-kabul-airport-attack.html">said Thursday that the US would retaliate for the attacks</a>. But putting aside the US withdrawal for a moment, is ISIS-K a big threat to the Taliban and the Taliban’s ability to govern Afghanistan?
</p>
<h4 id="DNFNSG">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4Hs1al">
Yes, yes. The short answer is yes.
</p>
<h4 id="XBc94t">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="C13zsX">
Okay! How so?
</p>
<h4 id="zlhUUT">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UiygnI">
We look at three things. The first is, again, that message, it has the playbook of the group from Iraq and Syria, which was effective. We saw that in 2011, and onwards.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="COzx90">
It has the personnel and the core membership necessary to stay relevant but also to expand and go through this period of, “okay, this is the low point.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nFprTO">
The third part is the conditions. It really is early days, and I’m not one to really speculate. But when<strong> </strong>Amira and I looked at the kind of fatalities, and then casualties occurring to ISIS-K, over time, the vast majority of them are coming from the US-led coalition, Afghan airpower, and ground operations. The Afghan Taliban is routing ISIS in areas, sometimes by itself, but when we look at how ISIS-K suffered over time, a lot of that’s been at the hand of US forces, alongside Afghan partners, and especially US airpower. Without that, I don’t know what that’s going to look like. Biden’s into an “<a href="https://www.npr.org/2021/05/17/997494815/the-u-s-looks-to-support-the-afghan-military-from-over-the-horizon">over the horizon</a>” posture. But it is just early days, so we don’t know what that’s going to look like yet.
</p>
<h4 id="SbkYKy">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="i0sefV">
As you’re saying this, I’m having flashbacks to Iraq a little bit. I know you don’t want to make predictions, but it does seem like there’s the possibility of history repeating itself?
</p>
<h4 id="u210aT">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4WU3hd">
It’s sad, and you hate to see these kinds of things play out, and obviously, there are different dynamics — there’s no Taliban equivalent in Iraq, of course. But those predictions so far look like they’re on track.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="2kiMqe">
Again, it’s early days, and we’ll see, and I know the US’s primary mission is getting people who have helped us and our people out of there. But ISIS-K has ambitions beyond this evacuation timeline. We need to treat them with the seriousness of their ambitions.
</p>
<figure class="e-image">
<pre><code> &lt;img alt=" " src="https://cdn.vox-</code></pre>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">cdn.com/thumbor/NUQbXTp2SyemEGze7aFnCFBYlN0=/800x0/filters:no_upscale()/cdn.vox- cdn.com/uploads/chorus_asset/file/22810180/AP21239344419672_copy.jpg" /&gt; <cite>Wali Sabawoon/AP</cite></p>
<figcaption>
A woman tries to identify a body at a hospital in Kabul on August 27.
</figcaption>
</figure>
<h4 id="djRrJt">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Tl9udh">
Okay, so I know it’s early days, but what are you watching for in regards to ISIS-K?
</p>
<h4 id="bQao91">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JXoAny">
That depends on what the US does next. It really does. But if we stick to where we’re at, and we don’t put too many more assets on the ground, more or less we’re out of there in a real meaningful sense, very, very rapidly, as in within the next week or two. My safe bet is that you just replace the Afghan government as a target with the Taliban as a target.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jA0Eae">
If the Taliban is now going to be the guarantor of security in the country, who does ISIS-K need to attack to make sure that they are seen as the viable alternative to some power that can’t provide security to the people? That’s going to be the Afghan Taliban.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="eQPItn">
At the same time, they will still need to stick to their brand messaging, so: targeting minorities, check. Targeting government infrastructure and government personnel, and in this case, it will be Taliban-run and Taliban personnel, check. Targeting civilian spaces to create that panic and chaos and confusion to show that the Taliban can’t protect, check. That’ll be the playbook.
</p>
<h4 id="1xePhe">
Jen Kirby
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NkwBuE">
So what does corporate headquarters think about all this? Where does Afghanistan fit in terms of ISIS’s larger dynamics?
</p>
<h4 id="vzFfT6">
Andrew Mines
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UJpAks">
Afghanistan, from the start, was really important to this group — the greater region, Khorasan, has this huge lore in Middle East history, and I won’t bother you with the boring details of that.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TFYnQJ">
But it’s always had this lore for them. And the legacy of [al Qaeda’s No. 2, Abu Musab al-] <a href="https://www.theatlantic.com/magazine/archive/2006/07/the-short-violent-life-of-abu-musab-al-
zarqawi/304983/">Zarqawi</a> and the legacy of bin Laden is there. They try to seize that legacy. They try to seize that mantle. “We are the jihadist group; there’s no alternative. Al Qaeda, they failed; they are not the true inheritance of Zarqawi and Bin Laden’s legacy, we are.” And so Afghanistan has always been important to them.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NnzPpe">
From ISIS’s perspective, it’s really about how you allocate resources. <a href="https://www.theguardian.com/world/2021/jun/25/isis-linked-groups-open-up-new-fronts-across-sub-saharan-
africa">Especially as Africa has become just as huge</a>, the movement starts to dedicate a lot of resources. The same thing we saw with Afghanistan — share money a little bit, but also trainers, advisers. And so there’s a clear precedent and clear historical interest for them to send advisors, to send assets and money that they can get into Afghanistan to make sure that ISIS-K has what it needs to pursue this next chapter.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="haRRcw">
</p>
<h1 data-aos="fade-right" id="from-the-hindu-sports">From The Hindu: Sports</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Paralympics 2020 | Nishad Kumar wins silver in men’s high jump</strong> - This was India’s second medal of the Paralympics Games.</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>Afghan athletes arrive for Paralympics; to be mostly out of sight</strong> - Zakia Khudadadi and Hossain Rasouli have arrived in Tokyo from Paris</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>Rohit Chamoli clinches gold for India in Asian junior boxing</strong> - He defeated Mongolia’s Otgonbayar Tuvshinzaya.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>IPL 2021: Fit-again Shreyas Iyer ready to convert DC’s trophy dream into reality</strong> - Shreyas, who led DC to their first IPL final in 2020, missed the first part of the postponed IPL 2021 due to surgery.</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>Eng. vs Ind. third Test | You cannot have four rabbits from 8-11, says Michael Vaughan</strong> - Vaughan feels senior off-spinner Ravichandran Ashwin’s inclusion in the playing XI can solve the problem.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-the-hindu-national-news">From The Hindu: National News</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Other posters will have Nehru’s image, unnecessary controversy over issue: ICHR official</strong> - Facing flak from Opposition parties for excluding Jawaharlal Nehru from a poster celebrating the 75th year of independence, the Indian Council of His</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>CBI inquiry found no ‘cognisable offence’ by Anil Deshmukh</strong> - But FIR was still registered against former minister</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>Farmers in Punjab block roads, burn effigies over lathicharge on Haryana peasants</strong> - Owing allegiance to various farmer bodies, the protesters burnt the effigies of the BJP-led government in Haryana for using “force” on farmers in Karnal where around 10 people were injured.</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>Cannot imagine Ayodhya without Ram, says Ram Nath Kovind</strong> - President visits makeshift Ram Janmabhoomi temple and offers prayers</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>Suspension of scheduled international passenger flights extended till September 30</strong> - Scheduled international passenger flights have been suspended in India since March 23, 2020 due to the coronavirus pandemic</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>Europe migrant crisis: More than 500 people rescued off Italian island</strong> - Italian coastguards rescue 539 people from a small fishing boat believed to have set off from Libya.</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>Austrian ex-far-right leader Strache guilty of corruption</strong> - The verdict comes two years after a video sting ended Heinz-Christian Strache’s political career.</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>French woman arrested over jewellery thefts from coffins</strong> - Police believe the woman was posing as a mourner to strip valuables from the recently deceased.</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>French presidency: Michel Barnier joins race ‘to change France’</strong> - The former EU Brexit negotiator says he will take on Emmanuel Macron in the elections next spring.</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>Afghans in Calais prepare to risk lives again to reach UK</strong> - Aid agencies on the French coast are preparing for a new influx of migrants trying to get to the UK.</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>A bad solar storm could cause an “Internet apocalypse”</strong> - Undersea cables would be hit especially hard by a coronal mass ejection. - <a href="https://arstechnica.com/?p=1790321">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Myst remake impressions: Handsome island touch-ups, launch-week woes</strong> - Tastefully done, fun in VR, but we hope noted issues are rendered moot before long. - <a href="https://arstechnica.com/?p=1790309">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The weekend’s best deals: Samsung microSD cards, gaming chairs, and more</strong> - Dealmaster also has webcams, MagSafe chargers, and AMD Ryzen processors. - <a href="https://arstechnica.com/?p=1788833">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Vaccine mandates work, especially when they’re done right</strong> - Requirements always have to be achievable and equitable. - <a href="https://arstechnica.com/?p=1790329">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Samurai-themed sci-fi flick It’s A Summer Film! expertly slices expectations</strong> - Stream this samurai-loving genre mashup when you can. Speaking of: ATTENTION US DISTRIBUTORS. - <a href="https://arstechnica.com/?p=1789926">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
<ul>
<li><strong>Can we ban the “yo momma” jokes from this sub? They’re old, stupid and have been used by everyone hundreds of times.</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Just like yo momma.
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/yomommafool"> /u/yomommafool </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pdhhmb/can_we_ban_the_yo_momma_jokes_from_this_sub/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pdhhmb/can_we_ban_the_yo_momma_jokes_from_this_sub/">[comments]</a></span></p></li>
<li><strong>The only cow in a small town in USA stopped giving milk. The people did some research and found that they could buy a cow from BC Canada for 1,000 dollars, or one from Alberta Canada for 800 dollars. Being poor, they bought the cow from Alberta. The cow was wonderful.</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
It produced lots of milk all the time, and the people were amazed and very happy. They decided to acquire a bull to mate with the cow and produce more cows like it. Then they would never have to worry about the milk supply again.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
They bought a bull and put it in the pasture with their beloved cow. However, whenever the bull came close to the cow, the cow would move away. No matter what approach the bull tried, the cow would move away from the bull and he could not succeed in his quest. The people were very upset and decided to ask the rabbi, who was very wise, what to do.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
They told the rabbi what was happening; “Whenever the bull approaches our cow, she moves away. If he approaches from the back, she moves forward. When he approaches her from the front, she backs off. An approach from the side and she just walks away to the other side.” The rabbi thought about this for a minute and asked, “Did you buy this cow from Alberta?” The people were dumbfounded. They had never mentioned where they had gotten the cow. “You are truly a wise rabbi. How did you know we got the cow from Alberta?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The rabbi answered sadly, “My wife is from Alberta.”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/since1700"> /u/since1700 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pdtiuq/the_only_cow_in_a_small_town_in_usa_stopped/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pdtiuq/the_only_cow_in_a_small_town_in_usa_stopped/">[comments]</a></span></p></li>
<li><strong>Yo momma is so ugly</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Your dad wakes up with morning wouldn’t
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/cok3noic3"> /u/cok3noic3 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pdnwq7/yo_momma_is_so_ugly/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pdnwq7/yo_momma_is_so_ugly/">[comments]</a></span></p></li>
<li><strong>Can your dick touch your ass?</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
A son walks into his fathers room to find him eating a bad of potato chips. He kindly asks his father if he could have some.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
His father replies “well son, can your dick touch your ass?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The boy seems puzzled and replies with a simple “no?” and his father explains they’re his and the boy can’t have any then.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
A few days later the son walks in on his father with a big bag of marshmallows, and boy does the kid love marshmallows! So he asks his dad if he could please have some, they’re his favorite after all, and his dad replies with the same response as before, “can your dick touch your ass?”. The son thinks about the question and hesitates before he sadly replies “no” again and walks away with his head down
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The boy comes home from school one day to find his grandmother had left some of her homemade cookies for the family and he digs right in.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Just then, the boys father comes home from work and sees his son and the cookies at the kitchen table. The father is so excited because he already knows it’s his mom’s cookies and they’re his favorite.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The father pulls up a chair and asks his son for a cookie. The son looks at him with innocent eyes and says “can your dick touch your ass?”. The father smirks and replies “of course my son”, and before the father could say another word the boy shouts “well go fuck yourself because these are my cookies!”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/BipolarKanyeFan"> /u/BipolarKanyeFan </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pd9isl/can_your_dick_touch_your_ass/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pd9isl/can_your_dick_touch_your_ass/">[comments]</a></span></p></li>
<li><strong>Camel in the Camp</strong> - <!-- SC_OFF -->
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
There was a major that got newly stationed in a base in the middle east. As he inspecting the base, he saw a camel tied to a post. Confused, he calls the nearest private.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Private Doe!” “Sir! Yes, sir?” “What is this camel doing here at our base?” Asks the Major “Sir, the camel is here sir for when the urges of the troops need to be fulfilled sir!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Understanding the situation, the Major told him to carry on. . . . Months have passed with no woman in sight. The Major was having urges that he couldn’t control anymore. So one day, he calls the private.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Private Doe!” “Sir! Yes sir?” “Bring the camel to my tent!” “Sir, yes sir!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
When the camel arrives and the private leaves, The Major vigorously fucks the camel like there was no tomorrow. As the Major finishes and steps out, he asks Private Doe:
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Private, isn’t that how it’s done?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
To which the private replies: . . . “Sir, no sir! We use the camel to go to the nearest town where the women are, sir!”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/PH_Bravstar"> /u/PH_Bravstar </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/pdq9jc/camel_in_the_camp/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/pdq9jc/camel_in_the_camp/">[comments]</a></span></p></li>
</ul>
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