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<title>04 October, 2023</title>
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<title>Covid-19 Sentry</title><meta content="width=device-width, initial-scale=1.0" name="viewport"/><link href="styles/simple.css" rel="stylesheet"/><link href="../styles/simple.css" rel="stylesheet"/><link href="https://unpkg.com/aos@2.3.1/dist/aos.css" rel="stylesheet"/><script src="https://unpkg.com/aos@2.3.1/dist/aos.js"></script></head>
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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>Moral Judgments Impact Perceived Risks from COVID-19 Exposure</strong> -
<div>
The COVID-19 pandemic has created enormously difficult decisions for individuals trying to navigate both the risks of the pandemic and the demands of everyday life. Good decision making in such scenarios can have life and death consequences. For this reason, it is important to understand what drives risk assessments during a pandemic, and, in particular, to investigate the ways that these assessments might deviate from ideal risk assessments. Two studies (N = 841) investigate risk judgments related to COVID-19. The results indicate that risk judgments are sensitive to factors unrelated to the objective risks of infection. In particular, activities that are morally justified are perceived as safer while those that might subject people to blame, or culpability, are seen as riskier.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://psyarxiv.com/59s2g/" target="_blank">Moral Judgments Impact Perceived Risks from COVID-19 Exposure</a>
</div></li>
<li><strong>Prevalence and factors associated with fear of COVID-19 in military personnel during the second epidemic wave in Peru</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
There is few research in military members that provided protection and security during the COVID-19 crisis. We aimed to determine the prevalence and factors associated with fear of COVID-19 in military members. A cross-sectional study was conducted between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic in the region of Lambayeque, Peru. The outcome was fear of COVID-19, measured with the Fear of COVID-19 Scale. The association with resilience (abbreviated CD-RISC), food insecurity (HFIAS), physical activity (IPAQ-S), eating disorder (EAT-26), and other socio-labor variables were assessed. Of 525 participants, the median age was 22, 95.8% were male, and 19.2% experienced fear of COVID-19. A higher prevalence of fear of COVID-19 was associated with age (PR=1.03; 95% CI: 1.01-1.06), religion (PP=2.05; 95% CI: 1.04-4.05), eating disorder (PR=2.95; 95% CI: 1.99-4.36), and having a relative with mental disorder (PR=2.13; 95% CI: 1.09-4.17). Overweight (PR=0.58; 95% IC: 0.37-0.90) and a high level of resilience (PR=0.63; 95% IC: 0.43-0.93) were associated with a lower prevalence of fear of COVID-19. Two out of ten military personnel were afraid of COVID-19. We recommend special attention to the factors associated with the development of suicide risk in military personnel.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.03.23296474v1" target="_blank">Prevalence and factors associated with fear of COVID-19 in military personnel during the second epidemic wave in Peru</a>
</div></li>
<li><strong>Mendelian Randomization Reveals the Role of HMGCR in Pulmonary Arterial Hypertension Treatment, Independent of LDL Cholesterol Concentration</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Introduction: Specific lipid-reducing therapeutics, including statins, are known for mitigating cardiovascular diseases due to their comprehensive benefits including anti-inflammatory properties, antioxidative stress response, and enhancement of endothelial function. The objective of our study was to determine the causative impact of lipid-reducing agents (HMGCR inhibitors, PCSK9 inhibitors, and NPC1L1 inhibitor) on the outcomes of pulmonary hypertension via a two-sample Mendelian randomization (MR) analysis.   Methods: Two types of genetic tools were employed to estimate the exposure to lipid-lowering drugs, comprising expression quantitative trait loci of the drug9s target genes and genetic variations close to or within the target genes related to low-density lipoprotein (LDL cholesterol derived from a genome-wide association study). We utilized summary-data-based MR (SMR) and inverse-variance-weighted MR (IVWMR) methodologies for estimating effect sizes.   Results: SMR analysis indicated that elevated HMGCR expression correlates with increased pulmonary hypertension risk (β=-0.964, se=0.276). Yet, no evident causative link between HMGCR-regulated LDL cholesterol and COVID-19 hospitalization was observed in the IVW-MR analysis (β = -0.21, se= 0.17).   Conclusions:  Our Mendelian randomization investigation unveiled a possible positive impact of lipid-lowering therapeutics on the prognosis of pulmonary hypertension. Importantly, no causal relation was established between LDL cholesterol and pulmonary hypertension.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.02.23295606v1" target="_blank">Mendelian Randomization Reveals the Role of HMGCR in Pulmonary Arterial Hypertension Treatment, Independent of LDL Cholesterol Concentration</a>
</div></li>
<li><strong>Modeling spillover dynamics: understanding emerging pathogens of public health concern</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The emergence of infectious diseases with pandemic potential is a major public health threat worldwide. According to the World Health Organization, around 60% of the reported emerging infectious diseases are zoonoses and have been triggered by spillover events. Although the dynamics of spillover events are not yet well understood, mathematical modeling has the potential to characterize the highly complex interactions among pathogens, wildlife, humans, and the environment where they coexist. In this work, motivated by discussions on the introductory phase of SARS-CoV-2 towards a pandemic scenario, we address the so far unexplored emergence of novel infectious agents. Aiming at gaining insights into the dynamics of spillover events and the final outcome of an eventual disease outbreak in a population, we propose a continuous time stochastic modeling framework to describe a cross-species disease transmission by coupling the dynamics of animal reservoirs and human hosts. A complete analysis of the system is conducted, followed by numerical experiments where we investigate different scenarios of spillover events. Applied to the emergence of SARS-CoV-2 and monkeypox viruses, our results provide insights into the emergence of new infectious diseases able to cause not only local outbreaks but eventually explosive epidemics towards a pandemic.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.02.23296428v1" target="_blank">Modeling spillover dynamics: understanding emerging pathogens of public health concern</a>
</div></li>
<li><strong>Development of an Integrated Sample Amplification Control for Salivary Point-of-Care Pathogen Testing</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background: The COVID-19 pandemic has led to a rise in point-of-care (POC) and home-based tests, but concerns over usability, accuracy, and effectiveness have arisen. The incorporation of internal amplification controls (IACs), essential control for translational POC diagnostics, could mitigate false- negative and false-positive results due to sample matrix interference or inhibition. Although emerging POC nucleic acid amplification tests (NAATs) for detecting SARS-CoV-2 show impressive analytical sensitivity in the lab, the assessment of clinical accuracy with IACs is often overlooked. In some cases, the IACs were run spatially, complicating assay workflow. Therefore, the multiplex assay for pathogen and IAC is needed. Results: We developed a one-pot duplex reverse transcriptase loop-mediated isothermal amplification (RT-LAMP) assay for saliva samples, a non-invasive and simple collected specimen for POC NAATs. The ORF1ab gene of SARS-CoV-2 was used as a target and a human 18S ribosomal RNA in human saliva was employed as an IAC to ensure clinical reliability of the RT-LAMP assay. The optimized assay could detect SARS-CoV-2 viral particles down to 100 copies/μL of saliva within 30 minutes without RNA extraction. The duplex RT-LAMP for SARS-CoV-2 and IAC is successfully amplified in the same reaction without cross-reactivity. The valid results were easily visualized in triple-line lateral flow immunoassay, in which two lines (flow control and IAC lines) represent valid negative results and three lines (flow control, IAC, and test line) represent valid positive results. This duplex assay demonstrated a clinical sensitivity of 95%, specificity of 100%, and accuracy of 96% in 30 clinical saliva samples. Significance: IACs play a crucial role in ensuring user confidence with respect to the accuracy and reliability of at-home and POC molecular diagnostics. We demonstrated the multiplex capability of SARS-COV-2 and human18S ribosomal RNA RT-LAMP without complicating assay design. This generic platform can be extended in a similar manner to include human18S ribosomal RNA IACs into different clinical sample matrices.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.03.23296477v1" target="_blank">Development of an Integrated Sample Amplification Control for Salivary Point-of-Care Pathogen Testing</a>
</div></li>
<li><strong>Some principles for using epidemiologic study results to parameterize transmission models</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background: Infectious disease models, including individual based models (IBMs), can be used to inform public health response. For these models to be effective, accurate estimates of key parameters describing the natural history of infection and disease are needed. However, obtaining these parameter estimates from epidemiological studies is not always straightforward. We aim to 1) outline challenges to parameter estimation that arise due to common biases found in epidemiologic studies and 2) describe the conditions under which careful consideration in the design and analysis of the study could allow us to obtain a causal estimate of the parameter of interest. In this discussion we do not focus on issues of generalizability and transportability. Methods: Using examples from the COVID-19 pandemic, we first identify different ways of parameterizing IBMs and describe ideal study designs to estimate these parameters. Given real-world limitations, we describe challenges in parameter estimation due to confounding and conditioning on a post-exposure observation. We then describe ideal study designs that can lead to unbiased parameter estimates. We finally discuss additional challenges in estimating progression probabilities and the consequences of these challenges. Results: Causal estimation can only occur if we are able to accurately measure and control for all confounding variables that create non-causal associations between the exposure and outcome of interest, which is sometimes challenging given the nature of the variables we need to measure. In the absence of perfect control, non-causal parameter estimates should still be used, as sometimes they are the best available information we have. Conclusions: Identifying which estimates from epidemiologic studies correspond to the quantities needed to parameterize disease models, and determining whether these parameters have causal interpretations, can inform future study designs and improve inferences from infectious disease models. Understanding the way in which biases can arise in parameter estimation can inform sensitivity analyses or help with interpretation of results if the magnitude and direction of the bias is understood.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.03.23296455v1" target="_blank">Some principles for using epidemiologic study results to parameterize transmission models</a>
</div></li>
<li><strong>SARS-CoV-2 neurotropism-induced anxiety and depression-like behaviors require Microglia activation</strong> -
<div>
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with a wide range of long COVID neurological symptoms. However, the mechanisms governing SARS-CoV-2 neurotropism and its effects on long-term behavioral changes remain poorly understood. Using a highly virulent mouse-adapted SARS-CoV-2 strain, denoted as SARS2-N501YMA30, we demonstrated that intranasal inoculation of SARS2-N501YMA30 results in viral dissemination to multiple brain regions, including the amygdala and hippocampus. Behavioral assays show a significant increase in anxiety- and depression-like behaviors 14 days following viral infection. Moreover, we observed microglia activation following SARS2-N501YMA30 infection, along with an augmentation in microglia-dependent neuronal activity in the amygdala. Pharmacological inhibition of microglial activity subsequent to viral spike inoculation mitigates microglia-dependent neuronal hyperactivity. Furthermore, transcriptomic analysis of infected brains revealed the upregulation of inflammatory and cytokine-related pathways, implicating microglia-driven neuroinflammation in the pathogenesis of neuronal hyperactivity and behavioral abnormality. Overall, these data provide critical insights into the neurological consequences of SARS-CoV-2 infection and underscore microglia as a potential therapeutic target for ameliorating virus-induced neurobehavioral abnormalities.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.02.560570v1" target="_blank">SARS-CoV-2 neurotropism-induced anxiety and depression-like behaviors require Microglia activation</a>
</div></li>
<li><strong>Virological characteristics correlating with SARS-CoV-2 spike protein fusogenicity</strong> -
<div>
The severe acute respiratory syndrome coronavirus (SARS-CoV-2) spike (S) protein is essential in mediating membrane fusion of the virus with the target cells. Several reports demonstrated that SARS-CoV-2 S protein fusogenicity is reportedly closely associated with the intrinsic pathogenicity of the virus determined using hamster models. However, the association between S protein fusogenicity and other virological parameters remains elusive. In this study, we investigated the virological parameters of eleven previous variants of concern (VOCs) and variants of interest (VOIs) correlating with S protein fusogenicity. S protein fusogenicity was found to be strongly correlated with S1/S2 cleavage efficiency and plaque size formed by clinical isolates. However, S protein fusogenicity was less associated with pseudoviral infectivity, pseudovirus entry efficiency, and viral replication kinetics. Taken together, our results suggest that S1/S2 cleavage efficiency and plaque size could be potential indicators to predict the intrinsic pathogenicity of newly emerged SARS-CoV-2 variants.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.03.560628v1" target="_blank">Virological characteristics correlating with SARS-CoV-2 spike protein fusogenicity</a>
</div></li>
<li><strong>A tale of two springs: contrasting forest soundscapes during the COVID-19 lockdown (2020) and after the record snowstorm Filomena (2021) from Central Spain</strong> -
<div>
During the COVID-19 pandemic, humanity temporarily retired from the outdoors. The strict lockdown measures in Spain coincided with the onset of the nesting season of birds, thriving in an unusually quiet environment. Here, we have recorded in forests near San Lorenzo de El Escorial (Central Spain) during the lockdown period in 2020, and the closer to normal spring in 2021. We found strong differences in soundscapes by recording year and location, regardless of the effects of meteorology and human mobility. Species altered their behaviour by increasing their calling intensity during 2021 to cope with higher noise levels, however, acoustic activity was generally less diverse and complex. The difference between years was particularly detrimental for the highest-pitched biophony in 2021. We interpret that an extreme snowfall, Filomena, may have caused a mortality event with lasting effects in the community during the 2021 spring. Since extreme climatic events are likely going to keep happening in the area due to climate change, our data is a useful baseline to guide future conservation efforts, and examine how our activity and climate change are changing the soundscapes of Spanish Mediterranean forests.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.02.560514v1" target="_blank">A tale of two springs: contrasting forest soundscapes during the COVID-19 lockdown (2020) and after the record snowstorm Filomena (2021) from Central Spain</a>
</div></li>
<li><strong>Implementing evidence ecosystems in the public health service: Development of a seven-step framework for designing tailored training programs</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The COVID-19 pandemic has highlighted the importance of local evidence-ecosystems in which academia and practice in the Public Health Service (PHS) are interconnected. However, appropriate organizational structures and well-trained staff are lacking and evidence use in local public health decision-making has to be integrated into training programs in Germany. To address this issue, we developed a toolbox to conceptualize training programs designed to qualify public health professionals for working at the interface between academia and practice. We conducted a scoping review of training programs, key-informant interviews with public health experts, and a multi-professional stakeholder workshop and triangulated their output. The toolbox consists of four core elements, encompassing 15 parameters: (1) content-related aspects, (2) context-related aspects, (3) aspects relevant for determining the training format, and (4) aspects relevant for consolidation and further development. Guiding questions with examples supports the application of the toolbox. The developed seven-step framework aims to facilitate new training programs for knowledge-transfer at the academia-practice interface, equipping public health researchers and practitioners with relevant skills for needs-based PHS research. The joint development of training approaches can foster cross-institutional collaboration and enhance evidence utilization, resulting in long-term resource savings and a stronger evidence base for implementing complex public health measures on site. In this way, co-development of tailored solutions within the local evidence ecosystem has the potential to enhance both scientific and practical impact.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.02.23295684v1" target="_blank">Implementing evidence ecosystems in the public health service: Development of a seven-step framework for designing tailored training programs</a>
</div></li>
<li><strong>The impact of COVID-19 on medication reviews in English primary care. An OpenSAFELY-TPP analysis of 20 million adult electronic health records.</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background The COVID-19 pandemic caused significant disruption to routine activity in primary care. Medication reviews are an important primary care activity to ensure safety and appropriateness of ongoing prescribing and a disruption could have significant negative implications for patient care. Aim Using routinely collected data, our aim was to i) describe the SNOMED CT codes used to report medication review activity ii) report the impact of COVID-19 on the volume and variation of medication reviews. Design and setting With the approval of NHS England, we conducted a cohort study of 20 million adult patient records in general practice, in-situ using the OpenSAFELY platform. Method For each month between April 2019 - March 2022, we report the percentage of patients with a medication review coded monthly and in the previous 12 months. These measures were broken down by regional, clinical and demographic subgroups and amongst those prescribed high risk medications. Results In April 2019, 32.3% of patients had a medication review coded in the previous 12 months. During the first COVID-19 lockdown, monthly activity substantially decreased (-21.1% April 2020), but the rate of patients with a medication review coded in the previous 12 months was not substantially impacted according to our classification (-10.5% March 2021). There was regional and ethnic variation (March 2022 - London 21.9% vs North West 33.6%; Chinese 16.8% vs British 33.0%). Following the introduction of “structured medication reviews”, the rate of structured medication review in the last 12 months reached 2.9% by March 2022, with higher percentages in high risk groups (March 2022 - care home residents 34.1%, 90+ years 13.1%, high risk medications 10.2%). The most used SNOMED CT medication review code across the study period was Medication review done - 314530002 (59.5%). Conclusion We have reported a substantial reduction in the monthly rate of medication reviews during the pandemic but rates recovered by the end of the study period.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.07.31.23293419v3" target="_blank">The impact of COVID-19 on medication reviews in English primary care. An OpenSAFELY-TPP analysis of 20 million adult electronic health records.</a>
</div></li>
<li><strong>Stringent COVID-19 government restrictions were associated with a marked increase in Twitter activity in Europe</strong> -
<div>
The COVID-19 pandemic has had an unprecedented effect on health, well-being, and socioeconomic conditions worldwide. One consequence was changes in social media activity, disruption of schedules, and potentially sleep. We use Twitter data to explore changes in daily and nightly online activity at the onset of the COVID-19 pandemic in 2020. Using a pseudo-random sample of 2,489 users across 6 cities in the UK (Aberdeen, Belfast, Bristol, Cardiff, London, and Manchester), 4 cities in Italy (Milan, Naples, Rome, and Turin), and 4 cities in Sweden (Göteborg, Malmo, Stockholm, Uppsala), we test the extent to which the COVID-19 pandemic changed online activity in Europe. Using a dataset of ~24 million tweets, we show that tweet activity increased by ~20% in 2020 relative to the previous non-pandemic year of 2019. We further show that tweet activity is associated with the degree of government response to COVID-19, particularly during the day, and that the stringency of restrictions was the strongest predictive component of change in tweet count.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/socarxiv/g9apk/" target="_blank">Stringent COVID-19 government restrictions were associated with a marked increase in Twitter activity in Europe</a>
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<li><strong>Lineage frequency time series reveal elevated levels of genetic drift in SARS-CoV-2 transmission in England</strong> -
<div>
Genetic drift in infectious disease transmission results from randomness of transmission and host recovery or death. The strength of genetic drift for SARS-CoV-2 transmission is expected to be high due to high levels of superspreading, and this is expected to substantially impact disease epidemiology and evolution. However, we don’t yet have an understanding of how genetic drift changes over time or across locations. Furthermore, noise that results from data collection can potentially confound estimates of genetic drift. To address this challenge, we develop and validate a method to jointly infer genetic drift and measurement noise from time-series lineage frequency data. Our method is highly scalable to increasingly large genomic datasets, which overcomes a limitation in commonly used phylogenetic methods. We apply this method to over 490,000 SARS-CoV-2 genomic sequences from England collected between March 2020 and December 2021 by the COVID-19 Genomics UK (COG-UK) consortium and separately infer the strength of genetic drift for pre-B.1.177, B.1.177, Alpha, and Delta. We find that even after correcting for measurement noise, the strength of genetic drift is consistently, throughout time, higher than that expected from the observed number of COVID-19 positive individuals in England by 1 to 3 orders of magnitude, which cannot be explained by literature values of superspreading. Our estimates of genetic drift will be informative for parameterizing evolutionary models and studying potential mechanisms for increased drift.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2022.11.21.517390v2" target="_blank">Lineage frequency time series reveal elevated levels of genetic drift in SARS-CoV-2 transmission in England</a>
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<li><strong>Protection of second booster vaccinations and prior infection against SARS-CoV-2 in the UK SIREN healthcare worker cohort</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
<b>Background</b> The protection of fourth dose mRNA vaccination against SARS-CoV-2 is relevant to current global policy decisions regarding ongoing booster roll-out. We estimate the effect of fourth dose vaccination, prior infection, and duration of PCR positivity in a highly-vaccinated and largely prior-COVID-19 infected cohort of UK healthcare workers. <b>Methods</b> Participants underwent fortnightly PCR and regular antibody testing for SARS-CoV-2 and completed symptoms questionnaires. A multi-state model was used to estimate vaccine effectiveness (VE) against infection from a fourth dose compared to a waned third dose, with protection from prior infection and duration of PCR positivity jointly estimated. <b>Results</b> 1,298 infections were detected among 9,560 individuals under active follow-up between September 2022 and March 2023. Compared to a waned third dose, fourth dose VE was 13.1% (95%CI 0.9 to 23.8) overall; 24.0% (95%CI 8.5 to 36.8) in the first two months post-vaccination, reducing to 10.3% (95%CI -11.4 to 27.8) and 1.7% (95%CI -17.0 to 17.4) at 2-4 and 4-6 months, respectively. Relative to an infection &gt;2 years ago and controlling for vaccination, 63.6% (95%CI 46.9 to 75.0) and 29.1% (95%CI 3.8 to 43.1) greater protection against infection was estimated for an infection within the past 0-6, and 6-12 months, respectively. A fourth dose was associated with greater protection against asymptomatic infection than symptomatic infection, whilst prior infection independently provided more protection against symptomatic infection, particularly if the infection had occurred within the previous 6 months. Duration of PCR positivity was significantly lower for asymptomatic compared to symptomatic infection. <b>Conclusions</b> Despite rapid waning of protection, vaccine boosters remain an important tool in responding to the dynamic COVID-19 landscape; boosting population immunity in advance of periods of anticipated pressure, such as surging infection rates or emerging variants of concern. <b>Funding</b> UK Health Security Agency, Medical Research Council, NIHR HPRU Oxford, and others.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.09.29.23296330v2" target="_blank">Protection of second booster vaccinations and prior infection against SARS-CoV-2 in the UK SIREN healthcare worker cohort</a>
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<li><strong>Group A streptococcal cases and treatments during the COVID-19 pandemic and 2022 outbreak: a retrospective cohort study in England using OpenSAFELY-TPP</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Objective To investigate the impact of the COVID-19 pandemic on Group A streptococcal (GAS) cases and related antibiotic prescriptions. Design A retrospective cohort study with supporting dashboards with the approval of NHS England. Setting Primary care practices in England using TPP SystmOne software from January 2018 through March 2023. Participants Patients included were those registered at a TPP practice for each month of the study period. Patients with missing sex or age were excluded, resulting in a population of 23,816,470 in January 2018, increasing to 25,541,940 by March 2023. Main outcome measures We calculated monthly counts and crude rates of GAS cases (sore throat/tonsillitis, scarlet fever, invasive group A strep) and prescriptions linked with a GAS case, before (pre-April 2020), during and after (post-April 2021) COVID-19 restrictions. We calculated the maximum and minimum count and rate for each season (years running September-August), and the rate ratio (RR) of the 2022/23 season to the last comparably high season (2017/18). Results Recording of GAS cases and antibiotic prescription linked with a GAS case peaked in December 2022, higher than the 2017/2018 peak. The peak rate of monthly sore throat/tonsillitis (possible group A strep throat) recording was 5.33 per 1,000 (RR 2022/23 versus 2017/18 1.39 (CI: 1.38 to 1.40)). Scarlet fever recording peaked at 0.51 per 1,000 (RR 2.68 (CI: 2.59 to 2.77)), and invasive group A streptococcal infection (iGAS) at 0.01 per 1,000 (RR 4.37 (CI: 2.94 to 6.48)). First line antibiotics with a record of a GAS infection peaked at 2.80 per 1,000 (RR 1.37 (CI:1.35 to 1.38)), alternative antibiotics at 2.03 per 1,000 (RR 2.30 (CI:2.26 to 2.34)), and reserved antibiotics at 0.09 per 1,000 (RR 2.42 (CI:2.24 to 2.61)). For individual antibiotics, azithromycin with GAS indication showed the greatest relative increase (RR 7.37 (CI:6.22 to 8.74)).This followed a sharp drop in recording of cases and associated prescriptions during the period of COVID-19 restrictions where the maximum count and rates were lower than any pre COVID-19 minimum. More detailed demographic breakdowns can be found in our regularly updated dashboard report. Conclusions Rates of scarlet fever, sore throat/tonsillitis and iGAS recording and associated antibiotic prescribing peaked in December 2022. Primary care data can supplement existing infectious disease surveillance through linkages with relevant prescribing data and detailed clinical and demographic subgroups.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.09.22.23295850v3" target="_blank">Group A streptococcal cases and treatments during the COVID-19 pandemic and 2022 outbreak: a retrospective cohort study in England using OpenSAFELY-TPP</a>
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<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>Effects of Cacao FLAvonoids in LOng Covid Patients (FLALOC)</strong> - <b>Conditions</b>: Long Covid19; Fatigue Syndrome, Chronic <br/><b>Interventions</b>: Dietary Supplement: Flavonoids <br/><b>Sponsors</b>: Guillermo Ceballos Reyes; Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado <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>Exercise Interventions in Post-acute Sequelae of Covid-19</strong> - <b>Conditions</b>: COVID-19 <br/><b>Interventions</b>: Behavioral: Exercise <br/><b>Sponsors</b>: University of Virginia <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>The Efficacy of the 2023-2024 Updated COVID-19 Vaccines Against COVID-19 Infection</strong> - <b>Conditions</b>: COVID-19; Vaccine-Preventable Diseases; SARS CoV 2 Infection; Upper Respiratory Tract Infection; Upper Respiratory Disease <br/><b>Interventions</b>: Biological: Novavax COVID-19 vaccine (2023-2024 formula XBB containing); Biological: Pfizer COVID-19 mRNA vaccine (2023-2024 formula XBB containing) <br/><b>Sponsors</b>: Sarang K. Yoon, DO, MOH; Westat; Novavax <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>Motivational Interviewing for Vaccine Uptake in Latinx Adults</strong> - <b>Conditions</b>: Vaccine Hesitancy <br/><b>Interventions</b>: Other: EHR alert; Behavioral: Motivational Interviewing; Behavioral: Warm hand off to nurse <br/><b>Sponsors</b>: Boston College; East Boston Neighborhood Health Center; Harvard School of Public Health (HSPH); Boston Children’s Hospital; National Institute of Nursing Research (NINR) <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>Clinical Trial to Evaluate the Safety of RQ-01 in SARS-CoV-2 Positive Subjects</strong> - <b>Conditions</b>: COVID-19; Infectious Disease; Symptomatic COVID-19 Infection Laboratory-Confirmed; SARS CoV 2 Infection <br/><b>Interventions</b>: Combination Product: RQ-001; Other: Placebo <br/><b>Sponsors</b>: Red Queen Therapeutics, Inc.; PPD <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>Study of “Sputnik Lite” for the Prevention of COVID-19 With Altered Antigenic Composition.</strong> - <b>Conditions</b>: COVID-19 <br/><b>Interventions</b>: Biological: “Sputnik Lite” vaccine for the prevention of COVID-19 with altered antigenic composition <br/><b>Sponsors</b>: Gamaleya Research Institute of Epidemiology and Microbiology, Health Ministry of the Russian Federation <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>Study Will Assess the Safety, Neutralizing Activity and Efficacy of AZD3152 in Adults With Conditions Increasing Risk of Inadequate Protective Immune Response After Vaccination and Thus Are at High Risk of Developing Severe COVID-19</strong> - <b>Conditions</b>: COVID-19, SARS-CoV-2 <br/><b>Interventions</b>: Biological: Biological: AZD3152; Biological: Biological: Placebo <br/><b>Sponsors</b>: AstraZeneca <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>Examining the Function of Cs4 on Post-COVID-19 Disorders</strong> - <b>Conditions</b>: Long COVID <br/><b>Interventions</b>: Other: Chinese medicine nutritional supplement Cs4 <br/><b>Sponsors</b>: The University of Hong Kong <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>Stellate Ganglion Block With Lidocaine for the Treatment of COVID-19-Induced Parosmia</strong> - <b>Conditions</b>: Parosmia <br/><b>Interventions</b>: Procedure: Stellate Ganglion Block; Other: Placebo <br/><b>Sponsors</b>: Lawson Health 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>Amantadine Therapy for Cognitive Impairment in Long COVID</strong> - <b>Conditions</b>: Long COVID; Post-COVID19 Condition; Post-Acute COVID19 Syndrome <br/><b>Interventions</b>: Drug: Amantadine <br/><b>Sponsors</b>: Ohio State University <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>CPAP Efficacy in Post-COVID Patients With Sleep Apnea</strong> - <b>Conditions</b>: COVID-19; Sleep Apnea <br/><b>Interventions</b>: Device: Continuous positive airway pressure <br/><b>Sponsors</b>: University of Pittsburgh <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>Cell Therapy With Treg Cells Obtained From Thymic Tissue (thyTreg) to Control the Immune Hyperactivation Associated With COVID-19 (THYTECH2)</strong> - <b>Conditions</b>: Systemic Inflammatory Response Syndrome <br/><b>Interventions</b>: Biological: Allogeneic thyTreg 5.000.000; Biological: Allogeneic thyTreg 10.000.000 <br/><b>Sponsors</b>: Hospital General Universitario Gregorio Marañon; Instituto de Salud Carlos III <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>SA55 Injection: a Potential Therapy for the Prevention and Treatment of COVID-19</strong> - <b>Conditions</b>: COVID-19 <br/><b>Interventions</b>: Drug: SA55 Injection; Other: Placebo for SA55 injection <br/><b>Sponsors</b>: Sinovac Life Sciences Co., Ltd. <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>ACTIV-6: COVID-19 Study of Repurposed Medications - Arm G (Metformin)</strong> - <b>Conditions</b>: Covid19 <br/><b>Interventions</b>: Other: Placebo; Drug: Metformin <br/><b>Sponsors</b>: Susanna Naggie, MD; National Center for Advancing Translational Sciences (NCATS); Vanderbilt University Medical Center <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>Mind Body Intervention for Long COVID</strong> - <b>Conditions</b>: Long COVID; Post-Acute Sequelae of COVID-19; COVID Long-Haul <br/><b>Interventions</b>: Behavioral: Mind Body Intervention #1 <br/><b>Sponsors</b>: Beth Israel Deaconess Medical Center <br/><b>Not yet recruiting</b></p></li>
</ul>
<h1 data-aos="fade-right" id="from-pubmed">From PubMed</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>What do we know about the function of SARS-CoV-2 proteins?</strong> - The COVID-19 pandemic has highlighted the importance in the understanding of the biology of SARS-CoV-2. After more than two years since the first report of COVID-19, it remains crucial to continue studying how SARS-CoV-2 proteins interact with the host metabolism to cause COVID-19. In this review, we summarize the findings regarding the functions of the 16 non-structural, 6 accessory and 4 structural SARS-CoV-2 proteins. We place less emphasis on the spike protein, which has been the subject of…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>High-affinity binding to the SARS-CoV-2 spike trimer by a nanostructured, trivalent protein-DNA synthetic antibody</strong> - Multivalency enables nanostructures to bind molecular targets with high affinity. Although antibodies can be generated against a wide range of antigens, their shape and size cannot be tuned to match a given target. DNA nanotechnology provides an attractive approach for designing customized multivalent scaffolds due to the addressability and programmability of the nanostructure shape and size. Here, we design a nanoscale synthetic antibody (“nano-synbody”) based on a three-helix bundle DNA…</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>Bioactive metabolites identified from Aspergillus terreus derived from soil</strong> - Aspergillus terreus has been reported to produce many bioactive metabolites that possess potential activities including anti-inflammatory, cytotoxic, and antimicrobial activities. In the present study, we report the isolation and identification of A. terreus from a collected soil sample. The metabolites existing in the microbial ethyl acetate extract were tentatively identified by HPLC/MS and chemically categorized into alkaloids, terpenoids, polyketides, γ-butyrolactones, quinones, and…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Effects of tea, catechins and catechin derivatives on Omicron subvariants of SARS-CoV-2</strong> - The Omicron subvariants of SARS-CoV-2 have multiple mutations in the S-proteins and show high transmissibility. We previously reported that tea catechin (-)-epigallocatechin gallate (EGCG) and its derivatives including theaflavin-3,3’-di-O-digallate (TFDG) strongly inactivated the conventional SARS-CoV-2 by binding to the receptor binding domain (RBD) of the S-protein. Here we show that Omicron subvariants were effectively inactivated by green tea, Matcha, and black tea. EGCG and TFDG strongly…</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>AMPK inhibitor, compound C, inhibits coronavirus replication in vitro</strong> - The coronavirus disease (COVID-19) pandemic has resulted in more than six million deaths by October 2022. Vaccines and antivirals for severe acute respiratory syndrome coronavirus 2 are now available; however, more effective antiviral drugs are required for effective treatment. Here, we report that a potent AMP-activated protein kinase (AMPK) inhibitor, compound C/dorsomorphin, inhibits the replication of the human coronavirus OC43 strain (HCoV-OC43). We examined HCoV-OC43 replication in control…</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 First-In-Human Phase 1 Study of Simnotrelvir, a 3CL-like Protease Inhibitor for Treatment of COVID-19, in Healthy Adult Subjects</strong> - Safe and efficacious antiviral therapeutics are in urgent need for the treatment of coronavirus disease 2019. Simnotrelvir is a selective 3C-like protease inhibitor that can effectively inhibit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the safety, tolerability, and pharmacokinetics of dose escalations of simnotrelvir alone or with ritonavir (simnotrelvir or simnotrelvir/ritonavir) in healthy subjects, as well as the food effect (ClinicalTrials.gov Identifier:…</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>An in-vitro evaluation of antifungal, anti-lungcancer (A549), and anti-hyperglycemic activities potential of Andrographis paniculata (Burm. f.) flower extract</strong> - The medical plant research has received more attention among researchers especially after the Covid-19 pandemic. This research performed to evaluate the antifungal, anti-lung cancer (A549), and anti-hyperglycemic activities of aqueous extract of Andrographis paniculata flower. Interestingly, A. paniculata flower aqueous extract contains pharmaceutically valuable phytochemicals such as alkaloid, phenolics, terpenoids, tannins, flavonoids, and protein. It also showed fine antifungal activity…</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>Development in biomarkers of breast cancer: a bibliometric analysis from 2011 to 2020</strong> - CONCLUSIONS: In the past decade, most research has focused on basic and clinical studies, of which microRNAs (miRNAs) and circulating tumor DNAs (ctDNAs) associated with the inhibition and attenuation of BC have become the focus of recent research.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The effect of loneliness on depression in young people: a multiple mediated effects model</strong> - CONCLUSIONS: The findings indicate that the inability to alleviate negative emotions through socialization and interpersonal companionship during COVID-19 contributed to increased loneliness and subsequent depression. Reduced resilience due to loneliness may lead individuals to project unfavorable interpersonal experiences onto other aspects of life and believe they are incapable of overcoming challenges, thereby deteriorating depression conditions. Enhancing an individual’s resilience may help…</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>Virus on surfaces: Chemical mechanism, influence factors, disinfection strategies, and implications for virus repelling surface design</strong> - While SARS-CoV-2 is generally under control, the question of variants and infections still persists. Fundamental information on how the virus interacts with inanimate surfaces commonly found in our daily life and when in contact with the skin will be helpful in developing strategies to inhibit the spread of the virus. Here in, a critically important review of current understanding of the interaction between virus and surface is summarized from chemistry point-of-view. The…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The role of cross-reactive immunity to emerging coronaviruses: Implications for novel universal mucosal vaccine design</strong> - Host immune response to coronaviruses and the role of cross-reactivity immunity among different coronaviruses are crucial for understanding and combating the continuing COVID-19 outbreak and potential subsequent pandemics. This review paper explores how previous exposure to common cold coronaviruses and more pathogenic coronaviruses may elicit a protective immune response against SARS-CoV-2 infection, and discusses the challenges posed by some variants of concern that may escape current…</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>Multi-structural molecular docking (MOD) combined with molecular dynamics reveal the structural requirements of designing broad-spectrum inhibitors of SARS-CoV-2 entry to host cells</strong> - New variants of SARS-CoV-2 that can escape immune response continue to emerge. Consequently, there is an urgent demand to design small molecule therapeutics inhibiting viral entry to host cells to reduce infectivity rate. Despite numerous in silico and in situ studies, the structural requirement of designing viral-entry inhibitors effective against multiple variants of SARS-CoV-2 has yet to be described. Here we systematically screened the binding of various natural products (NPs) to six…</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>Effect of monovalent COVID-19 vaccines on viral interference between SARS-CoV-2 and several DNA viruses in patients with long-COVID syndrome</strong> - Epstein-Barr virus (EBV) reactivation may be involved in long-COVID symptoms, but reactivation of other viruses as a factor has received less attention. Here we evaluated the reactivation of parvovirus-B19 and several members of the Herpesviridae family (DNA viruses) in patients with long-COVID syndrome. We hypothesized that monovalent COVID-19 vaccines inhibit viral interference between SARS-CoV-2 and several DNA viruses in patients with long-COVID syndrome, thereby reducing clinical symptoms….</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>Antibacterial and anti-corona virus (229E) activity of Nigella sativa oil combined with photodynamic therapy based on methylene blue in wound infection: in vitro and in vivo study</strong> - Microbial skin infections, antibiotic resistance, and poor wound healing are major problems, and new treatments are needed. Our study targeted solving this problem with Nigella sativa (NS) oil and photodynamic therapy based on methylene blue (MB-PDT). Antibacterial activity and minimum inhibitory concentration (MIC) were determined via agar well diffusion assay and broth microdilution, respectively. Transmission electron microscopy (TEM) proved deformations in Staphylococcus aureus ATCC 6538….</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>N-linked glycoproteins and host proteases are involved in swine acute diarrhea syndrome coronavirus entry</strong> - Swine acute diarrhea syndrome coronavirus (SADS-CoV) is highly pathogenic to piglets and poses a major threat to the swine industry. SADS-CoV has a wide cell tropism and pathogenic potential in younger animals. Therefore, understanding how SADS-CoV enters cells is essential for curbing its re-emergence and spread. Here, we report that tunicamycin, an N-linked glycoprotein inhibitor, inhibited the attachment of SADS-CoV to host cells, suggesting that the SADS-CoV receptor may be an N-linked…</p></li>
</ul>
<h1 data-aos="fade-right" id="from-patent-search">From Patent Search</h1>
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<h1 data-aos="fade-down" id="daily-dose">Daily-Dose</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-new-yorker">From New Yorker</a></li>
<li><a href="#from-vox">From Vox</a></li>
<li><a href="#from-the-hindu-sports">From The Hindu: Sports</a></li>
<li><a href="#from-the-hindu-national-news">From The Hindu: National News</a></li>
<li><a href="#from-bbc-europe">From BBC: Europe</a></li>
<li><a href="#from-ars-technica">From Ars Technica</a></li>
<li><a href="#from-jokes-subreddit">From Jokes Subreddit</a></li>
</ul>
<h1 data-aos="fade-right" id="from-new-yorker">From New Yorker</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Powerful New York Law That Finally Brought Trump to Book</strong> - In investigating the former President, New York’s attorney general relied on legislation passed at the behest of one of her Republican predecessors, Jacob Javits. - <a href="https://www.newyorker.com/news/our-columnists/the-powerful-new-york-law-that-finally-brought-trump-to-book">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Worrying Democratic Erosions in South Korea</strong> - In recent months, authorities have raided offices of press outlets publishing critical reports on President Yoon Suk-yeol. - <a href="https://www.newyorker.com/news/daily-comment/the-worrying-democratic-erosions-in-south-korea">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Violent End of Nagorno-Karabakh’s Fight for Independence</strong> - In less than a day, indiscriminate shelling in the region killed hundreds, displaced tens of thousands, and wiped out a thirty-five-year battle for political autonomy. - <a href="https://www.newyorker.com/news/our-columnists/the-violent-end-of-nagorno-karabakhs-fight-for-independence">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Why Obama’s “Car Czar” Thinks Biden Should Stay Out of the U.A.W. Strike</strong> - Last week, Steve Rattner called the President’s trip to the picket line “outrageous.” Whom did he help—or harm—by going? - <a href="https://www.newyorker.com/news/q-and-a/why-obamas-car-czar-thinks-biden-should-stay-out-of-the-uaw-strike">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Should the West Threaten the Putin Regime Over Ukraine?</strong> - The historian Stephen Kotkin on the state of the war and the dangers of a Russian Tet Offensive. - <a href="https://www.newyorker.com/news/q-and-a/should-the-west-threaten-the-putin-regime-over-ukraine">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>David Brooks thinks Americans are getting meaner</strong> -
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He blames the collapse of moral education. But what about capitalism?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UgChCx">
One of the things you hear often these days is that America is becoming a more polarized country. As far as I can tell, almost no one quibbles with this claim.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GS5GS3">
A <a href="https://www.theatlantic.com/magazine/archive/2023/09/us-culture-moral-education-formation/674765/">recent essay in the Atlantic</a> by columnist and author David Brooks makes a related but slightly different argument, which is that America is also becoming meaner. It’s an interesting assertion, but is it really true? And if it is true, what would the evidence look like?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vaQPID">
The story Brooks tells is mostly about the collapse of moral education in America and how that has produced less civil and compassionate citizens. What you don’t find in that story is anything about the evolution of capitalism and its gradual erosion of public life. That seemed like an important oversight.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="oi8iIm">
So I invited Brooks onto <a href="https://www.vox.com/the-gray-area"><em>The Gray Area</em></a> to talk about what I think he gets right and what I thought was missing from his account. Below is an excerpt of our conversation, edited for length and clarity. As always, there’s much more in the full podcast, so listen and follow <a href="https://www.vox.com/the-gray-area"><em>The Gray Area</em></a> on <a href="https://podcasts.apple.com/gb/podcast/the-gray-area-with-sean-illing/id1081584611">Apple Podcasts</a>, <a href="https://podcasts.google.com/search/vox%20conversations">Google Podcasts</a>, <a href="https://open.spotify.com/show/6NOJ6IkTb2GWMj1RpmtnxP">Spotify</a>, <a href="https://www.stitcher.com/show/vox-conversations">Stitcher</a>, or wherever you find podcasts. New episodes drop every Monday.
</p>
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<h4 id="OflXU1">
Sean Illing
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WvA16b">
Before we dive into it, can you lay out the basic argument you wanted to make in this piece?
</p>
<h4 id="I2avku">
David Brooks
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="aP1Af8">
It starts with two questions. The first is, why are we so sad? And everybody knows the statistics on depression and <a href="https://www.vox.com/mental-health">mental health</a> problems and suicide. But there’s a whole range of statistics saying we’re also in the middle of some relational crisis. Fifty-four percent of Americans say, “No one knows me well.” The number of people who say they have no close friends has quadrupled. A third of Americans are not in a romantic relationship. We spend a lot less time with our friends than we used to. If you ask high school seniors, are you persistently hopeless and despondent, 45 percent now say yes. That’s sadness, and all that sadness makes us mean.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4ZVohE">
My second question is, why are we so mean? I was in a restaurant a couple months ago, and the owner told me that he has to kick somebody out of the restaurant once a week for abusive behavior. That never used to happen. I have a friend who’s a nurse at a hospital, and she says their main task is finding nurses because people want to leave the profession because the patients have become so abusive. In the past, something like two-thirds of Americans gave to charity; now it’s less than half. So there’s sadness and meanness everywhere.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1B1OhW">
A lot of people have had different stories to tell about how this came to be. One of them is the social media story. It’s driving us all crazy. Another is the sociology story: We’re not involved in civic groups, we’re bowling alone. Another is the inequality story: We’re so economically distant from each other, we are not good at knowing each other. But the story I tell is a moral story. It’s the most direct story. We don’t treat each other well because we haven’t taught young people for several generations how to be considerate to each other in the small circumstances of life, how to sit with somebody who’s suffering from depression, how to disagree well.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rxihlD">
I focus on moral formation, that we haven’t morally formed each other in ways to make us kind to each other and in ways that make us see each other. When I say moral formation, it sounds super pompous and pretentious, but I mean it in three simple ways. Moral formation is helping us find a way to restrain our natural selfishness. The second thing is moral formation is helping us find a goal in life, an ideal to pursue that gives us meaning and purpose. Then the third part of moral formation is giving us the skills, social skills, to know how to end a conversation with grace, know how to have a hard conversation across difference. So teaching those basic, elemental social skills that help us be decent to one another.
</p>
<h4 id="5OxywF">
Sean Illing
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="57OyZt">
Some of those statistics are pretty startling. I don’t even know how it’s possible to get to a place where half the country says no one knows them well —
</p>
<h4 id="UGPTg4">
David Brooks
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LBvHP8">
Yeah, and that includes members of your immediate family. And people who have had divorces know that feeling that the person who should know you best has no clue who you are.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fpRnU6">
For my next book, I interviewed a guy named Dan McAdams, who’s a psychologist at Northwestern. He studies how people tell their life stories. He asks people to come into his lab and gives them a research fee for their time. And then he asks them questions about their life stories. What are your high points? What are your low points? What are your turning points? It takes about four hours, and he says half the people cry when talking about some part of their lives.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xKxuAa">
But then at the end, he gives them the check for their time, and a lot of them want to give the check back. They say, “I don’t want money for this. This has been the best afternoon of my life. No one has ever asked me about my life story before.” I have certainly found that a lot of people just have never been asked.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7xqeU4">
I’ll often go to a party and leave and think, “That whole time, nobody asked me a question.” I’ve come to believe that only about 30 percent of humans are questioners. The other people are nice, they tell funny stories, they’re just not curious about other people. I think we’ve drifted into a world where we’re always broadcasting and social media is about how I’m broadcasting, but it’s not about listening, it’s not about taking the time to get to know another human story and making them feel seen, heard, and understood.
</p>
<h4 id="Fx7XPq">
Sean Illing
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jtXkMQ">
Sadness seems easy enough to measure, but meanness seems a little more complicated. How do you measure it? What are the manifestations of meanness?
</p>
<h4 id="fJvr4A">
David Brooks
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jAINvq">
Yeah, I try to do that as best I could. You look at murder rates, you look at hate crimes, you look at gun sales. I would say distrust is maybe the closest proxy. To me, the most important statistic we have about the health of our society morally is distrust statistics. Americans lost a sense of trust in their institutions in the ’60s and ’70s — Vietnam, Watergate, inflation. They’ve lost trust in each other, what researchers call interpersonal distrust, mostly in the last 40 years or so.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vLuWfO">
Two generations ago, if you asked people, “Do you trust the people around you?” 60 percent said, “Yeah, people around me are trustworthy.” Now that’s down to about 30 percent, and the younger you go, the more distrustful you are. And why are we distrustful? Robert Putnam at Harvard gave the simplest, clearest answers: We’re distrustful because the people around us have been untrustworthy. It’s not about our perception; it’s about reality.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DXuIa8">
I used to tell this to my students where I used to teach about distrust, and one young woman said to me, “Have you seen our social lives? If you’re getting ghosted all the time or you’re getting mistreated, then you’re going to be pretty distrustful.” That <a href="https://www.vox.com/psychology">psychology</a> of distrust is a very punishing psychology because you armor yourself up; you perceive threat everywhere. You lash out because you think, “If I’m not lashing out, then they’re going to get me.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jgPwnv">
One of the things loneliness does is it distorts the way you see reality. You come to fear the thing you desire most, which is relationships.
</p>
<h4 id="PMDs6A">
Sean Illing
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qHpzjV">
If I struggled with anything in the piece, it was less about what you say and more about what you don’t talk about. There are two words in particular that don’t appear anywhere in the piece: capitalism and neoliberalism. Was that a deliberate omission on your part? Did you feel like that wasn’t all that relevant to the story you wanted to tell?
</p>
<h4 id="wY4OCi">
David Brooks
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fGXROS">
It was a 10,000-word piece that got chopped down to 4,500 words. So that’s part of it. Even in 10,000 words, I can’t cover everything. I guess my view on capitalism and neoliberalism is that I’m pretty pro-capitalist. I call myself a liberal. But I would not want capitalism and the rules of the market to be determining my human relationships with another person.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="a37vQV">
Capitalism has a tendency to make all connections transactional. Capitalism has a tendency to make our view of each other instrumental, so we’re thinking, “How can I use you for my own selfish gain?” I’m glad we’re capitalists, but you have to balance capitalism with an ethos that really cuts against capitalism. For a lot of places, <a href="https://www.vox.com/religion">religion</a> serves as that ethos. For a lot of people, secular humanism serves as that ethos, which is really about valuing the person, seeing them in their full selves.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="112o28">
But we’ve allowed, maybe over the past few decades, all those other logics to fade away. Religion is a less important part of American life than it used to be. I would say the humanities and humanism is a less important part. People aren’t majoring in English and history and literature the way they did. Everything has become way more instrumental. And the logic of the market has come to dominate.
</p>
<h4 id="X82JpH">
Sean Illing
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="f9Op7b">
To my mind, it’s so hard to talk about alienation and meanness and despair in this country without telling a more materialist story about how capitalism, and really the <a href="https://www.vox.com/the-big-idea/2017/7/18/15992226/neoliberalism-chait-austerity-democratic-party-sanders-clinton">neoliberal strain of capitalism</a>, has transformed our society. So much of public life has been swallowed up, as you were saying, by market logic. The vehicles of social solidarity and democratic engagement, like <a href="https://www.vox.com/unions">unions</a> or other civic associations, those things have been systematically undermined. And communities are as atomized as they’ve ever been. These transformations have so much to do with our happiness and well-being, but it sounds like you think I’m overstating the causal role of capitalism in all this.
</p>
<h4 id="tXOxQf">
David Brooks
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vQyfQF">
I’d say a couple things. First, I agree, but if you look around the world, we have a lot of free-market countries that do not suffer the way we suffer from these things.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BBKoWU">
The story I would tell is more about individualism. We’ve always been a pretty capitalistic country, but if you go back to a certain period, there was a greater sense of collectivity. I’m thinking now of Robert Putnam’s book called <a href="https://www.amazon.com/Upswing-America-Together-Century-Again/dp/198212914X"><em>The Upswing</em></a>, which is about how a lot of social indicators went in the right direction from about 1890. They improved across a whole range of things: reduced income inequality, less political polarization, more civic engagements, more family formation, more charitable donations. All those things went up together in the first half of the 20th century. And they’ve been going down really since about early 1960s.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SpynrH">
Why have all these different social indicators, which seem unrelated, been following the same bell curve up and then down? Putnam’s argument is a culture of individualism. He calls his curve the Me-We-Me curve. We had a very individualistic culture in the 1890s; we had a more collectivist and cooperative culture because of the world wars, because of the depression. Since then, we’ve had an individualistic culture, and that has taken two forms.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mUa2DL">
One is the form you mentioned, which is capitalist Darwinism. But the second is lifestyle individualism: I get to control my own life. I get to do whatever I want. It’s not yours to judge. I’m glad we went through this more individualistic phase, but we’ve overshot the mark, and we’re too cut off one from another. It’s that isolation, which manifests in economic form but also in social form, that reduces the connections between people.
</p>
<h4 id="In0j58">
Sean Illing
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SNOmPo">
I keep going back to the role that our species of capitalism has played in engineering that culture of individualism. You mention in the piece how, in 1967, something like 85 percent of college students said that they were “strongly motivated to develop a meaningful philosophy of life.” Then, by 2015, roughly 80 percent of students say wealth and money is their primary aim.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WOcAfr">
My response to that it is, “Well, yeah, of course!” If we drop people into a society that demands we optimize our life for success in the market, then it’s hard to turn around and reproach them when they become reflections of the moral nihilism of the market.
</p>
<h4 id="CSgoBr">
David Brooks
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Rrp3H4">
Yeah, I guess. Although we can all point to people who are plenty embedded in capitalism but have rebelled against it and who we find amazingly admirable people. I saw a study recently where they asked people during the <a href="https://www.vox.com/recode/22841490/work-remote-wages-labor-force-participation-great-resignation-unions-quits">Great Resignation</a> why they left their firm. First they asked the CEOs, “Why did people quit your firm?” The No. 1 answer they gave was that people left to get more money. Then they asked the people who quit why they left. The No. 1 answer was, “My manager didn’t recognize me.” So they left because they didn’t feel seen.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IPF9UJ">
Within a capitalist firm, it’s very useful if you can really understand the people around you and treat them with respect and some compassion and care. So I don’t want to paint capitalism as this completely ruthless dog-eat-dog world, because I think good companies can set a certain standard for how to behave.
</p>
<h4 id="rWbiKH">
Sean Illing
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bvSj69">
I really do believe in the benefits of a moral and humanistic education, and I agree that we don’t do a good job at cultivating virtue. What I keep coming back to is that even that vision of moral education, important as it is, requires a community in which to practice it, as you’ve already said, and I think we’ve built a society without much community.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YRc7J9">
So when you write that the most important story about why Americans have become sad and alienated and rude is that “We inhabit a society in which people are no longer trained in how to treat each other with kindness and consideration,” I tend to think that that’s incomplete in an important way. I’m not sure more churches and Boys &amp; Girls Clubs and more humanist curriculums is a sustainable counterweight to all the economic and social forces we’re talking about —
</p>
<h4 id="hrF9nQ">
David Brooks
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KZLBhy">
I don’t think capitalism is so corrosive that we can’t overcome its weaknesses with that kind of community action. And I do think it’s amazingly true that we no longer are in as many groups. If morality happens anywhere, it happens in groups, not in a classroom. We learn morality the way we learn crafts, through practicing them in morally coherent communities.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7JEmDu">
So if you’re Jewish, when somebody dies, you sit shiva with them: You go to the home of the family and you sit with them. It’s this beautiful tradition of showing compassion for the family, but in a way that sort of keeps them busy. They’ve got to host all these people, and you don’t want to raise the name of the dead, but if they want to talk about it, they’re perfectly free to do so. That little practice of sitting shiva is, to me, a moral education in itself. If we’re not involved in our religions, then we’re not going to learn that tradition.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MXQ3M5">
Hence, the question for me is, why have we created a society where we don’t join groups? Joining groups is one of the most fun things you can do. It definitely leads to happiness.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CXOYoc">
<em>To hear the rest of the conversation, </em><a href="https://podcasts.apple.com/us/podcast/is-america-getting-meaner/id1081584611?i=1000629886049"><em>click here</em></a><em>, and be sure to follow </em><a href="https://www.vox.com/thegrayarea">The Gray Area</a><em> on </em><a href="https://podcasts.apple.com/gb/podcast/the-gray-area-with-sean-illing/id1081584611"><em>Apple Podcasts</em></a><em>, </em><a href="https://podcasts.google.com/search/vox%20conversations"><em>Google Podcasts</em></a><em>, </em><a href="https://open.spotify.com/show/6NOJ6IkTb2GWMj1RpmtnxP"><em>Spotify</em></a><em>, </em><a href="https://www.stitcher.com/show/vox-conversations"><em>Stitcher</em></a><em>, or wherever you listen to podcasts.</em>
</p></li>
<li><strong>What a striking new study of death in America misses</strong> -
<figure>
<img alt="A worker wearing a mask, surgical gown, and gloves places a body wrapped in a sheet onto a stretcher inside a morgue." src="https://cdn.vox-cdn.com/thumbor/RknON5KjFHF8IQ-wpOZwmVYcKl8=/233x0:5097x3648/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72719151/1225640248.0.jpg"/>
<figcaption>
Maryland Cremation Services transporter Morgan Dean-McMillan gently moves the remains of a Covid victim onto a stretcher in a morgue in May 2020, in Silver Spring, Maryland. | Chip Somodevilla/Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The big divide on premature death isn’t between college grads and non-grads. It’s between high school dropouts and everyone else.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6pH0pa">
For the past decade or so, Princeton economists Angus Deaton and Anne Case have been promoting a particular <a href="https://www.vox.com/science-and-health/2018/1/12/16863282/opioid-epidemic-study-deaths-of-despair">story about death in America</a>. Less-educated Americans, particularly those without college degrees, have seen their life expectancy outcomes diverge from those of more-educated Americans. Much of this divide can be explained through a category that Deaton and Case call “deaths of despair”: deaths from suicide, opioid overdoses, and liver cirrhosis and other alcohol-related causes. The deaths are <a href="https://www.washingtonpost.com/news/wonk/wp/2017/04/06/how-dare-you-work-on-whites-professors-under-fire-for-research-on-white-mortality/">concentrated in non-Hispanic whites</a>. This phenomenon indicates something is deeply wrong with the way American society treats its most marginalized citizens, including lower-class whites.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0YYyAd">
The two have been pursuing research into the death divide for the better part of a decade now; their <a href="https://press.princeton.edu/books/hardcover/9780691190785/deaths-of-despair-and-the-future-of-capitalism">2020 book</a> on the topic became a bestseller. Events over recent years — including the sharp <a href="https://www.vox.com/future-perfect/2022/9/7/23339734/life-expectancy-shorter-united-states-covid">decline in life expectancy</a> in the US as a whole in 2020 and 2021 due to Covid-19, and before that the even more shocking first <a href="https://www.vox.com/2016/12/8/13875150/life-expectancy-us-dropped-first-time-decade">overall decline</a> in decades in 2016 — gave the topic added urgency.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OqbLtV">
Now their work is receiving renewed attention (including a <a href="https://www.nytimes.com/2023/10/03/opinion/life-expectancy-college-degree.html">New York Times op-ed</a> from the authors) after they presented <a href="https://www.brookings.edu/articles/accounting-for-the-widening-mortality-gap-between-american-adults-with-and-without-a-ba/">their most recent paper last week at the Brookings Institution</a>, centered around the following striking graphic:
</p>
<div id="NweJUQ">
<blockquote class="twitter-tweet">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" dir="ltr" lang="en">
Ann Case &amp; Angus Deaton right now at BPEA: <a href="https://t.co/cVCW5tVVVd">pic.twitter.com/cVCW5tVVVd</a>
</p>
— DeLong (<span class="citation" data-cites="delong">@delong</span>) <a href="https://twitter.com/delong/status/1707443172845224119?ref_src=twsrc%5Etfw">September 28, 2023</a>
</blockquote></div></li>
</ul>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AM0WOZ">
So what’s going on here? Is there an American underclass that’s falling behind and dying earlier than the rest of the country? Is the divide between college graduates and non-graduates increasingly central in determining life outcomes for Americans, down to the very number of years we get on this planet?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DIfLPM">
These are two different questions, and the answers seem to be, respectively, “yes” and “no.” Case and Deaton are highlighting a real problem, confirmed by other researchers: Americans with different levels of education die at different rates, and the least-educated Americans have seen their death rates surge in a way that more-educated Americans have not.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WHHZfz">
But the relevant divide does not seem to be between people who earned a bachelor’s degree — who remain a <a href="https://www.census.gov/newsroom/press-releases/2022/educational-attainment.html">minority among American adults</a> — and people who didn’t. Other research suggests that the problem is concentrated in specific areas of the US, and between the very least-educated Americans (particularly high school dropouts) and the rest of the country, rather than between college grads and non-grads.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xqkiXv">
Moreover, the cause of the divergence between high school dropouts and the rest of the country does not seem to be caused by “deaths of despair.” There is no doubt that the opioid epidemic in particular has wrought spectacular damage in the US. But some researchers are finding that stagnating progress against cardiovascular disease is an even bigger contributor to US life expectancy stalling out, and to mortality divides between the most- and least-educated Americans.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hsN5hX">
That implies we might want to think more specifically about heart disease, and about the American underclass, and less about the bachelor’s/non-bachelor’s divide that Case and Deaton highlight. That might enable us to produce a more useful policy agenda for tackling the problem.
</p>
<h3 id="dTienI">
Non-college grads in 1992 and non-college grads in 2021 are very different groups of people
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cjOyRY">
The biggest problem to be aware of when evaluating the Case-Deaton results is that the divide they’re describing, between college grads and non-grads, has changed a lot over time. In 1992, the year they begin their analysis, 22 percent of people between the ages of 25 and 84 had a four-year college degree. In 2021, the final year they analyze, the share was 35 percent.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rIthxs">
This rising education level suggests that there’s a large population of people — some 13 percent of adults — who wouldn’t have finished college 30 years ago, but who do now. One might reasonably expect this group to be healthier than people who wouldn’t have finished college in either period — and less healthy than people who would have finished in either period. The people still left out of college in 2021 are probably more socially and economically disadvantaged, and thus less healthy, than people who were able to attend, and people who could afford college in 1992 were relatively more advantaged, and probably healthier, than those who could.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cYMUnd">
So a group of people moving from not finishing college to finishing it should have the effect of making both college grads and non-grads, as groups, less healthy. The non-grads are losing their healthiest compatriots, and the grads are adding a somewhat less healthy group to their mix.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Zusq32">
This means we cannot look at graphs showing a widening mortality gap between college grads and non-grads and conclude, “Something is really going wrong with less-educated Americans.” That may be true, but it may just be a statistical artifact. As Stanford economist Caroline Hoxby noted in <a href="https://www.brookings.edu/wp-content/uploads/2023/08/1b_Hoxby_comments_on_Case_and_Deaton.pdf">her comments</a> on the latest Case-Deaton paper, it’s “entirely plausible that selection accounts for most or even all of the widening mortality gap.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Jb8ib8">
Case and Deaton try to adjust for this problem. They look at how the gaps between grads and non-grads change within specific birth cohorts: among people born in 1940, say, have college grads and non-grads seen their death rates diverge more and more over time? This analysis muddies the picture considerably. For men born in 1940, for instance, the gap between grads and non-grads has shrunk over time. There’s no noticeable increase in the gap for men or women born in 1950 and 1960. Gaps do emerge over time for the cohorts born in 1970, 1980, and 1990.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gf2Nuc">
What’s more, this approach doesn’t really fix the problem. To separate the world into college grads and non-grads, they check to see if people have completed a degree by age 25. But they concede that a growing share of people are getting bachelor’s degrees after 25. That means that these aren’t fixed categories, and the very same selection issues might come into play when looking at cohorts like this.
</p>
<h3 id="vqX5r0">
The problem is with high school dropouts, not all non-college grads
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Oj5oKv">
The good news is that other researchers have attempted more rigorous approaches to get around the selection problem. Economists <a href="https://www.aeaweb.org/articles?id=10.1257/app.20190297">Paul Novosad, Charlie Rafkin, and Sam Asher</a> analyze mortality from 1992 to 2018 among the least-educated 10 percent of Americans. By definition, this group becomes no larger or smaller as a share of the population over time: it’s always 10 percent. Identifying just who this group is requires some clever statistical work, but yields some very interesting results:
</p>
<div id="QeclK1">
<blockquote class="twitter-tweet">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" dir="ltr" lang="en">
This is how the trends look once you hold ranks constant. From 1992–2018, most White Americans have been doing fine mortality-wise — but the least educated 10% have faced catastrophic mortality increases. 9/N <a href="https://t.co/3ZpybrYyYj">pic.twitter.com/3ZpybrYyYj</a>
</p>
— Paul Novosad (<span class="citation" data-cites="paulnovosad">@paulnovosad</span>) <a href="https://twitter.com/paulnovosad/status/1603834402517155854?ref_src=twsrc%5Etfw">December 16, 2022</a>
</blockquote>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="shKK9v">
Among both Black and white middle-aged Americans, death rates were falling among the most-educated groups pre-Covid. For those in the middle of the education spectrum, death rates have been falling for Black Americans and stagnant for whites; <a href="https://www.kff.org/other/state-indicator/death-rate-by-raceethnicity/?dataView=1&amp;currentTimeframe=3&amp;selectedDistributions=white--black&amp;selectedRows=%7B%22wrapups%22:%7B%22united-states%22:%7B%7D%7D%7D&amp;sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">Black death rates still exceed those for whites</a> but the gap is narrowing. For the least-educated, which roughly means high school dropouts, death rates have been rising starkly for white men and women, and rising slightly for Black women, while staying roughly constant for Black men. (Novosad, Rafkin, and Asher also look at death rates in other age ranges, but note that death is rare enough before you get to your 50s that it doesn’t affect life expectancies in the US as much.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GXEJQJ">
Case and Deaton in their latest piece describe this as confirmation that the “qualitative” takeaway from their research is correct. I’m not sure I’d be that generous. “White high school dropouts are dying at higher and higher rates” implies that a small but significant share of the population is experiencing a mortality crisis. “Americans without a college degree are dying at higher and higher rates” implies that the majority of Americans are experiencing a crisis, since a majority of Americans don’t possess a college degree even today. That might be a better narrative for convincing people to care about the most vulnerable, but it doesn’t give us as much information about where the problem is.
</p>
<h3 id="5vX9Aq">
The problem is highly geographically concentrated
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QaVFsi">
At this point you may be wondering: If we’re concerned about how lower-socioeconomic-status Americans are doing in terms of mortality, why are we dividing them by education? Why not compare rich versus poor Americans, normally identified based on income?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="b9CPA6">
In 2016, economists Raj Chetty and others used US income tax data and death certificates to <a href="https://jamanetwork.com/journals/jama/article-abstract/2513561">track how mortality varied based on income</a> and how the relationship changed between 2001 and 2014. That isn’t a terribly long period across which to compare, but Chetty and colleagues confirmed that more income is associated with lower death rates and that the gap got worse over the period studied.
</p>
<figure class="e-image">
<img alt="Four charts showing that richer Americans have seen life expectancy grow faster" src="https://cdn.vox-cdn.com/thumbor/wzV0NxpfUMNVqCRNvI853GFH-oQ=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24970417/jsc160006f3.png"/> <cite><a class="ql-link" href="https://jamanetwork.com/journals/jama/fullarticle/2513561?guestAccessKey=4023ce75-d0fb-44de-bb6c-8a10a30a6173" target="_blank">Chetty et al 2016</a></cite>
<figcaption>
Life expectancy has grown faster for richer Americans since 1992.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XAGcKR">
But they also found that the gap varies substantially based on geography. While it’s true that rich people in America live significantly longer than poor people, that’s much less true in New York City. It’s not true in California as a whole. Heavily urban areas with high education levels see a modest relationship between income and death rates. More-rural, less-educated areas, by contrast, see a very strong relationship between the two.
</p>
<figure class="e-image">
<img alt="Two charts showing that in New York and San Francisco, being low-income hurts your life expectancy less than it does in Detroit or Dallas" src="https://cdn.vox-cdn.com/thumbor/fNsuP3jHCSrg0aZuDIPnsb3DKkg=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24970427/jsc160006f4.png"/> <cite><a class="ql-link" href="https://jamanetwork.com/journals/jama/fullarticle/2513561?guestAccessKey=4023ce75-d0fb-44de-bb6c-8a10a30a6173" target="_blank">Chetty et al 2016</a></cite>
<figcaption>
Different US cities have very different relationships between income and life expectancy.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wlm1Dr">
Areas with smaller mortality gaps tend to be places, the researchers find, with lower rates of smoking and higher rates of exercise, which makes sense when you consider that the variation in death rates between cities is driven not by factors like car crashes or suicide but conditions like heart disease and cancer, which are themselves driven in part by lifestyle conditions. Local unemployment rates and other indicators of the health of the local labor market did not seem to be associated with longevity, nor did income inequality. These aren’t firmly causal findings, to be clear, but they might be suggestive of potential causes to investigate.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="sOslnU">
This work doesn’t debunk the Case-Deaton research, but it does highlight ways in which that research is somewhat incomplete. Case and Deaton do not break down their findings by state or city to see if the relationship they find is only showing up in certain places. Together with the Novosad research, this data suggests that if we want to tackle rising mortality among some Americans, we need to be thinking specifically about problems with the very poorest high-school dropouts in certain areas of the country, rather than about some kind of broader — and therefore harder to address — national malaise.
</p>
<h3 id="FSHfgl">
What’s causing these early deaths?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WPYJth">
One of the more useful contributions of the latest Case-Deaton paper is its decision to zoom out from focusing on “deaths of despair” to include other contributions to rising mortality in the US, in particular cardiovascular disease.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0GiGdO">
There’s little doubt that the <a href="https://www.vox.com/science-and-health/2018/1/12/16863282/opioid-epidemic-study-deaths-of-despair">ongoing opioid crisis</a> has contributed to surging deaths, particularly among more vulnerable Americans, with smaller roles attributable to non-drug suicides and alcohol. One <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226732">recent paper</a> found that increasing drug use from 1999 to 2016 reduced the life expectancy of American men by 1.4 years, and that of women by 0.7. In West Virginia, the most affected state, the reductions were 3.6 and 1.9 years respectively. In 2020 and 2021, Covid was the dominant force reducing life expectancy, with the effects <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7226a5.htm">very different based on class</a>: People with disproportionately high-paying laptop jobs who were able to work from home were less exposed and so died less.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gMUe3e">
But the overall life expectancy problem in the US also has far more to do than we often recognize with stagnating progress against cardiovascular disease, which is still the <a href="https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm">leading cause of death</a> in the US. Researchers Neil Mehta, Leah Abrams, and Mikko Myrskylä <a href="https://www.pnas.org/doi/10.1073/pnas.1920391117">argued in a 2020 paper</a> that the dominant reason life expectancy has stalled in the US is not that drug deaths have grown but that a previously large, robust decline in deaths from cardiovascular disease has stalled out. The death rate fell by half between 1970 and 2002, but given that it’s still common enough to cause <a href="https://www.cdc.gov/heartdisease/facts.htm">695,000 deaths in 2021</a>, a stalled decline could be a very big deal.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZIDR6e">
Though explanations for this stagnation are still unclear, the authors present a couple of options: <a href="https://www.cdc.gov/obesity/data/adult.html">rising levels of obesity</a> (especially at younger ages, compounding negative health effects over more time), or, counterintuitively, the US’s <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm#:~:text=Current%20smoking%20has%20declined%20from,every%20100%20adults)%20in%202021.">early success at discouraging smoking</a> (which could explain why its cardiovascular death rates aren’t falling as fast as those in Europe, which gave up smoking later on). They find that the stagnation from cardiovascular disease is broad-based geographically in the US, unlike the rising death rates among low-income Americans studied by Chetty et al. 
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fZigLf">
Economists <a href="https://www.aeaweb.org/articles?id=10.1257/app.20190297">Novosad, Rafkin, and Asher</a> make similar points in their paper on the fate of the least-educated Americans over time. As of their data endpoint in 2018, “deaths of despair” — that is, from drug overdoses, suicides, and alcoholism — “account for a large share of mortality increases for young whites, but a very small share of rising mortality among older whites and very little of the divergent mortality rates of black,” they note. “Further, deaths of despair have increased more uniformly across the education distribution than deaths from other causes.” In other words, while the overall rise in mortality is concentrated among the least-educated, the opioid, suicide, and alcohol-related rise is not.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hhkb0J">
The middle-aged whites without high school diplomas Novosad and colleagues study have, however, seen their death rates from cancer, heart disease, and respiratory disease increase, while more-educated Americans have seen death rates from these diseases fall. A <a href="https://www.washingtonpost.com/health/interactive/2023/american-life-expectancy-dropping/">new investigation from the Washington Post</a> similarly concludes that chronic conditions like heart disease and cancer are driving more of the life expectancy divide between rich and poor counties than factors like opioid overdoses or homicides.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TD0xC3">
All this points to a very specific challenge that policymakers must confront: How to reduce deaths from cardiovascular disease (and also cancer) among the poorest, least-educated Americans. Case and Deaton like to <a href="https://www.nytimes.com/2023/10/03/opinion/life-expectancy-college-degree.html">prescribe</a> various economic measures as ways to combat rising death rates, like eliminating the link between employers and health insurance, expanding affordable housing, strengthening unions, and removing needless requirements that certain workers have bachelor’s degrees.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jUJ4yE">
I happen to think all those policies are good ideas. But I’m somewhat skeptical they would move the needle on heart disease among high school dropouts, especially compared to more targeted approaches like expanding <a href="https://www.ahajournals.org/doi/10.1161/JAHA.122.028205">cholesterol screening</a> or ensuring Medicaid covers medicines like semaglutide that <a href="https://www.vox.com/health/23826023/wegovy-ozempic-heart-disease-attack-stroke-death-lower-risk-diabetes">reduce the risk of heart disease</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZNSRhS">
People dying now cannot wait for the whole US economy to transform to be more worker-friendly, as nice as that might be. They need solutions that are tailored for their specific problems, that can be implemented soon.
</p>
<ul>
<li><strong>Why Kenya is sending police officers into Haiti</strong> -
<figure>
<img alt="Police with guns and helmets walk down a street." src="https://cdn.vox-cdn.com/thumbor/l8aAJ1qsQvrqeSqghtuflbvoo5g=/334x0:5283x3712/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72719050/1252173695.0.jpg"/>
<figcaption>
The UN authorized a multilateral intervention in Haiti to help train and support the island nation’s police, pictured here in April, in combatting gang-related violence. | Richard Pierrin/AFP via Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The world is intervening in Haiti — again.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zSyQIU">
Once again, the international community will intervene in Haiti, this time to stabilize the security situation in the capital of Port-au-Prince, where gangs have terrorized civilians for the past two years.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0eWcpW">
The United Nations Security Council passed a resolution Monday authorizing a multinational security mission — led not by UN peacekeepers but by Kenya’s national police force — to tackle gang-related violence. Following the assassination of Haitian President Jovenel Moïse in 2021, several armed groups, mostly under the banners of the gang federations of G9 and G-PEP, effectively took control of the capital — trafficking drugs, extorting and kidnapping ordinary citizens, recruiting children, and raping and murdering both their enemies and innocent civilians alike.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LHxxvz">
A number of stakeholders agree that an intervention is critical to stop the violence, and given that the Haitian National Police force is <a href="https://www.theguardian.com/world/2023/feb/02/haiti-cops-outgunned-gangs#:~:text=Like%20every%20institution%20in%20Haiti,warfare%20on%20behalf%20of%20gangs.">outgunned and underpaid</a>, it has to be an external force of some kind. But given the sometimes-grim <a href="https://www.nytimes.com/2021/06/06/world/americas/cholera-haiti-ban-ki-moon-memoir.html">history</a> of international security missions in Haiti (including creating one of the worst cholera outbreaks in modern times), <a href="https://www.nytimes.com/2022/10/12/opinion/haiti-montana-accords-reparations.html">a longer history of imperial and colonial</a> interference, and a lack of investment in Haiti’s governance structure and economy, there is also real fear about the long-term effects of another such intervention.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="H1jvzJ">
Complicating all of this is Haiti’s political situation. Following Moïse’s assassination, Ariel Henry — a neurosurgeon who was awaiting appointment to the prime ministership — took control of the government. In his capacity as head of state, Henry has presided over a rout of Haiti’s governmental institutions (such as they were). He’s also allowed gang violence to proliferate to the point that it has effectively cut off Port-au-Prince from the rest of the country.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SmgvQh">
“It’s as bad as it’s ever been,” <a href="https://www.usip.org/people/keith-mines">Keith Mines</a>, the director of the Latin America program at the US Institute of Peace, told Vox.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="peBeF1">
Most Haitians outside of the elite and political class do not consider Henry the legitimate leader, experts said. But the United Nations and the international community, including the United States, recognize Henry, prompting <a href="https://thehill.com/latino/4222348-haitian-american-leaders-call-on-biden-to-dump-ariel-henry/">yet another concern about this intervention</a>: that it will ultimately serve Henry — not Haitians.
</p>
<h3 id="xshlDy">
What would this international intervention look like?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="i7bi8j">
Kenya’s national police force has stepped up to lead the current proposed intervention, pledging to send 1,000 officers to assist and train Haiti’s own police force. Several Caribbean countries will also provide officers or potentially troops, and US Assistant Secretary for Western Hemisphere Affairs Brian Nichols indicated there were offers of support for the mission from countries in “Asia, Africa, Latin America, [and] the Caribbean” <a href="https://www.state.gov/acting-deputy-secretary-of-state-and-under-secretary-for-political-affairs-victoria-nuland-and-assistant-secretary-for-western-hemisphere-affairs-brian-nichols-after-the-addressing-the-urgent-security/">in a September press conference</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TqErSQ">
The Multinational Security Support mission, or MSS, will be deployed for a year, with a review after nine months, according to the <a href="https://apnews.com/article/haiti-un-kenya-armed-force-resolution-3749ac5db9d6c5903e61dee7b4206e6c">Associated Press</a>. Alfred Mutua, Kenya’s minister of foreign and diaspora affairs, <a href="https://www.bbc.com/news/world-africa-66946156">told the BBC</a> that he expected to have boots on the ground by the first of the year. He also expects the mission to train Haitian officers, patrol with them, and guard specific sites like ports, <a href="https://www.nytimes.com/2023/10/02/world/americas/haiti-kenya-un-vote.html">the New York Times reported</a>. Experts have said <a href="https://news.un.org/en/story/2023/10/1141757">the focus</a> will have to be on working with the Haitian police to identify gang structures, funding streams, and more to be able to effectively tackle one of the worst gang violence issues the country has faced.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Y2FPOo">
Gang violence has long been intimately entwined with Haitian politics, from the Tonton Macoutes under former dictator <a href="https://www.nytimes.com/1971/04/23/archives/papa-doc-a-ruthless-dictator-kept-the-haitians-in-illiteracy-and.html">François “Papa Doc” Duvalier</a> to <a href="https://www.vox.com/world-politics/2023/3/26/23657163/haitis-gang-violence-crisis-explained">Aristide’s Chimères</a>. But under Henry, the armed groups have taken advantage of a political vacuum and gained brutal power over everyday life in Port-au-Prince.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="V2YET1">
​In the past, “the gangs had some ties with political movements, not only because they had arrangements for the elections and something like that, but also because of a shared ideology,” explained Diego da Rin, a researcher with the International Crisis Group. They “have acquired a great amount of independence over the last three years. And now they are not talking to members of the elite as sponsors, but rather as partners.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UpNLNn">
Kenya might seem an unlikely country to lead this intervention. <a href="https://twitter.com/DrAlfredMutua/status/1685314557823037440">Mutua</a> has framed it as part of Nairobi’s “commitment to Pan Africanism,” as well as “reclaiming of the Atlantic crossing.” But it’s unlikely this would have happened without other countries’ involvement.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RCPkzP">
Though the US has supported an international intervention since Henry began calling for it last October — and pledged $100 million toward the effort at September’s UN General Assembly — there’s no appetite on the US side to lead such a mission. The US tried to pressure <a href="https://www.wilsoncenter.org/article/canada-united-states-and-haiti-dilemmas-foreign-policy-and-immigration">Canada’s military into leading a security operation</a> last fall (Canada would have soldiers who spoke French, one of Haiti’s official languages, and had participated in peacekeeping operations there before). But Canada, too, was reluctant to put boots on the ground given its commitments in Ukraine and the challenges of its previous role in the United Nations Stabilization Mission in Haiti (known by its French acronym MINUSTAH) from 2004 to 2017. Other regional leaders, like Brazil, were also reluctant to take the lead on an intervention.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TlQphK">
Then, this July, Kenya announced it would do so.
</p>
<div id="2Pe5YV">
<blockquote class="twitter-tweet">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" dir="ltr" lang="en">
HAITI<br/>At the request of Friends of Haiti Group of Nations, Kenya has accepted to positively consider leading a Multi-National Force to Haiti. Kenya’s commitment is to deploy a contingent of 1,000 police officers to help train and assist Haitian police restore normalcy in the… <a href="https://t.co/CBwIlAOSyd">pic.twitter.com/CBwIlAOSyd</a>
</p>
— . . (<span class="citation" data-cites="DrAlfredMutua">@DrAlfredMutua</span>) <a href="https://twitter.com/DrAlfredMutua/status/1685314557823037440?ref_src=twsrc%5Etfw">July 29, 2023</a>
</blockquote></div></li>
</ul>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="p9Rjr0">
“Kenya has recognized and increasingly sees value in regional security partnerships and regional security engagements more generally,” Joseph Siegle, research director at the Africa Center for Strategic Studies, told Vox in an interview. Kenya has been part of an <a href="https://amisom-au.org/kenya-kdf/">African Union peacekeeping force in Somalia</a> since 2011 to help combat the al-Shabaab insurgent group in the country. That effort has <a href="https://www.aljazeera.com/news/2023/7/6/kenya-delays-reopening-border-with-somalia-all-the-details">yielded mixed results</a>, though, and many news reports have pointed to the Kenyan National Police force’s track record of human rights abuses within Kenya as cause for concern, particularly in a hostile environment like Haiti.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dV5YxE">
Over the past few weeks, Kenya has ramped up its diplomatic efforts with both the US and Haiti; the East African nation signed a defense agreement with the US that will provide resources for Kenya’s fight against al-Shabaab, <a href="https://apnews.com/article/kenya-united-states-haiti-defense-austin-ed1496d72b426011f3e8a36a971ca12d">as the AP reported last week</a>. Kenya and Haiti also <a href="https://www.voanews.com/a/haiti-kenya-set-up-diplomatic-ties/7277628.html#:~:text=Haiti%20and%20Kenya%20established%20diplomatic,escalating%20gang%20warfare%20in%20Haiti.">established diplomatic relations in September</a>.
</p>
<h3 id="uzlVI3">
Will this be different from previous international interventions? That’s a good question.
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VISKWY">
Since Haiti’s independence, wealthy nations have meddled in the island country <a href="https://www.npr.org/sections/money/2021/10/05/1042518732/-the-greatest-heist-in-history-how-haiti-was-forced-to-pay-reparations-for-freed">to its detriment</a>. But, as Jake Johnston, a senior research associate at the Center for Economic and Policy Research, told Vox, “It’s not always the same, and the interventions we’re talking about now — it’s not the same as the early 20th century US occupation, or France sending gunboats off the shore in the early 19th century.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="j3kYbx">
Still, more recent peacekeeping efforts have a checkered past as well. Though they may have succeeded in stabilizing Haiti in the short term, they have failed to bring lasting stability and peace to the country and in some cases contributed to destabilization.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ij9YLa">
In 1994, a <a href="https://history.state.gov/milestones/1993-2000/haiti">US-led</a> <a href="https://peacekeeping.un.org/en/mission/past/unmihbackgr2.html">UN peacekeeping mission deployed</a> to Haiti following a 1991 coup, which overthrew the democratically elected Jean-Bertrand Aristide. Mines, who was part of that mission, argued that “the interventions have been, often, the only thing that resets a government in Haiti so that it could function and people [could] eat again.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hiY3nF">
“It created the foundation for a very, very, very long process of democratic consolidation,” he added. “That is a long process, particularly for a country like Haiti, whose total civil society had been destroyed.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="U74KfF">
But whatever democratic consolidation successfully occurred over that mission and the peacekeeping period that followed through 2000 later collapsed, partly due to the economic strain of international sanctions and alleged corruption after Aristide’s return to power. He fled an armed uprising in 2004, and once again UN peacekeeping forces came to calm the violence that broke out between Aristide’s opponents and his supporters.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CzCixI">
Peacekeepers on that mission — which lasted for over a decade — were likely responsible for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9105971/">a cholera epidemic</a> that began in 2010 after the disastrous earthquake, killing 10,000 Haitians and sickening hundreds of thousands more. That incident, according to a 2016 report from then-Special Rapporteur Philip Alston, provided “highly combustible fuel for those who claim that UN peacekeeping operations trample on the rights of those being protected, and it undermines both the UN’s overall credibility and the integrity of the Office of the Secretary-General,” the<a href="https://www.nytimes.com/2016/08/18/world/americas/united-nations-haiti-cholera.html"> New York Times</a> reported.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WZgYAt">
Sexual abuse and exploitation were also an issue during that UN peacekeeping mission, though it’s not unique to Haiti, according to a <a href="https://www.hrw.org/news/2020/01/11/un-peacekeeping-has-sexual-abuse-problem">2020 Human Rights Watch report</a>. Sri Lankan peacekeepers have been accused of heinous sexual abuses in Haiti, including hundreds of allegations of sexual abuse and exploitation of children <s></s>, going back as far as 2007,<a href="https://apnews.com/article/africa-arrests-united-nations-only-on-ap-e6ebc331460345c5abd4f57d77f535c1"> the Associated Press </a>reported in 2017.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hfs7UU">
It’s too early to know what oversight for the present security mission will look like. A State Department spokesperson told Vox via email that “we continue to prioritize the protection of human rights, and the promotion of accountability for MSS personnel, in conversations with international partners on the Multinational Security Support mission.”
</p>
<h3 id="9r5nBY">
But the big question is: Will this actually work?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4vkpB3">
Even if this intervention can somehow mitigate gang violence and stabilize Port-au-Prince, it will do nothing to address a parallel crisis: the government’s lack of political legitimacy.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ddjsf9">
Henry took over as acting prime minister and acting president of Haiti on July 20, 2021, 13 days after Moïse’s assassination. At the time of his death, Moïse had chosen Henry as his next prime minister but Claude Joseph was still technically in the position, creating confusion about who would lead the country. Joseph initially took over leadership of the government, but quickly stepped down in favor of Henry. Over the next half year, <a href="https://www.nytimes.com/2022/01/10/world/americas/haitian-prime-minister-assassination-suspect.html">doubts developed</a> about Henry’s commitment to seeking justice for Moïse’s assassination.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tvpdrk">
In the two-plus years of Henry’s leadership, not only has the immediate crisis of the gang violence grown worse, but he has also enabled the hollowing out of Haiti’s institutions. The judiciary — though it was <a href="https://apnews.com/article/port-au-prince-prisons-judiciary-latin-america-united-nations-86043172b27e2fa42cd105a097ae3380">dysfunctional before Henry’s leadership</a> — is largely <a href="https://www.undp.org/sites/g/files/zskgke326/files/2023-04/undp-ht-ProgrammeJustice-Factsheet-042023-En.pdf">unable to prosecute gang-related and corruption crimes</a>, and the terms of Haiti’s last remaining senators expired in January, leaving the government with <a href="https://www.theguardian.com/world/2023/jan/10/haiti-no-elected-officials-anarchy-failed-state">no elected officials</a>, as Henry <a href="https://www.aljazeera.com/news/2021/9/28/haiti-elections-postponed-indefinitely-amid-crisis">indefinitely postponed</a> parliamentary and presidential elections in 2021.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QGyYDQ">
And right now, that doesn’t look like it’s going to change. There’s no political agreement for Henry to step down or for Haitians to install a transitional government to go along with it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="sKVwOk">
That’s not to say that a framework doesn’t exist; in fact, there are multiple frameworks. Two hold particular promise: <a href="https://akomontana.ht/en/home/">the Montana Accord</a> and the December 21 Accord, two proposals designed by cross-sections of Haitian society over the last two years.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Tezv33">
The <a href="https://akomontana.ht/wp-content/uploads/2023/04/English-Anglais-Translation-of-Accord-du-30-aout-dit-Montana-Accord-Version-4-Aug-Citizen-Conference-for-a-Haitian-Solution-to-the-Crisis.pdf">Montana Accord</a> provides a roadmap “to create the conditions for national stability with a view to a return to constitutional normality and the restoration of democratic order” over a period of two years. It proposes a National Transitional Council, composed of members of civil society organizations and political parties, which would choose and oversee transitional leadership. Within a month, the leadership would establish an independent body to hold elections. The framework also addresses the matters of constitutional changes and justice and accountability for the perpetrators of the current crisis. It also provides for needs like education, health care, and public safety. The Montana group <a href="https://www.csis.org/analysis/haiti-betting-montana-accord">even chose its proposed leadership in 2022</a>, but negotiations between Henry and the group <a href="https://www.justsecurity.org/82968/as-haitis-henry-refuses-checks-on-power-the-us-should-aid-efforts-to-build-true-democracy/">stalled in August 2022</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kuqUaL">
The December 21 Accord, negotiated after the Montana Accord stalled by a group of political leaders, civil society actors, business sector leaders, and Henry, is also a potential transitional framework, as <a href="https://www.usip.org/publications/2023/03/have-haitians-finally-found-formula-moving-forward">Mines discussed in a March blog post</a>. Henry, as part of the agreement, was supposed to hold elections this year, for a new government in February 2024, but there’s no indication that he’ll actually do that.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YlC26d">
Thus far, however, the US and the UN have effectively treated Henry as Haiti’s legitimate government representative, which isn’t a view most Haitians, either in the country or in exile, share. That contributes to the perception <a href="https://thehill.com/latino/4222348-haitian-american-leaders-call-on-biden-to-dump-ariel-henry/">among some constituencies</a> that a security mission will only entrench Henry’s power.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kKkjFG">
“Henry has been the sole leader, the executive, for over two years,” da Rin said. “He has ruled without any oversight or control from the judiciary or the parliament that ceased completely to exist in January of this year, when the last elected officials’ mandate expired. So it is really necessary to have a more legitimate government, to have a legitimate interlocutor with the international community and for Haitians to not believe that the … security mission won’t be helping only to consolidate his power.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7otlpr">
But the lack of a political solution shouldn’t preclude an intervention, Rep. Sheila Cherfilus-McCormick (D-FL), the <a href="https://www.c-span.org/video/?525556-11/rep-sheila-cherfilus-mccormick-profile-interview">first Haitian American Democrat elected to Congress</a>, told Vox in an interview. “When you see people who are suffering, living in atrocities and violence like we’ve never seen before in Haiti asking for help, who are we to say, ‘No, we don’t want to help, we’re not going to send peacekeepers to fight the gangs,’” she said. “The more we wait, the more lives we risk.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BNDKmp">
Cherfilus-McCormick insisted that Henry must step down, though, and that the US has a role to play in that process. “The [Biden] administration does need to go a step further and no longer support [Henry] and support the transition government. There are civil society members who have come together and who have private sector support, who can compose this transition government,” she said. “So why aren’t we supporting them?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AzWHlv">
A State Department spokesperson told Vox in an email that the security mission “will not support any political leader or party. It will strictly focus on improving security in Haiti, answering the call from across the Haitian government, private sector, and civil society” and that the Department of Defense will assist with “logistics, equipment, billeting, basing, airlift, communications, and medical support.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4cjAGv">
Details about additional humanitarian support — food and fuel for people in Port-au-Prince, medical care, and other critical aspects of everyday life — remain scarce for now, and it will be months before the multinational force has the necessary training, equipment, and cohesion to start its specific mission in the first place. But even though that aspect of stabilizing the country is just getting underway, it’s unclear how far into the future various stakeholders have thought about their decision.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DHI10F">
“You can’t send troops in there and combat gangs and think that that’s actually addressing the drivers of instability and insecurity,” Johnston said. “And so what’s your plan? Are you going to occupy Haiti forever with foreign troops to prevent any instability? I don’t think so.”
</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>Encantamento and Pure For Sure catch the eye</strong> -</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>Harmilan Bains wins silver in women’s 800m at Asian Games</strong> - Bains had earlier won a silver in the women’s 1500m race in this edition of the 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>Hangzhou Asian Games badminton | Satwiksairaj-Chirag secure quarterfinal berth; Sindhu, Prannoy in last eight; Srikanth out</strong> - Sindhu was excellent in rallies and dictated terms to her opponent from the go, and so was Prannoy.</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>Street Child World Cup 2023: Through the eyes of photographer Vicky Roy</strong> - The Street Child World Cup 2023 in Chennai was home to some fond moments celebrating community. We take a look at the tournament through the eyes of award-winning documentary photographer Vicky Roy</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>World Cup 2023 | Chennai musicians create Carnatic music anthem to celebrate cricket</strong> - P Unnikrishnan, Palghat R Ramprasad and Sikkil Gurucharan have teamed up for ‘Cricket Endraal Bharatham’, a Carnatic cricket anthem</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>Here are the big stories from Karnataka today</strong> - Welcome to the Karnataka Today newsletter, your guide from The Hindu on the major news stories to follow today. Curated by Nalme Nachiyar.</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>Gang of five caught with MDMA in Chandanagar</strong> -</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>Ajit Pawar gets his way again, snags plum Guardian Ministership of Pune district</strong> - The list of 12 Guardian Ministers shows increasing weight of rebel NCP faction within the tripartite ruling alliance; appointments come after Mr. Shinde, Mr. Fadnavis meet BJP national leaders</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>Cabinet approves tenancy regulations for 3 UTs</strong> - Article 240 empowers the president to make regulations for the Union territories.</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>Man arrested for threatening CBI public prosecutor in Soujanya murder case</strong> - The accused alleged that Mr. Perla had taken a huge bribe to derail the Soujanya murder case, and said he would soon come out with documentary evidence</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>Venice tourist bus plunges from bridge, killing 21</strong> - Children are among dead after a bus fell from an overpass and caught fire.</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>Marina Ovsyannikova: Anti-war Russian journalist sentenced in absentia</strong> - Maria Ovsyannikova, who protested live on air against the invasion of Ukraine, gets more than 8 years in jail.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Climate change: Pope Francis warns world ‘may be nearing breaking point’</strong> - Pope Francis criticises attempts to deny or gloss over the issue in a new intervention.</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>Boat carrying 280 migrants lands in Canary Islands</strong> - It is thought to be the largest number of people ever to arrive in the Spanish archipelago in one go.</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>Rules of engagement issued to hacktivists after chaos</strong> - The Red Cross writes rules of engagement for civilian hackers as numbers rise</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>This EV restomod highlights the joys and flaws of the classic MGB</strong> - It’s lighter and more powerful than the original but only by a sensible amount. - <a href="https://arstechnica.com/?p=1973008">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>It’s crunch time for companies building NASA’s commercial lunar landers</strong> - Big tests loom in the months ahead for NASA’s lander fleet. - <a href="https://arstechnica.com/?p=1972839">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Dealmaster: Early Amazon Prime Big Deal Days sales heat up, Apple deals, and more</strong> - Get sweet discounts on Apple tech and home gear ahead of Amazon’s Big Deal Days. - <a href="https://arstechnica.com/?p=1972877">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>They’ve begun: Attacks exploiting vulnerability with maximum 10 severity rating</strong> - Will attacks be as big as those targeting MOVEit? Maybe not, but they still can be plenty bad. - <a href="https://arstechnica.com/?p=1973010">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Probiotic bacterium kills preterm infant; FDA blasts supplement maker</strong> - Genomic sequencing matched baby’s fatal sepsis case to bacteria in Evivo with MCT Oil. - <a href="https://arstechnica.com/?p=1972989">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Jim and Edna are both mental patients. One day Jim jumps into the swimming pool but, doesn’t come up for air. Quick as a flash, Edna sees her friend in trouble, so dives in and pulls him out.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Later, the hospital director calls Edna into his office and sayes “Edna, Ive got some good news and some bad news. The good news is, we are releasing you as you are obviously sane ‘saving anothers life’. But unfortunately, the bad news is that Jim hanged himself in the bathroom …” “Oh no’ Edna replies, that’s where I put him to dry !”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/YZXFILE"> /u/YZXFILE </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/16z73o0/jim_and_edna_are_both_mental_patients_one_day_jim/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/16z73o0/jim_and_edna_are_both_mental_patients_one_day_jim/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>There’s these three guys, and they’re sitting around a table.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The first guy says “You know what, I’m fast. I think I’m so fast, I might be the fastest guy in the world” So his buddies time him, take a picture, and send it to the Guinness book of world records.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The second guy says “You know what, I’m tall. I think I’m so tall, I might be the tallest guy in the world” So his buddies measure him, take a picture, and send it to the Guinness book of world records.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The third guy says “You know what, I got a small penis. I think it’s so small, it might be the smallest in the world” So his buddies get a ruler, measure it, take a picture, and send it to the Guinness book of world records.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
They’re sitting around a few weeks later, and the results come back. The first guy opens his letter and shouts “I DID IT! I’m the fastest guy in the world!” The second guy opens his and shouts “I DID IT! I’m the tallest guy in the world!” The third guy opens his letter and shouts angrily “WHO THE FUCK IS (insert your mates name here)!!!”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Rankler32"> /u/Rankler32 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/16zhcme/theres_these_three_guys_and_theyre_sitting_around/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/16zhcme/theres_these_three_guys_and_theyre_sitting_around/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Actually happened: I saw a girl at a party who was distraught and crying because she had accidentally swallowed a tongue piercing.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Her boyfriend put his arm around her and said, “This, too, shall PASS.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
If she doesn’t marry him, I will.
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/bennetthaselton"> /u/bennetthaselton </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/16z6jxz/actually_happened_i_saw_a_girl_at_a_party_who_was/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/16z6jxz/actually_happened_i_saw_a_girl_at_a_party_who_was/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A horse walks into a bar..</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The bartender asks, “Why the long face?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The horse says, “My boss just fired me, my kids won’t talk to me and my wife just filed for divorce. Got anything to help with that?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The bartender looks him up and down, and says “Neigh.”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Vandrew226"> /u/Vandrew226 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/16zby79/a_horse_walks_into_a_bar/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/16zby79/a_horse_walks_into_a_bar/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A woman comes home early, and finds her husband in bed with a girl.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
</p><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">She is furious, threatens to kill them both… the husband says:</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"></p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
</p><ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">Believe me, darling, this is just a misunderstanding. I was driving home, and saw this young lady trying to catch a ride. So I decided to give her a lift. I ask her where she needs to go, and she tells me she wants to visit some relatives, but isn’t sure about their address. So, I took her home so she could check our phonebook.
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"></p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
</p><ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">Once there, I saw her dress is pretty ragged, so I decided to give her your old dress. Nearly two years that it’s been hanging in the closet, and you never wore it.
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"></p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
</p><ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">Then, I saw her shoes are also about to fall apart, so I gave her your old shoes, which have been doing nothing but collecting dust for three years. Of course, she said thanks, and then asked:
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"></p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Excuse me sir, but is there anything else in this house your wife never uses?”
</p>
</li></ul></li></ul></li></ul></div>
<!-- SC_ON -->
submitted by <a href="https://www.reddit.com/user/Omeganian"> /u/Omeganian </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/16ymiyu/a_woman_comes_home_early_and_finds_her_husband_in/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/16ymiyu/a_woman_comes_home_early_and_finds_her_husband_in/">[comments]</a></span></li>
</ul>
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