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Christina Applegate details bout of Covid and Sapovirus amid MS battle

<p>Christina Applegate has detailed her latest health battle amid her multiple sclerosis (MS).</p> <p>Speaking on her <em>MesSy</em> podcast with co-host Jamie-Lynn Sigler, the actress revealed her rough experience after contracting Covid for the first time, which then turned into long Covid, and to make matters worse, she then contracted Sapovirus from contaminated food. </p> <p>Sapoviruses can cause acute gastroenteritis, and the actress candidly shared that she had been wearing diapers in recent weeks because of how often she has had to go to the bathroom. </p> <p>"I finally got the Covies.. someone real close to me dropped the ball and came home with the stuff and it spread all over the house," she began.</p> <p>"I had one day when I had a headache and chills and I thought I was making it through this."</p> <p>"It turned into long covid and it turned into a chest infection and then my heart was doing weird stuff, where it just speeds up... so I was like mother f--ker!"</p> <p>She then continued, saying that after contracting the virus she was "p---ing out of her a** for a few days".</p> <p>"I was so dizzy. I was so sick. I couldn't eat... Someone else's poop went into my mouth and I ate it."</p> <p>The actress recently revealed that she has 30 lesions on her brain from her MS,  a condition where the body's own immune system mistakenly attacks and damages the fatty material around the nerves, which can cause a range of symptoms. </p> <p>It is the most common acquired chronic neurological disease affecting young adults, according to MS Australia. </p> <p><em>Image: Getty</em></p>

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How long does immunity last after a COVID infection?

<p><em><a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/dr-wesley-freppel-1408971">Dr Wesley Freppel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p>Nearly four years into the pandemic, Australia, like many other countries, is still seeing large numbers of <a href="https://nindss.health.gov.au/pbi-dashboard/">COVID cases</a>. Some 860,221 infections were recorded around the country in 2023, while 30,283 cases have already been reported in 2024.</p> <p>This is likely to be a significant underestimate, with fewer people testing and reporting than earlier in the pandemic. But the signs suggest parts of Australia are experiencing yet <a href="https://www.abc.net.au/news/2024-01-23/covid-19-case-numbers-from-australia-states-and-territories/103374656">another COVID surge</a>.</p> <p>While some lucky people claim to have never had COVID, many are facing our second, third or even fourth infection, often despite having been vaccinated. You might be wondering, how long does immunity last after a previous infection or vaccination?</p> <p>Let’s take a look at what the evidence shows.</p> <h2>B cells and T cells</h2> <p>To answer this question, we need to understand a bit about how <a href="https://theconversation.com/what-happens-in-our-body-when-we-encounter-and-fight-off-a-virus-like-the-flu-sars-cov-2-or-rsv-207023">immunity</a> to SARS-CoV-2 (the virus that causes COVID) works.</p> <p>After being infected or vaccinated, the immune system develops specific antibodies that can neutralise SARS-CoV-2. B cells remember the virus for a period of time. In addition, the immune system produces memory T cells that can kill the virus, and remain in the blood for some months after the clearance of the infection or a vaccination.</p> <p>A <a href="https://www.science.org/doi/full/10.1126/science.abf4063?rfr_dat=cr_pub++0pubmed&amp;url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org">2021 study</a> found 98% of people had antibodies against SARS-CoV-2’s spike protein (a protein on the surface of the virus that allows it to attach to our cells) one month after symptom onset. Six to eight months afterwards, 90% of participants still had these neutralising antibodies in their blood.</p> <p>This means the immune system should have recognised and neutralised the same SARS-CoV-2 variant if challenged within six to eight months (if an infection occurred, it should have resulted in mild to no symptoms).</p> <h2>But what about when the virus mutates?</h2> <p>As we know, SARS-CoV-2 has mutated over time, leading to the emergence of new variants such as alpha, beta, delta and omicron. Each of these variants carries mutations that are new to the immune system, even if the person has been previously infected with an earlier variant.</p> <p>A new variant likely won’t be <a href="https://www.science.org/doi/10.1126/science.adj0070">perfectly recognised</a> – or even <a href="https://www.cell.com/cell/pdf/S0092-8674(21)01578-6.pdf">recognised at all</a> – by the already activated memory T or B cells from a previous SARS-CoV-2 infection. This could explain why people can be so readily reinfected with COVID.</p> <p>A recent <a href="https://www.thelancet.com/article/S0140-6736(22)02465-5/fulltext#seccestitle10">review of studies</a> published up to the end of September 2022 looked at the protection conferred by previous SARS-CoV-2 infections.</p> <p>The authors found a previous infection provided protective immunity against reinfection with the ancestral, alpha, beta and delta variants of 85.2% at four weeks. Protection against reinfection with these variants remained high (78.6%) at 40 weeks, or just over nine months, after the previous infection. This protection decreased to 55.5% at 80 weeks (18 months), but the authors noted there was a lack of data at this time point.</p> <p>Notably, an earlier infection provided only 36.1% protection against a reinfection with omicron BA.1 at 40 weeks. Omicron has been described as an <a href="https://www.nature.com/articles/s41564-022-01143-7">immune escape variant</a>.</p> <p>A prior infection showed a high level of protection against severe disease (above 88%) up to 40 weeks regardless of the variant a person was reinfected with.</p> <h2>What about immunity after vaccination?</h2> <p>So far almost 70 million COVID vaccines <a href="https://www.health.gov.au/topics/covid-19/reporting">have been administered</a> to more than <a href="https://www.health.gov.au/resources/publications/covid-19-vaccine-rollout-update-12-january-2023?language=en">22 million people</a> in Australia. Scientists estimated COVID vaccines prevented around <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00320-6/fulltext">14.4 million deaths</a> in 185 countries in the first year after they became available.</p> <p>But we know COVID vaccine effectiveness wanes over time. A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804451?utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_term=050323">2023 review</a> found the original vaccines were 79.6% and 49.7% effective at protecting against symptomatic delta infection at one and nine months after vaccination respectively. They were 60.4% and 13.3% effective against symptomatic omicron at the same time points.</p> <p>This is where booster doses come into the picture. They’re important to keep the immune system ready to fight off the virus, particularly for those who are more vulnerable to the effects of a COVID infection.</p> <p>Plus, regular booster doses can provide immunity against different variants. COVID vaccines are constantly being <a href="https://mvec.mcri.edu.au/references/covid-19/">reviewed and updated</a> to ensure optimal protection against <a href="https://www.who.int/activities/tracking-SARS-CoV-2-variants">current circulating strains</a>, with the latest shot available designed to target <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants">the omicron variant XBB 1.5</a>. This is similar to how we approach seasonal flu vaccines.</p> <p>A <a href="https://www.nature.com/articles/s41598-023-50335-6">recent study</a> showed a COVID vaccination provides longer protection against reinfection than natural protection alone. The median time from infection to reinfection in non-vaccinated people was only six months, compared with 14 months in people who had received one, two or three doses of vaccine after their first infection. This is called <a href="https://www.science.org/doi/10.1126/science.abj2258">hybrid immunity</a>, and other research has similarly found it provides better protection than natural infection alone.</p> <p>It also seems timing is important, as receiving a vaccine too soon after an infection (less than six months) appears to be <a href="https://www.nature.com/articles/s41598-023-50335-6">less effective</a> than getting vaccinated later.</p> <h2>What now?</h2> <p>Everyone’s immune system is slightly unique, and SARS-CoV-2 continues to mutate, so knowing exactly how long COVID immunity lasts is complicated.</p> <p>Evidence suggests immunity following infection should generally last six months in healthy adults, and can be prolonged with vaccination. But there are exceptions, and all of this assumes the virus has not mutated so much that it “escapes” our immune response.</p> <p>While many people feel the COVID pandemic is over, it’s important we don’t forget the lessons we have learned. Practices such as wearing a mask and staying home when unwell can reduce the spread of many viruses, not only <a href="https://www.bmj.com/content/375/bmj-2021-068302">COVID</a>.</p> <p>Vaccination is not mandatory, but for older adults eligible for a booster under the <a href="https://www.health.gov.au/news/atagi-update-on-the-covid-19-vaccination-program">current guidelines</a>, it’s a very good idea.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221398/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/lara-herrero-1166059"><em>Lara Herrero</em></a><em>, Research Leader in Virology and Infectious Disease, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/dr-wesley-freppel-1408971">Dr Wesley Freppel</a>, Research Fellow, Institute for Glycomics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-immunity-last-after-a-covid-infection-221398">original article</a>.</em></p>

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I have COVID. How likely am I to get long COVID?

<p><em><a href="https://theconversation.com/profiles/andrew-baillie-646956">Andrew Baillie</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/amelia-gulliver-17440">Amelia Gulliver</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a>; <a href="https://theconversation.com/profiles/lena-sanci-523666">Lena Sanci</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/lucette-cysique-1495512">Lucette Cysique</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/philip-britton-1127089">Philip Britton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>EG.5 or the Eris COVID variant is dominant in parts of <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/respiratory-surveillance-20231202.pdf">Australia</a>. Eris, along with other circulating strains, are descendants of Omicron.</p> <p>While these strains appear less severe than the original Alpha and Delta variants, the risk of long COVID remains.</p> <p>So what does the latest data say about the chance of long COVID? What symptoms should you look out for? And what can be done to support people with long COVID?</p> <h2>When COVID becomes ‘long COVID’</h2> <p>For most people, long COVID means not getting better after a COVID infection.</p> <p>The World Health Organization <a href="https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1">defines long COVID</a> as continuing or new symptoms at least three months from the start of a COVID infection that last at least two months and cannot be explained by an alternative diagnosis.</p> <p>The most <a href="https://link.springer.com/article/10.1007/s10654-022-00962-6">common symptoms</a> include fatigue, brain fog, breathlessness, headaches and abdominal pain. But people with long COVID can experience <a href="https://www.sciencedirect.com/science/article/pii/S1684118222001864?via%3Dihub">a wide range</a> of problems including cardiovascular issues, mental health problems such as depression and anxiety, insomnia, muscle and joint pain, and gastrointestinal problems.</p> <h2>How common is long COVID?</h2> <p>Australian data on long COVID <a href="https://www.mja.com.au/journal/2023/218/10/long-covid-australia-achieving-equitable-access-supportive-health-care">remains limited</a> compared to <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2023001/article/00015-eng.htm">international data</a>, and estimates of its prevalence have varied. A report from Australia’s parliamentary inquiry into long COVID, <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportrep/RB000006/toc_pdf/SickandtiredCastingalongshadow.pdf">published in April</a>, suggested 2%-20% of people may develop long COVID following an infection.</p> <p>A recent Australian study conducted when vaccines were widely available indicates earlier Omicron variants <a href="https://doi.org/10.3390/ijerph20186756">saw 10% of people</a> who caught COVID develop long COVID.</p> <p>Another recent study, yet to be peer-reviewed, found <a href="https://www.medrxiv.org/content/10.1101/2023.08.06.23293706v1">18.2%</a> of those infected went on to have long COVID. The wide-ranging estimates are likely to be because of different COVID variants, differences in vaccination, and different long COVID definitions and assessment methods.</p> <p>The risk is lower in children. One Australian study indicated persistent symptoms in <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00124-3/fulltext">8% of children</a> who had COVID in 2020, while <a href="https://www.medrxiv.org/content/10.1101/2023.03.14.23287239v1">preliminary research</a> points to a slightly lower risk among children infected in 2021.</p> <p>But more research is needed, especially as the virus continues to evolve. This can be complicated because typical long COVID symptoms are common to many other health problems. As in other countries, more research is now underway <a href="https://www.apprise.org.au/broad-research-area/insights-into-long-covid/">in Australia</a> to determine the accurate prevalence of the condition using a definition and methods that carefully exclude other causes.</p> <p>Although research on long COVID risk factors with new variants is ongoing, we expect being female, having more severe initial disease and having other health conditions will <a href="https://doi.org/10.1001/jamainternmed.2023.0750">increase a person’s chance</a> of getting long COVID.</p> <h2>What’s different this time?</h2> <p>Research shows COVID vaccines offer <a href="https://www.mdpi.com/1660-4601/19/19/12422">protection</a> against long COVID. As well as vaccinations, immunity from previous COVID infections and antiviral treatments are contributing to less severe COVID and potentially <a href="https://theconversation.com/could-antivirals-reduce-your-risk-of-long-covid-where-the-research-is-up-to-on-prevention-and-treatment-216529">less long COVID</a> than we saw earlier in the pandemic.</p> <p>But while the Omicron waves may lead to <a href="https://www.smh.com.au/national/newer-virus-strains-less-likely-to-cause-long-covid-20231123-p5emag.html">fewer cases of long COVID</a> than the earlier Alpha and Delta variants, because so many Australians are contracting COVID, this will still result in a large number of people with long COVID. And each <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2023001/article/00015-eng.htm">repeat infection</a> presents a new risk of prolonged symptoms.</p> <h2>Long COVID can affect all aspects of life</h2> <p>Long COVID can <a href="https://doi.org/10.1093/ije/dyad033">impact</a> a person’s life in many ways. Fatigue following exertion, brain fog and other symptoms can reduce capacity to perform tasks such as concentrating at a computer, manual labour, and even normal household tasks.</p> <p>Many people with long COVID submitted evidence to the recent <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/LongandrepeatedCOVID/Report/Chapter_4_-_Lived_experiences_of_long_COVID">parliamentary inquiry</a> that they were unsupported, stigmatised, isolated, and not taken seriously by health professionals.</p> <p>Evidence suggests many symptoms <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-77622200250-2/fulltext">will improve</a> in most people over <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00138-4/fulltext">12 to 18 months</a>, although recovery time can differ between symptoms. Some, including gastrointestinal and respiratory symptoms, tend to <a href="https://www.nature.com/articles/s41579-022-00846-2">resolve sooner than others</a>, such as cognitive symptoms.</p> <h2>I think I have long COVID, what can I expect from my doctor?</h2> <p>Long COVID is the kind of challenge Australia’s <a href="https://dx.doi.org/10.5694/mja2.51950">health system finds most difficult</a>. GPs are stretched and the small number of specialist <a href="https://www.abc.net.au/news/2023-12-12/long-covid-clinics-are-closing-as-us-clinic-expands/103186272">long COVID clinics</a> are struggling to maintain funding.</p> <p>Australia has trailed behind the US, the UK and Europe in rolling out care for long COVID, and in collecting data on the condition.</p> <p>As a result, support for long COVID in Australia is <a href="https://doi.org/10.3389/phrs.2023.1606084">hard to access</a>, expensive and patchy.</p> <p>However, there is consensus on what constitutes good care. Clinicians seeing patients with possible long COVID should:</p> <ul> <li> <p>validate the person’s experience of symptoms and the impact their symptoms are having on their functioning, particularly when the cause is not clear</p> </li> <li> <p>diagnose and treat any other health conditions that are part of the picture</p> </li> <li> <p>support people to minimise the impairment their symptoms cause by pacing of physical and cognitive activities. Importantly, this doesn’t involve pushing through fatigue.</p> </li> </ul> <p>These steps are not a cure but they may improve a person’s ability to function in their day-to-day life, at work and to fulfil their caring responsibilities.</p> <h2>We still need to focus on reducing COVID transmission</h2> <p>The best way to prevent long COVID is to avoid contracting – and spreading – COVID. This means:</p> <ul> <li> <p>getting vaccinated or boosted, if you’re eligible</p> </li> <li> <p>staying home if you feel unwell</p> </li> <li> <p>wearing a mask to protect yourself and vulnerable community members</p> </li> <li> <p>testing for COVID if you have symptoms and if you test positive, taking antivirals (if eligible) and isolating until your symptoms resolve.</p> </li> </ul> <p>Long COVID is not going away, but we all have a role to play in preventing and responding to it.</p> <p><em>Ruby Biezen from the APPRISE Network and the University of Melbourne and Andrew Lloyd from the Kirby Institute at UNSW contributed to this article.</em><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/218808/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/andrew-baillie-646956"><em>Andrew Baillie</em></a><em>, Professor of Allied Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/amelia-gulliver-17440">Amelia Gulliver</a>, Senior Research Fellow, ANU College of Health and Medicine, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a>; <a href="https://theconversation.com/profiles/lena-sanci-523666">Lena Sanci</a>, Professor, Department of General Practice and Primary Care, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/lucette-cysique-1495512">Lucette Cysique</a>, Senior Research Fellow, Viral Immunology Systems Program, The Kirby Institute, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/philip-britton-1127089">Philip Britton</a>, Associate Professor, Child and Adolescent Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-have-covid-how-likely-am-i-to-get-long-covid-218808">original article</a>.</em></p>

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Should we still be using RATs to test for COVID? 4 key questions answered

<p><em><a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a></em></p> <p>We’re currently navigating <a href="https://www.thenewdaily.com.au/life/health/2023/11/15/covid-australia-eighth-wave">an eighth wave</a> of <a href="https://theconversation.com/were-in-a-new-covid-wave-what-can-we-expect-this-time-216820">COVID infections</a> in Australia. However the threat COVID poses to us is significantly less than it has ever been, thanks to immunity we’ve acquired through <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00801-5/fulltext">a combination</a> of prior infection and vaccination.</p> <p>That said, COVID is by no means behind us. The threat of severe illness remains higher for many people, and we’re all potentially at risk of developing <a href="https://www.health.gov.au/topics/covid-19/long-covid">long COVID</a>.</p> <p>While many people appear to be doing fewer rapid antigen tests (RATs) than they used to – if any at all – with rising cases, and as we head towards the festive season, testing continues to be important.</p> <p>So what do you need to know about testing in this wave? Here are four key questions answered.</p> <h2>1. When should I do a RAT?</h2> <p>There are a few situations where determining your COVID status is important to inform your actions, particularly during an uptick in infections. With more circulating virus, your index of suspicion that you have COVID if you’re experiencing cold-like symptoms should be higher.</p> <p>RATs work best when they’re used to confirm whether you have COVID when you <a href="https://www.tga.gov.au/products/covid-19/covid-19-tests/how-testing-works-covid-19">have respiratory symptoms</a> and are infectious. So the primary use of RATs should be to determine your COVID status when you’re sick. A positive test should prompt you to isolate, and if you’re eligible, to seek antivirals.</p> <p>Testing might also be worthwhile if you’ve come into contact with someone with COVID but you haven’t developed symptoms. If you find you have in fact contracted the virus, you can take steps to avoid spreading it to other people (you can infect others even <a href="https://www.healthline.com/health/what-is-asymptomatic-covid#prevalence">when you’re asymptomatic</a>). This is especially important if you’re going to be socialising in large groups or in contact with people who are vulnerable.</p> <p>Another situation in which to consider testing, particularly at this time of year, is before attending large social gatherings. While the reliability of a RAT is never perfect, do the test as close to the event as possible, because your disease status <a href="https://www.businessinsider.com/omicron-rapid-test-hour-before-party-not-day-before-expert-2021-12">can change quickly</a>.</p> <h2>2. Should I test multiple times?</h2> <p>Yes. RATs are not as sensitive as PCR tests, which is the trade-off we make for being able to do this test at home and <a href="https://www.wsj.com/articles/public-health-officials-pursue-covid-19-tests-that-trade-precision-for-speed-11599562800">getting a rapid result</a>.</p> <p>This means that while if you test positive with a RAT you can be very confident you have COVID, if you test negative, you cannot be as confident that you don’t have COVID. That is, the test may give you a false negative result.</p> <p>Although RATs from different manufacturers have different accuracies, all RATs approved by Australia’s Therapeutic Goods Administration must have a sensitivity of <a href="https://www.tga.gov.au/products/covid-19/covid-19-tests/covid-19-rapid-antigen-self-tests-home-use/covid-19-rapid-antigen-self-tests-are-approved-australia#:%7E:text=For%20rapid%20antigen%20tests%2C%20this,specificity%20of%20at%20least%2098%25.">at least 80%</a>.</p> <p>The way to increase your confidence in a negative result is to do multiple RATs serially – each negative test increases the confidence you can have that you don’t have COVID. If you have symptoms and have tested negative after your first RAT, <a href="https://www.fda.gov/medical-devices/safety-communications/home-covid-19-antigen-tests-take-steps-reduce-your-risk-false-negative-results-fda-safety">the advice</a> is to repeat the test after 48 hours, and potentially a third time after another 48 hours if the second test is also negative.</p> <h2>3. Do RATs detect the latest variants?</h2> <p>Since RATs <a href="https://www.healthdirect.gov.au/covid-19/testing#:%7E:text=Rapid%20antigen%20tests%2C%20or%20RATs,of%20proteins%20of%20the%20virus.">detect particular surface proteins</a> on SARS-CoV-2 (the virus that causes COVID), it’s theoretically possible that as the virus evolves, the reliability of these tests may be affected.</p> <p>However, RATs were designed to detect a part of the virus that is not as likely to mutate, so the hope is these tests <a href="https://www.health.com/do-covid-tests-work-new-variants-7967102">will continue to hold up</a> as SARS-CoV-2 evolves.</p> <p>The performance of RATs is continually being assessed by manufacturers. So far, there’s been no change reported in the ability of these tests to <a href="https://www.ama.com.au/articles/tga-updated-advice-rats-nearing-expiry-and-rats-efficacy-current-strains#:%7E:text=The%20TGA%20has%20received%20evidence,19%20RAT%20post%2Dmarket%20review.">detect the latest variants</a>.</p> <h2>4. Can I rely on expired RATs?</h2> <p>At this point in the pandemic, you might have a few expired tests at the back of your cupboard.</p> <p>Technically the most appropriate advice is to say you should never use a diagnostic test <a href="https://www.tga.gov.au/products/covid-19/covid-19-tests/covid-19-rapid-antigen-self-tests-home-use/covid-19-rapid-antigen-self-tests-are-approved-australia">past its expiry date</a>. As a general principle the performance of a test cannot be guaranteed beyond this date. The risk is that over time the components of the RAT degrade and if you use a test that’s not working optimally, it’s more likely to indicate <a href="https://www.health.com/can-you-use-expired-covid-test-6827970">you don’t have COVID</a> when you actually do, which may have consequences.</p> <p>However, as for all things COVID, the answer is not so black and white. Since these tests were new when they were introduced earlier in the pandemic, manufacturers didn’t have specific data on their performance over time, and so the expiry dates given were necessarily conservative.</p> <p>It’s likely these tests will work beyond the expiry dates on the packet, but just how long and how well they work is a bit of an unknown, so we need to be cautious.</p> <p>The other thing to consider is ensuring you store RATs correctly. Storage instructions should be found on the packet, but the key issue is making sure they’re not exposed to extreme temperatures. In particular, <a href="https://7news.com.au/lifestyle/health-wellbeing/how-to-properly-store-your-at-home-covid-19-rapid-antigen-tests-c-5465412">high temperatures</a> may damage the chemicals in the test which may reduce its sensitivity.</p> <h2>The path from here</h2> <p>Regular upticks in COVID cases are something we’re going to have to get used to. At these times, we should all be a bit more cautious about looking after ourselves and others as we go about our lives. What this looks like will vary for different people depending on their personal circumstances.</p> <p>However, being up to date with <a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">booster vaccinations</a>, having a plan for <a href="https://www.health.gov.au/topics/covid-19/oral-treatments">accessing antivirals</a> if you’re eligible, <a href="https://theconversation.com/with-covid-surging-should-i-wear-a-mask-217902">wearing masks</a> in high-risk settings and testing all continue to play an important role in responding to COVID.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/218016/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/hassan-vally-202904"><em>Hassan Vally</em></a><em>, Associate Professor, Epidemiology, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-we-still-be-using-rats-to-test-for-covid-4-key-questions-answered-218016">original article</a>.</em></p>

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What are the new COVID booster vaccines? Can I get one? Do they work? Are they safe?

<p><em><a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>As the COVID virus continues to <a href="https://pubmed.ncbi.nlm.nih.gov/36680207/">evolve</a>, so does our vaccine response. From <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants?language=en">December 11</a>, Australians will have access to <a href="https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-moderna-and-pfizer-monovalent-omicron-xbb15-covid-19-vaccines?language=en">new vaccines</a> that offer better protection.</p> <p>These “monovalent” booster vaccines are expected to be a <a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">better match</a> for currently circulating strains of SARS-CoV-2, the virus that causes COVID.</p> <p>Pfizer’s monovalent vaccine will be <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants?language=en">available</a> to eligible people aged five years and older. The Moderna monovalent vaccine can be used for those aged 12 years and older.</p> <p>Who is eligible for these new boosters? How do they differ from earlier ones? Do they work? Are they safe?</p> <h2>Who’s eligible for the new boosters?</h2> <p>The federal government has accepted the Australian Technical Advisory Group (ATAGI) recommendation to use the new vaccines, after Australia’s regulator <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">approved their use last month</a>. However, vaccine eligibility has remained the same since September.</p> <p>ATAGI <a href="https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-moderna-and-pfizer-monovalent-omicron-xbb15-covid-19-vaccines?language=en">recommends</a> Australians aged over 75 get vaccinated if it has been six months or more since their last dose.</p> <p>People aged 65 to 74 are recommended to have a 2023 booster if they haven’t already had one.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=315&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=315&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=315&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=396&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=396&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=396&amp;fit=crop&amp;dpr=3 2262w" alt="" /></a><figcaption><span class="caption">For people without risk factors.</span> <span class="attribution"><a class="source" href="https://www.health.gov.au/sites/default/files/2023-10/atagi-recommended-covid-19-vaccine-doses.pdf">Health.gov.au</a></span></figcaption></figure> <p>Adults aged 18 to 64 <em>with</em> underlying risk factors that increase their risk of severe COVID are also recommended to have a 2023 booster if they haven’t had one yet. And if they’ve already had a 2023 booster, they can consider an additional dose.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=311&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=311&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=311&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=391&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=391&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=391&amp;fit=crop&amp;dpr=3 2262w" alt="" /></a><figcaption><span class="caption">Advice for people with risk factors.</span> <span class="attribution"><a class="source" href="https://www.health.gov.au/sites/default/files/2023-10/atagi-recommended-covid-19-vaccine-doses.pdf">Health.gov.au</a></span></figcaption></figure> <p>For adults aged 18 to 64 <em>without</em> underlying risk factors who have already received a 2023 booster, an additional dose isn’t recommended. But if you’re aged 18 to 64 and haven’t had a booster in 2023, you can consider an additional dose.</p> <p>Additional doses aren’t recommended for children <em>without</em> underlying conditions that increase their risk of severe COVID. A primary course is not recommended for children aged six months to five years <em>without</em> additional risk factors.</p> <h2>Monovalent, bivalent? What’s the difference?</h2> <p><strong>From monovalent</strong></p> <p>The initial COVID vaccines were “monovalent”. They had one target – the original viral strain.</p> <p>But as the virus mutated, we assigned new letters of the Greek alphabet to each variant. This brings us to Omicron. With this significant change, we saw “immune evasion”. The virus had changed so much the original vaccines didn’t provide sufficient immunity.</p> <p><strong>To bivalent</strong></p> <p>So vaccines were updated to target an early Omicron subvariant, BA.1, plus the original ancestral strain. With two targets, these were the first of the “bivalent” vaccines, which were approved in Australia <a href="https://theconversation.com/omicron-specific-vaccines-may-give-slightly-better-covid-protection-but-getting-boosted-promptly-is-the-best-bet-190736">in 2022</a>.</p> <p>Omicron continued to evolve, leading to more “immune escape”, contributing to repeated waves of transmission.</p> <p>The vaccines were updated again in <a href="https://theconversation.com/havent-had-covid-or-a-vaccine-dose-in-the-past-six-months-consider-getting-a-booster-199096">early 2023</a>. These newer bivalent vaccines target two strains – the ancestral strain plus the subvariants BA.4 and BA.5.</p> <p><strong>Back to monovalent</strong></p> <p>Further changes in the virus have meant our boosters needed to be updated again. This takes us to the recent announcement.</p> <p>This time the booster targets another subvariant of Omicron known as XBB.1.5 (sometimes known as <a href="https://theconversation.com/the-kraken-subvariant-xbb-1-5-sounds-scary-but-behind-the-headlines-are-clues-to-where-covids-heading-198158">Kraken</a>).</p> <p>This vaccine is monovalent once more, meaning it has only one target. The target against the original viral strain has been removed.</p> <p>According to advice given to the World Health Organization <a href="https://www.who.int/news/item/18-05-2023-statement-on-the-antigen-composition-of-covid-19-vaccines">in May</a>, this is largely because immunity to this original strain is no longer required (it’s no longer infecting humans). Raising immunity to the original strain may also hamper the immune response to the newer component, but we’re not sure if this is occurring or how important this is.</p> <p>The United States <a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">approved</a> XBB.1.5-specific vaccines from Pfizer and Moderna in <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-action-updated-mrna-covid-19-vaccines-better-protect-against-currently-circulating">mid-September</a>. These updated vaccines have also been <a href="https://www.tga.gov.au/sites/default/files/2023-10/auspar-spikevax-xbb.1.5-231012.pdf">approved in</a> places including Europe, Canada, Japan and Singapore.</p> <p>In Australia, the Therapeutic Goods Administration (TGA) approved them <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">in October</a>.</p> <h2>Do these newer vaccines work?</h2> <p>Evidence for the efficacy of these new monovalent vaccines comes from the results of research <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&amp;id=CP-2023-PI-02409-1&amp;d=20231117172310101">Pfizer</a> and <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">Moderna</a> submitted to the TGA.</p> <p>Evidence also comes from a <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">preprint</a> (preliminary research available online that has yet to be independently reviewed) and an update Pfizer <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-09-12/10-COVID-Modjarrad-508.pdf">presented</a> to the US Centers for Disease Control.</p> <p>Taken together, the available evidence shows the updated vaccines produce good levels of antibodies in <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">laboratory studies</a>, <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">in humans</a> and <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">mice</a> when compared to previous vaccines and when looking at multiple emerging variants, including EG.5 (sometimes known as <a href="https://theconversation.com/the-who-has-declared-eris-a-variant-of-interest-how-is-it-different-from-other-omicron-variants-211276">Eris</a>). This variant is the one causing high numbers of cases around the world currently, including in Australia. It is very similar to the XBB version contained in the updated booster.</p> <p>The updated vaccines should also cover <a href="https://theconversation.com/how-evasive-and-transmissible-is-the-newest-omicron-offshoot-ba-2-86-that-causes-covid-19-4-questions-answered-212453">BA.2.86 or Pirola</a>, according to <a href="https://www.tga.gov.au/sites/default/files/2023-10/auspar-spikevax-xbb.1.5-231012.pdf">early results</a> from clinical trials and the US <a href="https://www.cdc.gov/respiratory-viruses/whats-new/covid-19-variant.html">Centers for Disease Control</a>. This variant is responsible for a rapidly increasing proportion of cases, with case numbers growing <a href="https://twitter.com/BigBadDenis/status/1725310295596560662?s=19">in Australia</a>.</p> <p>It’s clear the virus is going to continue to evolve. So performance of these vaccines against new variants will continue to be closely monitored.</p> <h2>Are they safe?</h2> <p>The <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&amp;id=CP-2023-PI-02409-1&amp;d=20231117172310101">safety</a> of the updated vaccines has also been shown to be similar to previous versions. Studies <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">comparing them</a> found no significant difference in terms of the adverse events reported.</p> <p>Given the availability of the updated vaccines, some countries have removed their approval for earlier versions. This is because newer versions are a closer match to currently circulating strains, rather than any safety issue with the older vaccines.</p> <h2>What happens next?</h2> <p>The availability of updated vaccines is a welcome development, however this is not the end of the story. We need to make sure eligible people get vaccinated.</p> <p>We also need to acknowledge that vaccination should form part of a comprehensive strategy to limit the impact of COVID from now on. That includes measures such as mask wearing, social distancing, focusing on ventilation and air quality, and to a lesser degree hand hygiene. Rapidly accessing antivirals if eligible is also still important, as is keeping away from others if you are infected.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217804/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/paul-griffin-1129798"><em>Paul Griffin</em></a><em>, Professor, Infectious Diseases and Microbiology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">original article</a>.</em></p>

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From COVID to gastro, why are cruise ships such hotbeds of infection?

<p><em><a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p>Dual outbreaks of <a href="https://www.abc.net.au/news/2023-11-12/grand-princess-ship-adelaide-covid-19-gastroenteritis/103095704">gastro and COVID</a> on the Grand Princess cruise ship that docked in Adelaide on Monday <a href="https://www.theguardian.com/australia-news/2023/nov/13/grand-princess-cruise-ship-covid-gastro-outbreak-docks-adelaide-south-australia">have now been declared over</a> by the <a href="https://www.canberratimes.com.au/story/8421009/cruise-ship-doctor-declares-dual-virus-outbreaks-over/">doctor on board</a>.</p> <p>A spokesperson for Princess Cruises, which operates the ship, said a number of passengers had presented with symptoms <a href="https://www.9news.com.au/national/grand-princess-no-double-covid19-gastro-outbreak-on-ship-cruise-line-says/5d02d423-3289-4a2b-a580-1ed565b78027">on a previous voyage</a>. But the ship has since been disinfected and the number of people who were ill when the ship arrived into Adelaide was said to be in single digits.</p> <p>While this is positive news, reports of infectious outbreaks on cruise ships evoke a sense of deja vu. We probably all remember the high-profile COVID outbreaks that occurred on cruise ships in 2020.</p> <p>So what is it about cruise ships that can make them such hotspots for infection?</p> <h2>First, what causes these outbreaks?</h2> <p>Respiratory infectious outbreaks on cruise ships may be caused by <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/air-land-sea/cruise-ship-travel">a range of pathogens</a> including SARS-CoV-2 (the virus that causes COVID) and influenza viruses. These can be spread by <a href="https://www.pnas.org/doi/10.1073/pnas.2015482118">respiratory droplets and aerosols</a> released when people breathe, talk, laugh, cough and sneeze.</p> <p>Historically, <a href="https://jmvh.org/article/the-navy-and-the-1918-19-influenza-pandemic/">troop transport ships</a> also helped to spread the lethal 1918 flu virus between continents.</p> <p>Gastro outbreaks on cruise ships are similarly well documented. More than 90% of cruise ship gastro outbreaks are caused by <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/air-land-sea/cruise-ship-travel#infectious">norovirus</a>, which is spread from person to person, and through contaminated objects or contaminated food or water.</p> <p>Gastro can also be caused by other pathogens such as <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/air-land-sea/cruise-ship-travel">bacteria in contaminated food or water</a>.</p> <h2>What is the risk?</h2> <p>In 2020, around 19% of <a href="https://www.bmj.com/content/369/bmj.m1632">Diamond Princess</a> passengers and crew docked in Japan tested positive to COVID. Ultimately, nearly one in four <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739343/">Ruby Princess</a> passengers and crew docked in Sydney tested positive.</p> <p>However, COVID generally presents a lesser risk nowadays, with most people having some level of immunity from vaccination or previous infection. The outbreak on the Grand Princess appears to have been much smaller in scale.</p> <p>A <a href="https://www.sciencedirect.com/science/article/abs/pii/S1477893916300680">three-year study</a> before COVID of influenza-like illness (which includes fever), acute respiratory illness (which <a href="https://www.cdc.gov/flu/about/glossary.htm">doesn’t require fever</a> to be present) and gastro on cruise ships found these were diagnosed in 32.7%, 15.9% and 17% of ill passengers, and 10.9%, 80% and 0.2% of ill crew, respectively.</p> <p>An <a href="https://www.cdc.gov/mmwr/volumes/70/ss/ss7006a1.htm">analysis</a> of data from 252 cruise ships entering American ports showed the overall incidence of acute gastro halved between 2006 and 2019. Passenger cases decreased from 32.5 per 100,000 travel days to 16.9, and crew cases from 13.5 per 100,000 travel days to 5.2. This decline may be due to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382806/">combination</a> of improved hygiene and sanitation standards.</p> <p>The risk of getting sick with gastro was significantly higher on <a href="https://www.cdc.gov/mmwr/volumes/70/ss/ss7006a1.htm">bigger ships and longer voyages</a>. This is because the longer you are in close contact with others, the greater the chance of exposure to an infectious dose of viruses or bacteria.</p> <h2>Why are cruise ships infection hotspots?</h2> <p>On cruise ships, people tend to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739343/">crowd together</a> in confined spaces for extended periods. These include dining halls, and during social activities in casinos, bars and theatres.</p> <p>The risk goes up when the environment is noisy, as more droplets and aerosols are shed when people are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382806/">laughing, shouting or talking loudly</a>.</p> <p>Passengers may come from <a href="https://www.sciencedirect.com/science/article/abs/pii/S1477893916300680?via%3Dihub">multiple countries</a>, potentially bringing variants from different parts of the world. Influenza, which is usually seasonal (late autumn to early spring) onshore, can occur at any time <a href="https://academic.oup.com/cid/article/31/2/433/295546">on a cruise ship</a> if it has international passengers or is calling at international ports.</p> <p>Human behaviour also contributes to the risk. Some passengers <a href="https://academic.oup.com/jtm/article/15/3/172/1821220">surveyed</a> following cruise ship gastro outbreaks indicated they were ill when they boarded the ship, or they became ill but didn’t disclose this because they didn’t want to pay for a doctor or be made to isolate, or they thought it wasn’t serious.</p> <p>Those who became ill were more likely than those who did not to think that hand hygiene and isolation were not effective in preventing infection transmission, and were less likely to wash their hands after using the toilet. Given <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/norovirus.aspx">faecal contamination</a> is a major source of norovirus transmission, this is concerning.</p> <p>While there are usually a la carte dining options on board, many people will choose a buffet option. From personal experience, food tongs are handled by multiple people, some of whom may not have cleaned their hands.</p> <h2>What can help?</h2> <p>The <a href="https://www.health.gov.au/news/ahppc-statement-advice-to-support-safe-cruising">Department of Health and Aged Care</a> recommends cruise companies encourage crew and passengers to be up-to-date with flu and COVID vaccinations, and encourage anyone who becomes ill to stay in their cabin, or at least avoid crowded spaces and wear a mask in public.</p> <p>They also recommend cruise ships have a plan to identify and contain any outbreaks, including testing and treatment capacity, and communicate to passengers and crew how they can reduce their transmission risk.</p> <p>All passengers and crew should report any signs of infectious illness, and practice good hand hygiene and <a href="https://www.cdc.gov/oralhealth/infectioncontrol/faqs/respiratory-hygiene.html">respiratory etiquette</a>, such as covering their mouth if coughing or sneezing, disposing of used tissues, and washing or sanitising hands after touching their mouth or nose.</p> <p>South Australia’s chief health officer has <a href="https://www.abc.net.au/news/2023-11-13/grand-princess-ship-covid-gastro-docks-in-adelaide/103096836">commended</a> the Grand Princess crew for their infection protection and control practices, and for getting the outbreak under control.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217534/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101"><em>Thea van de Mortel</em></a><em>, Professor, Nursing, School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/from-covid-to-gastro-why-are-cruise-ships-such-hotbeds-of-infection-217534">original article</a>.</em></p>

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You’ve heard of long COVID, but did you know there might also be a long cold?

<p><em><a href="https://theconversation.com/profiles/giulia-vivaldi-1476903">Giulia Vivaldi</a>, <a href="https://theconversation.com/institutions/queen-mary-university-of-london-1745">Queen Mary University of London</a></em></p> <p>At least <a href="https://www.nature.com/articles/s41579-022-00846-2">10% of people</a> infected with SARS-CoV-2, the virus that causes COVID, have symptoms that last more than four weeks after the infection. With more than <a href="https://covid19.who.int/">770 million infections</a> to date, this translates to tens of millions of people living with the long-term consequences of COVID, known as “long COVID”.</p> <p><a href="https://www.nature.com/articles/s41579-022-00846-2">More than 200 symptoms</a> of long COVID have been studied, with some of the most common being fatigue, breathlessness and cognitive difficulties, such as memory problems or “brain fog”. The condition can be debilitating – many people have to <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00387-5/fulltext">reduce their working hours</a> or are <a href="https://ifs.org.uk/publications/long-covid-and-labour-market">unable to work entirely</a>.</p> <p>But COVID may not be alone in causing long-lasting symptoms.</p> <p>In a <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00428-5/fulltext">new paper</a>, my colleagues and I report the findings of a study comparing long-term symptoms reported by people who experienced different types of acute respiratory infection. We asked more than 10,000 people to report on 16 symptoms commonly found in long COVID, such as fatigue, breathlessness, aches and pains, and dizziness. We then compared how common these symptoms were among three groups: people who had reported COVID, those who had reported another acute respiratory infection (but had tested negative for COVID), and those who had not reported either infection.</p> <p>We focused on long-term symptoms by only including people who had been infected more than four weeks earlier. We also took into account people’s general health before they were infected, and whether they had any existing respiratory conditions.</p> <p>Our study showed that all the symptoms considered were more common in people with previous COVID than in people with no infections, regardless of whether they reported long COVID. But this finding wasn’t unique to COVID. Almost all the symptoms we looked at were also more common in people with non-COVID respiratory infections than in those with no infection.</p> <p>In other words, our findings hinted towards the existence of a “long cold”: long-lasting health effects from other respiratory infections, such as colds, flu, or pneumonia, that are currently going unrecognised.</p> <p>Some of the most common symptoms of the long cold include coughing, stomach pain, and diarrhoea. These symptoms were reported an average of 11 weeks after the infection. While a severe initial infection seems to increase the risk of long-term symptoms, our research does not yet tell us why some people suffer extended symptoms while others do not.</p> <h2>Important differences</h2> <p>Importantly, we have no evidence that symptoms of the long cold have the same severity or duration as long COVID. In fact, we saw some important differences in the symptoms reported in the two groups, with those recovering from COVID more likely to experience light-headedness or dizziness and problems with taste and smell.</p> <p>These findings shine a light not only on the impact of long COVID on people’s lives, but also other respiratory infections.</p> <p>A lack of awareness, or even the lack of a common term, such as “long cold” or “long flu”, prevents both reporting and diagnosis of these conditions. And people who do report their long cold may still struggle to get a diagnosis, owing to the wide range of symptoms and <a href="https://www.nature.com/articles/s41591-022-01810-6">lack of diagnostic tests</a>.</p> <p>Long-lasting symptoms after respiratory infections are not a new phenomenon. Studies in survivors of two previous coronavirus outbreaks – the severe acute respiratory syndrome (Sars) pandemic and the Middle East respiratory syndrome (Mers) outbreak – have found long-term impacts on <a href="https://www.rcpjournals.org/content/clinmedicine/21/1/e68">lung function, quality of life and mental health</a>. And some people hospitalised with influenza A have experienced <a href="https://www.nature.com/articles/s41598-017-17497-6">respiratory and psychological problems</a> at least two years after being discharged from hospital.</p> <p>But most of the research so far has focused on people with severe disease, often severe enough to be hospitalised. Little is known about the long-term effects respiratory infections might have among people whose acute disease episode is less severe.</p> <p>Long COVID has bucked this trend, being studied in people with all levels of severity of the initial infection. This is in large part due to <a href="https://www.sciencedirect.com/science/article/pii/S0277953620306456">strong patient advocacy</a>, showing that it can affect even those with mild initial symptoms.</p> <p>In demanding recognition of their condition, people with long COVID have cast a much-needed spotlight on post-infection syndromes more generally. Now is the time to improve our understanding, diagnosis and treatment of these conditions. Let’s not wait for another pandemic.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/214995/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/giulia-vivaldi-1476903"><em>Giulia Vivaldi</em></a><em>, , <a href="https://theconversation.com/institutions/queen-mary-university-of-london-1745">Queen Mary University of London</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/youve-heard-of-long-covid-but-did-you-know-there-might-also-be-a-long-cold-214995">original article</a>.</em></p>

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What is POTS? And how is it related to long COVID?

<p><em><a href="https://theconversation.com/profiles/marie-claire-seeley-1364457">Marie-Claire Seeley</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> and <a href="https://theconversation.com/profiles/celine-gallagher-1454881">Celine Gallagher</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p>POTS or “postural orthostatic tachycardia syndrome” is a poorly recognised condition we’ve been <a href="https://www.smh.com.au/lifestyle/life-and-relationships/what-is-pots-and-how-is-it-related-to-covid-20230529-p5dc3v.html">hearing more</a> about recently.</p> <p>When people stand up, get out of bed or off the sofa, their heart races and they feel dizzy and fatigued, severely impacting their quality of life. Everyday tasks, such as washing their hair in the shower or working, become challenging because people cannot stay upright.</p> <p>Before COVID, this debilitating condition was not widely talked about. But during the pandemic, we’ve been learning about the strong similarities with long COVID.</p> <p>In fact, our recent research shows more than <a href="https://www.amjmed.com/article/S0002-9343(23)00402-3/fulltext">three-quarters</a> of people with long COVID we studied had POTS.</p> <h2>What triggers it?</h2> <p><a href="https://onlinelibrary.wiley.com/doi/10.1111/joim.12895">Multiple studies</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/37338634/">including our own</a>, have shown viral infection is the most common trigger for POTS.</p> <p>Then came the pandemic, with <a href="https://covid19.who.int">almost 800 million people</a> infected so far with SARS-CoV-2, the virus that causes COVID. The World Health Organization <a href="https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition">says</a> 10-20% of people infected with COVID are likely to develop long COVID – when unexplained symptoms persist three months or more after the infection.</p> <p>Now, more research is showing how long COVID resembles POTS. Many people with long COVID show similar symptoms.</p> <h2>What we and others have found</h2> <p>Our recent study found <a href="https://www.amjmed.com/article/S0002-9343(23)00402-3/fulltext">nearly 80%</a> of people with long COVID had POTS. In people who had both and were of similar age, symptoms were indistinguishable from those who got POTS from other causes.</p> <p>The people in our study either attended a specialist cardiology clinic for people with POTS or long COVID, or came via a long COVID support group on social media. So we cannot generalise our results to people managing their long COVID at home or with their GP.</p> <p>Earlier this year, a <a href="https://www.nature.com/articles/s41569-023-00842-w">review</a> said about 30% of people with people with “highly symptomatic” long COVID also had POTS. <a href="https://www.onlinecjc.ca/article/S0828-282X(22)01091-1/fulltext">Most (73%)</a> met criteria for POTS and other types of dysfunction of the autonomic nervous system.</p> <p>Taken together, we can conclude that many, but not all, cases of long COVID can be explained by POTS – a condition we’ve known about for years and know how to manage.</p> <h2>What happens if you have POTS?</h2> <p>We suspect some cases of POTS result from a hyper-vigilant immune response to an invading pathogen, such as a virus. This, or another trigger, affects the autonomic nervous system.</p> <p>This part of the nervous system balances a vast array of functions including maintaining blood flow to vital organs, digestion, temperature control, sweating and even sexual function.</p> <p>Even if the autonomic nervous system is marginally disturbed, it leads to the physiological equivalent of anarchy.</p> <p>The simplest of daily tasks – such as washing your hair in the shower – can result in profound symptoms of dizziness, a racing heart, breathlessness, brain fog and general exhaustion.</p> <p>In other research <a href="https://link.springer.com/article/10.1007/s10286-023-00955-9">published</a> earlier this year, we found people with POTS have a poor quality of life – poorer than people with chronic illnesses such as HIV, cancer, or cardiovascular and kidney disease.</p> <h2>A long path to diagnosis</h2> <p>Many patients are also forced to negotiate a diagnostic odyssey littered with tales of disbelief and dismissal by medical professionals, friends and family. Diagnosis can <a href="https://onlinelibrary.wiley.com/doi/10.1111/joim.12895">take years</a>.</p> <p>In our <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/LongandrepeatedCOVID/Submissions">submission</a> to the parliamentary inquiry into long COVID, we shared the experiences of people with POTS symptoms and their frustration at the lack of recognition by the medical profession. One health worker said: "I am a nurse myself and specifically brought up that I believed I had POTS after COVID infection. I was treated like a hypochondriac and told I had anxiety, which was absolutely ludicrous as I had physical symptoms […] I had many presentations to [the emergency department] with no help or diagnosis whatsoever."</p> <h2>We can do better</h2> <p>Prompt diagnosis is vital in the face of what we suspect are rising numbers of newly diagnosed cases associated with long COVID.</p> <p>Although many people with POTS report they were referred to <a href="https://onlinelibrary.wiley.com/doi/10.1111/joim.12895">multiple specialists</a> before they were diagnosed, this is not always necessary.</p> <p>GPs can ask you to do a <a href="https://potsfoundation.org.au/wp-content/uploads/2023/03/NASA-Lean-Test-vFinal.pdf">ten-minute standing test</a> to help diagnose it. They can also exclude other common causes of POTS symptoms, such as lung and heart conditions.</p> <p>There is no known cure for POTS. However, once diagnosed, there are <a href="https://www.ausdoc.com.au/therapy-update/postural-orthostatic-tachycardia-syndrome/">multiple things</a> that can improve and manage the condition. A <a href="https://potsfoundation.org.au/wp-content/uploads/2023/03/Malmo-POTS-Score-vFinal.pdf">questionnaire</a> your GP can give you can help prioritise which symptoms to manage. You then work with your trusted GP to manage these.</p> <p>Increasing fluid and salt intake (under the supervision of your GP), and using full-length compression tights is recommended. These help control heart rate and blood pressure, and reduce dizziness.</p> <p>Avoiding triggers is important. These include avoiding standing still for extended periods, hot showers, large meals high in carbohydrates, and hot environments.</p> <p>Many people also benefit from <a href="https://www.ausdoc.com.au/therapy-update/postural-orthostatic-tachycardia-syndrome/">medicines</a> to help control their blood pressure and heart rate.</p> <h2>How about referral?</h2> <p>If referral to specialist services are required, this can be complex and expensive. There are no specialised clinics for POTS in public hospitals. Instead, POTS is mainly managed in the private sector.</p> <p>Referral options can be overwhelming. People may benefit from referral to a range of health professionals to manage their symptoms, including a physiotherapist, psychologist, occupational therapist or exercise physiologist – ideally ones familiar with POTS.</p> <p>All these barriers means access to diagnosis and treatment largely depends on someone having sufficient money, or being confident enough to navigate the health system.</p> <hr /> <p><em>If you have symptoms such as those we’ve described, see your GP for assessment. For more information about the condition, see the Australian POTS Foundation <a href="https://potsfoundation.org.au">website</a>, which also <a href="https://potsfoundation.org.au/clinician-directory/">lists</a> doctors and allied health professionals who are “POTS aware”.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208280/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></em></p> <p><em><a href="https://theconversation.com/profiles/marie-claire-seeley-1364457">Marie-Claire Seeley</a>, PhD Candidate, Australian Dysautonomia and Arrhythmia Research Collaborative, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> and <a href="https://theconversation.com/profiles/celine-gallagher-1454881">Celine Gallagher</a>, Postdoctoral Fellow, Australian Dysautonomia and Arrhythmia Research Collaborative, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-pots-and-how-is-it-related-to-long-covid-208280">original article</a>.</em></p>

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Got no COVID-19 symptoms? A gene mutation might be the reason

<div class="copy"> <p>A global study has unearthed a possible genetic reason why some people infected with the virus that causes COVID-19 show no symptoms.</p> <p>Human leukocyte antigens – or HLAs – are important genes that support immune function in the human body, particularly in identifying viral pathogens.</p> <p>And a particular variation in the HLA-B complex has been found to at least double the likelihood that a person infected with SARS-CoV-2 will be asymptomatic.</p> <p>For people who inherit a copy of the HLA-B15 variant from one parent, there was a 2.4 times greater chance of avoiding symptoms. Homozygous carriers — born with copies of the variant from each parent — were 8.5 times more likely to avoid symptoms.</p> <p>It’s a somewhat common variant among certain ethnicities – about 1 in 10 people with European ancestry are potential carriers – but having the gene is not a guaranteed protector against coronavirus symptoms.</p> <p>The findings, <a href="https://doi.org/10.1038/s41586-023-06331-x" target="_blank" rel="noreferrer noopener" data-type="URL" data-id="https://doi.org/10.1038/s41586-023-06331-x">published</a> in <em>Nature</em>, have emerged from a joint study between researchers at the University of California San Fransisco and Australian institutions including Latrobe University, Monash University and the QIMR Berghofer Centre.</p> <p>The research came about almost by accident.</p> <div class="in-content-area content-third content-right"> </div> <p>Co-lead authors Professor Stephanie Gras from Latrobe and Jill Hollenbach from UCSF first met at a research conference in May 2022 and pooled their resources to track the association of possible gene variations with COVID-19 symptoms.</p> <p>Their teams narrowed a group of 30,000 people with high-quality HLA data to a cohort of about 1,500 unvaccinated people who tested positive for the virus. They then focussed on five locations of interest in the HLA genes while monitoring the emergence of symptoms to determine which variants, if any, might have a greater linkage to being COVID asymptomatic.</p> <p>“The [SARS-CoV-2] virus gets inside cells and ‘presents’ some small part of the virus on the surface via the HLA molecule,” Gras explains.</p> <p>“Those act as a red flag for T cells. The cell sends the signal to the T cell that it has been infected with the virus, and the T cells get activated and kill that [infected] cell.</p> <p>“HLA-B15 can actually present a small part of the spike protein that is very similar between SARS-CoV-2 and seasonal coronaviruses… [that] circulate every year in the population and give us the common cold during winter most of the time. They share some similarities.”</p> <p>The understanding provides a possible application for future treatments. Now an association between the variant and asymptomatic cases has been identified, the Gras and Hollenbach teams have begun to study the interaction between HLA-B15 and the SARS-CoV-2 spike protein at the atomic level.</p> <p>That research is already underway, including at the Australian Synchrotron at the Australian Nuclear Science and Technology Organisation.</p> <p>“We’re doing atomic-level models of proteins to understand the interaction,” Gras says.</p> <p>“We want to compare the T cells within people who are asymptomatic with HLA-B15 and people who are not asymptomatic with HLA-B15. Actually, HLA-B15 is not a magic bullet, you can have it and still have severe COVID.”</p> <p><em>Image credits: Getty Images</em></p> </div> <div id="contributors"> <p><em><a href="https://cosmosmagazine.com/health/covid/got-no-covid-19-symptoms-a-gene-mutation-might-be-the-reason/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/matthew-agius">Matthew Ward Agius</a>. </em></p> </div>

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Who’s taking COVID antivirals like Paxlovid? Hint: it helps if you’re rich

<p><em><a href="https://theconversation.com/profiles/nicole-allard-1349026">Nicole Allard</a>, <a href="https://theconversation.com/institutions/the-peter-doherty-institute-for-infection-and-immunity-2255">The Peter Doherty Institute for Infection and Immunity</a></em></p> <p>When it comes to COVID, people living in disadvantaged communities are hit with a triple whammy. First, they’re <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/covid-19/overview">more likely</a> to get infected, and when sick, are more likely to have serious disease. Second, they’re <a href="https://theconversation.com/first-covid-hit-disadvantaged-communities-harder-now-long-covid-delivers-them-a-further-blow-183908">more likely</a> to develop long COVID. Third, our <a href="https://www.mja.com.au/journal/2023/218/10/access-oral-covid-19-antivirals-community-are-eligibility-criteria-and-systems">recent research</a> suggests they’re less likely to get antivirals and when they do, it’s on average later.</p> <p>We’ve just <a href="https://www.mja.com.au/journal/2023/218/10/access-oral-covid-19-antivirals-community-are-eligibility-criteria-and-systems">published the data</a> to map how disadvantage is linked with access to COVID antiviral drugs you can take at home.</p> <p>Here’s why our findings matter and what we can do to level the playing field for this critical part of Australia’s COVID response.</p> <h2>What we did and what we found</h2> <p>Our team looked at Victorian and national prescribing data trends for the oral antiviral medications eligible Australians can take at home – Paxlovid (nirmatrelvir/ritonavir) and Lagevrio (molnupiravir).</p> <p>My health department colleagues linked data from the Pharmaceutical Benefits Scheme with information from the Victorian health department’s COVID surveillance database. They then matched levels of socioeconomic disadvantage by postcode, according to criteria from the Australian Bureau of Statistics.</p> <p>Their analysis showed people living in the most disadvantaged postcodes were 15% less likely to receive oral antivirals compared with those in the most advantaged postcodes.</p> <p>Those in the most disadvantaged postcodes were supplied with the antivirals on average a day later (three days versus two days) than those in the most advantaged postcodes.</p> <p>There are some limitations to our analysis. Not everyone who tests for COVID reports their positive result. And we suspect there may be more under-reporting of infections in disadvantaged areas.</p> <p>Nevertheless, our findings about the influence of disadvantage on antiviral supply are not surprising. In the United States, there have been <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7125e1.htm?utm">similar results</a>.</p> <h2>Why has this happened?</h2> <p>We know <a href="https://www.health.gov.au/health-alerts/covid-19/treatments/eligibility">early access to antivirals</a>, within the first five days of symptoms starting, is important to reduce the chances of severe disease and hospitalisation in those at risk.</p> <p>So why are people in disadvantaged areas less likely to have access to COVID antivirals? The answers are multiple and complex.</p> <p>Some relate to <a href="https://link.springer.com/article/10.1007/s11069-019-03584-6/tables/1">disadvantage</a> that existed before the pandemic – for instance, poverty, homelessness, lower levels of English or formal education, and being less likely to have a regular GP.</p> <p>Some factors relate specifically to antivirals. For instance, to access antivirals, you first have to know they exist and whether you might be eligible, then know how to access them and when. There may be out-of-pocket costs to see a GP to be assessed, then there’s the cost of filling the prescription, even with a concession card.</p> <h2>How can we address this?</h2> <p>We have an opportunity to address this inequity, whether that’s by addressing social determinants of health more broadly, or specifically related to antivirals access.</p> <p>Equity depends on continuing to address the structural inequalities in our health system that create barriers to people accessing primary health services, and tailoring responses to communities.</p> <p>For instance, earlier in the pandemic we saw funding to house homeless people, provide COVID-related health care to non-English speaking communities, and for people isolated at home. These initiatives need to continue.</p> <p>Other countries have also recognised the need for more equitable access to COVID antivirals. Initiatives have included:</p> <ul> <li> <p>COVID medicine <a href="https://phlgroup.co.uk/our-services/cmdu/">delivery units</a> in the United Kingdom. These identify, triage and arrange for high-risk people to receive antivirals at home</p> </li> <li> <p><a href="https://covid19.govt.nz/testing-and-isolation/if-you-have-covid-19/medicines-to-treat-covid-19">pharmacists prescribing antivirals</a> in New Zealand, and</p> </li> <li> <p>“<a href="https://aspr.hhs.gov/TestToTreat/Pages/default.aspx#:%7E:text=To%20find%20a%20participating%20Test%20to%20Treat%20site%20near%20you%3A&amp;text=Call%20the%20Centers%20for%20Disease,more%20than%20150%20other%20languages.">test to treat</a>” services in the US. This is where people can get tested, assessed and access antivirals in one spot, in one visit.</p> </li> </ul> <h2>What needs to happen next?</h2> <p>As <a href="https://theconversation.com/were-in-another-covid-wave-but-its-not-like-the-others-206493">COVID waves continue</a>, we must focus on reducing deaths and hospitalisations. Antiviral treatments are part of our armour and equity must drive our response.</p> <p>Our ongoing COVID response should be designed with consumer input, supported by an adequately funded public health system and be data driven. Here’s what needs to happen next:</p> <ul> <li> <p>encourage a tired public to see COVID testing as an important first step to accessing antiviral treatment, and why they should consider treatment</p> </li> <li> <p>address the health care inequality in primary care (for instance, boosting timely access to a GP people can afford to visit) by increasing resourcing in areas where we know there are gaps</p> </li> <li> <p>provide culturally safe health care, delivered in community languages, co-designed with community input</p> </li> <li> <p>evaluate current and future antiviral medications</p> </li> <li> <p>communicate up-to-date information to the public and health professionals about antivirals, particularity GPs</p> </li> <li> <p>access more data on the coverage and equity of antiviral COVID treatments, to help direct us to the gaps in the health system that need to be plugged.</p> </li> </ul> <h2>Why this matters now</h2> <p>For many of us in the past year, COVID has become another “cold” we encounter and may not even bother testing. Yet, we continue to see <a href="https://www.health.gov.au/health-alerts/covid-19/weekly-reporting">deaths and hospitalisations</a> across the country.</p> <p>Serious COVID infections continue to affect our most vulnerable people. These include elderly people, especially those over 80, First Nations people, people living with a disability and people who are socioeconomically disadvantaged.</p> <p>We have a chance to ensure antivirals are used to reduce existing disparities in hospitalisation and death – not to make them worse.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207822/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/nicole-allard-1349026">Nicole Allard</a>, Post doctoral researcher and medical epidemiologist, <a href="https://theconversation.com/institutions/the-peter-doherty-institute-for-infection-and-immunity-2255">The Peter Doherty Institute for Infection and Immunity</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whos-taking-covid-antivirals-like-paxlovid-hint-it-helps-if-youre-rich-207822">original article</a>.</em></p>

Caring

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Man living in a tent after partner “gave up” on Covid restrictions

<p dir="ltr">A hyper-vigilant man has resorted to living in a “pressurised” tent in a garage to avoid contracting Covid, after his girlfriend relaxed about restrictions. </p> <p dir="ltr">The Aussie man named Jason, who is a self-proclaimed “Covid education activist” caused a stir online after he posted a photo of his unusual sleeping arrangements. </p> <p dir="ltr">The now-viral post shared by Jason featured a picture of the peculiar tent he claims to be sleeping in, with an air purifier sticking out of the door, igniting a firestorm of reactions on Twitter, ranging from agreeance, to humour, to concern.</p> <p dir="ltr">Despite the media storm, Jason defended his decision to maintain strict pandemic precautions, despite never having contracted Covid-19. </p> <p dir="ltr">“This is my bed in the garage because my partner has dropped precautions. I take precautions 100 per cent of the time. Don’t tell me that this hasn’t upended every f**king second of my life,” Jason declared in his original post, which included the image of his extraordinary sleeping arrangement.</p> <p dir="ltr">Taking his precautions to the next level, Jason also revealed that he has experimented with sleeping in a face mask, but he admitted that he found it uncomfortable and could not sleep properly with it. </p> <p dir="ltr">“I’ve tried to sleep in a mask, and I can’t. I know people sleep in CPAP masks all the time, so it’s possible, but I can’t do it,” he shared on Twitter.</p> <p dir="ltr">Despite the flurry of reactions to Jason’s living arrangement, he did receive some support for his precautionary measures, while some even suggested Jason leave his partner, to which he admitted the thought “had occurred to me”. </p> <p dir="ltr">Another Twitter user commended the tent and air filter idea, considering it a cost-effective and potentially effective solution to avoid contracting Covid. </p> <p dir="ltr">“I like the tent+filter idea. It’s cheap and should be effective,” another agreed.</p> <p dir="ltr">A few people shared that they empathised with Jason, and are also maintaining strict pandemic precautions. </p> <p dir="ltr">One person wrote, “Initially didn’t think much of the pic, but this is infuriating. I spend all my salary in-flo mask, enovid (antiviral nasal spray), no social life, so yes, I take precautions 100 per cent of the time.”</p> <p dir="ltr">“I’m sorry you have to live like this. I no longer see my family since they stopped masking,” another added.</p> <p dir="ltr">However, not everyone empathised with Jason’s living arrangements, saying he was being unrealistic about the future of Covid. </p> <p dir="ltr">“I work in senior living, and in the two years we’ve been open, we’ve lost zero to Covid. Even the (85-year-olds) getting it now are mild cases. Why? They’re boosted, so they don’t panic or sleep in a garage,” one commenter explained. </p> <p dir="ltr">“The vaccine is meant to enable you to live normally without worrying. Covid is endemic, so you will be in the tent for the rest of your life, lol.” posted another.</p> <p dir="ltr">In response to the viral post, one Twitter user humorously remarked, “We’re a few years away from a really good documentary on how this virus broke people’s brains.”</p> <p dir="ltr" style="line-height: 1.38; margin-top: 0pt; margin-bottom: 18pt;"><em>Image credits: Getty Images / Twitter</em></p>

Real Estate

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19 cruise hacks to make travel easy

<p>Cruising can be wonderful. The wide-open space of the sea gives you time to relax and reconnect. You can tick off multiple destinations and only unpack once. </p> <p>But there are a few little tricks that cruise experts tell us will make your cruise even cruiser. </p> <p>Here’s the best tips we have uncovered.</p> <p><strong>1. Pack duct tape</strong></p> <p>On occasion the cruise may hit rough seas. If drawers begin to open, or cabin items go rolling, grab your duct tape and secure them. </p> <p><strong>2. Pack balloons</strong></p> <p>When our office manager told us to bring balloons on the cruise, we did think it was for a party. But in fact, she says that most cruise ships only have one or two hooks. Even the door handles don’t have surfaces for you to hang things. If you plan on doing washing in your room, then you can blow up the balloons and drape the clothes over them to dry. </p> <p><strong>3. Pack magnets</strong></p> <p>Another way to get organised is to bring magnets with you. Many cabin walls are made from metal. So, head to the hardware store and grab a bunch of magnets. Then you can attach hooks or even stick up important notes and your itinerary on the wall. </p> <p><strong>4 Put your bag under the bed</strong></p> <p>Normally when you travel, you stow the suitcase in the cupboard. Experts tell us that on a cruise, you should stow your bag under the bed. Wardrobe space is limited and storing your bag in there will reduce the space for clothes and shoes. </p> <p><strong>5. Steam your clothes</strong></p> <p>Most cruise ships don’t have irons. Fire and cruising don’t go together. They don’t want to take any chances. But what about when you need to wear a fancy shirt or dress to dinner and it’s been wrinkled from packing? Use the steam from the shower. It will un-wrinkle your clothes in no time flat. Alternatively, we’ve been told that you can buy “de-wrinkle spray” for clothes. We haven’t tested it though, so we can’t guarantee this will work. </p> <p><strong>6. Bring a multi-charger or power board</strong></p> <p>Most cruise cabins only have a few power points. These days most people travel with multiple devices. Grab a multi-charger and you can plug in multiple devices to the one power port. Or you can always bring a power board. </p> <p><strong>7. Pack a first aid kit</strong></p> <p>Yes, they have first aid on the ship. Yes, they have shops. But save your money and pack medicines that you may be likely to use such as Panadol, gastro-stop, antihistamines and antiseptic cream in a first aid kit. </p> <p><strong>8. Bring a HDMI cable</strong></p> <p>Love a great night in bed with a good film? Download them onto your laptop and you can use the HDMI cable to watch the films you want to see on the cabin’s TV. </p> <p><strong>9. Pack an extension cord</strong></p> <p>As we said, cruise cabins often have limited power points and sometimes they are in annoying locations. If you want to use your laptop and it has run out of battery, you will thank us for telling you to pack an extension lead.</p> <p><strong>10. Buy in bulk</strong></p> <p>This is one that surprised us. Apparently, some cruise lines give you a discount for buying drinks in bulk. Five beers for the price of four can save you $8 a round. Just pop the extra in the fridge for later. </p> <p><strong>11. Book excursions in advance</strong></p> <p>A huge part of cruising is visiting the onshore destinations. If you plan on cruising on a large boat, make sure you book your on-shore excursions early. That way you can be sure that you will be going. There would be nothing worse than getting off the boat only to find out that the tour you want to do is all sold out. </p> <p><strong>12. Budget for excursions</strong></p> <p>It seems obvious, but many first-time cruisers forget to factor in the added extras. Make sure you know which excursions you want to do and how much they cost. Then factor that into your budget. </p> <p><strong>13. Pack sticky notes</strong></p> <p>Need to remember the departure time? What time the bar opens? Or the time you will have your massage? Bring sticky notes and make your own message board on the cabin wall. </p> <p><strong>14. Stay fit</strong></p> <p>A lot of cruises have endless and bottomless food options. You will indulge. You will enjoy it. But maybe find some time to stay fit on board, even if it is just taking the stairs instead of the lift or swimming daily and doing early morning laps in the pool. </p> <p><strong>15. Pack ginger</strong></p> <p>First-time cruiser? Not sure if you are going to get seasick? Ginger is your friend. Ginger helps ease seasickness. </p> <p><strong>16. Choose your cabin wisely</strong></p> <p>Worried about seasickness? You are better off booking a lower deck room in the middle of the ship. Want a great view and never feel sick? Go for the upper deck edges. Whatever room you choose, think long and hard about what you really want to get out of the cruise. How long will you actually spend in the room?</p> <p><strong>17. Be hygienic </strong></p> <p>Sickness can and does spread on ships. To avoid nasties, make sure you have good hygiene habits. Wash your hands properly and perhaps pack some hand sanitiser. </p> <p><strong>18. Notify the ship of any medical conditions</strong></p> <p>Even if it is minor. In the event of an emergency, the staff will be the ones to help you. </p> <p><strong>19. Wear rubber shoes</strong></p> <p>It can get slippery on board. </p> <p><em>Written by Alison Godfrey. Republished with permission of <a href="https://www.mydiscoveries.com.au/stories/travel-hacks-to-make-your-cruise-easier/">My Discoveries</a>. </em></p> <p><em>Images: Getty</em></p>

Cruising

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Astonishing report identifies Covid’s alleged “patient zero”

<p>A bombshell report has claimed the infamous Covid-19 "patient zero” was a Wuhan scientist carrying out experiments on souped-up coronaviruses.</p> <p>The scientist in question, Ben Hu, was conducting risky tests at the Wuhan Institute of Virology with two colleagues, Ping You and Yan Zhu, the report states.</p> <p>It is understood that all three suffered Covid-like symptoms and required hospital care weeks before China broke the news of the virus outbreak to the rest of the world.</p> <p><em>The Sun</em> reported that the name of “patient zero" has never been disclosed until now.</p> <p>Many US government officials have now identified the three scientists in a shocking report by journalists Michael Shellenberger and Matt Taibbi.</p> <p>Writing in the Substack newsletter <em>Public</em>, the pair alleged the scientists were experimenting with coronaviruses when they fell ill in 2019.</p> <p>Several experts and intelligence officials have long suspected scientists at the lab accidentally spread the virus during so-called “gain of function” experiments on bat coronaviruses.</p> <p>The naming of “patient zero” could prove to be the smoking gun, only adding to mounting circumstantial evidence of a lab leak.</p> <p>It is unclear who in the US government had the intelligence about the sick lab workers, how long they had it, and why it was not shared with the public.</p> <p><em>The Australian</em> journalist and <em>Sky News</em> host Sharri Markson spoke to <em>The Sun</em> about the lab leak theory in 2021 and dubbed it an “explosive development”.</p> <p>Jamie Metzl, a former member of the World Health Organisation advisory committee on human genome editing, described it as a possible “game changer”.</p> <p>“It’s a game changer if it can be proven that Hu got sick with Covid before anyone else,” he said.</p> <p>“That would be the ‘smoking gun’. Hu was the lead hands-on researcher in (virologist Shi Zhengli’s) lab.”</p> <p>DRASTIC, an international team of scientists and sleuths attempting to piece together Covid-19’s origins, researched the three scientists in 2021.</p> <p>The Wuhan Institute of Virology’s website lists Hu’s biography showing he was working as an assistant researcher.</p> <p>He was said to be the “star pupil” of virologist Shi Zhengli — the virologist at the lab who became known as “batwoman” for her research on bat coronaviruses.</p> <p>Markson, the author of <em>What Really Happened in Wuhan</em>, said that Hu was running a state-funded project in 2019 to test if new coronaviruses could infect humans.</p> <p>The study involved souping up the viruses and experimenting with them on humanised mice.</p> <p>However, the results were never published and the study’s existence was erased from the internet as Covid-19 was spreading around the globe, which raised suspicion of a possible lab leak.</p> <p>A source told <em>The Sun</em> that footage from 2017 that was aired by Chinese state-run TV showed Hu working in the lab without protective gear.</p> <p>The same video shows scientists from the Wuhan lab searching for bat viruses with inadequate protective gear.</p> <p>Alina Chan, a molecular biologist at MIT and Harvard, told <em>Public</em>, “Ben Hu is essentially the next Shi Zhengli.</p> <p>“He was her star pupil. He had been making chimeric SARS-like viruses and testing these in humanised mice.</p> <p>“If I had to guess who would be doing this risky virus research and most at risk of getting accidentally infected, it would be him.”</p> <p>She noted, “If this info had been made public in May of 2020, I doubt that many in the scientific community and the media would have spent the last three years raving about a raccoon dog or pangolin in a wet market.”</p> <p>US scientist Dr Steven Quay, “He was always my first choice for one of the infected Wuhan Institute of Virology workers but it seemed too simple.”</p> <p>A bill signed by US President Joe Biden in 2023 called for the release of the names of the sick scientists, their symptoms, and whether they had been involved with or exposed to coronavirus research.</p> <p>The US is currently preparing to release previously classified material, which could include the names of the three Wuhan scientists.</p> <p>Earlier in 2023, FBI director Christopher Wray said, “the FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident in Wuhan”.</p> <p>China has long been accused of attempting to cover up or distort its involvement with Covid-19, but they continue to deny claims.</p> <p>In March 2023, China’s former government scientist confessed the Wuhan lab leak theory shouldn’t be ruled out, sparking uproar in Beijing.</p> <p>Professor George Gao, the former chief of China’s Centre for Disease Control, played a key role in the efforts to trace the origins of Covid-19, insisting scientists should “suspect anything”.</p> <p>Speaking to the BBC Radio 4 podcast <em>Fever: The Hunt for Covid’s Origin</em>, Professor Gao said, “You can always suspect anything. That’s science.</p> <p>“Don’t rule out anything.”</p> <p>Professor Gao retired from the CDC in 2022 after playing a key role in the pandemic response and efforts to find the mysterious origin of the virus.</p> <p>He would have had access to highly classified government information on the outbreak of Covid-19.</p> <p>According to Professor Gao, a formal investigation into the Wuhan Institute of Virology was carried out by a government department.</p> <p>The government scientist claimed the “lab was double-checked by the experts in the field”.</p> <p>Investigators believe scientists were working with the Chinese military to develop a mutant virus and pursue bioweapons just as the pandemic began.</p> <p>The findings followed a team of US investigators who combed through top-secret intercepted communications and research.</p> <p>In 2016, researchers discovered a new fatal type of coronavirus in a mineshaft in Mojiang, Yunnan province.</p> <p>However, they kept it under wraps, with the sample then transported to the Wuhan lab and dubbed as classified work.</p> <p>The virus is the only known immediate relative of Covid-19 known to exist prior to the pandemic.</p> <p>Speaking to<em> The Times</em>, one US investigator said, “The trail of papers starts to go dark.</p> <p>“That’s exactly when the classified program kicked off.</p> <p>“My view is that the reason it was covered up was due to military secrecy related to the army’s pursuit of dual-use capabilities in virological biological weapons and vaccines.”</p> <p>The findings came after a scientist who worked closely with the Wuhan lab claimed the virus was genetically engineered and leaked from the facility.</p> <p><em>Image credit: Getty</em></p>

Body

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Long COVID could be caused by the virus lingering in the body. Here’s what the science says

<p><a href="https://theconversation.com/profiles/stephen-kent-1283387">Stephen Kent</a>, <em><a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em> and <a href="https://theconversation.com/profiles/chansavath-phetsouphanh-1436741">Chansavath Phetsouphanh</a>, <em><a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>While most people survive and recover from COVID, for some people symptoms can <a href="https://www.nature.com/articles/s41586-021-03553-9">persist for months</a> or years. When symptoms last longer than 12 weeks, the condition is known as <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">long COVID</a>.</p> <p>Long COVID encompasses up to <a href="https://www.nature.com/articles/s41579-022-00846-2?utm_source=substack&amp;utm_medium=email">200 different symptoms</a>. To determine evidence-based treatments for these symptoms, we need to understand the causes. One factor that may be associated with long COVID is that the virus hasn’t fully cleared from the body after the initial infection.</p> <p>We know from other viruses that viral fragments can remain in different tissues for months or even years. This could be the case with SARS-CoV-2, the virus that causes COVID. Here’s what the science says so far.</p> <h2>Other viruses lurk in the body</h2> <p>Herpesviruses (such as Epstein-Barr virus, the cause of glandular fever), as well as HIV (human immunodeficiency virus) can exist in a “latency state” for life. This means the virus conceals itself within cells and remains dormant.</p> <p>HIV, in particular, can remain dormant in infected cells throughout the body. Even though it’s inactive, it can still promote immune activation and inflammation.</p> <p>Other viruses such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728251/">Zika</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492426/">measles</a> and <a href="https://bmjopen.bmj.com/content/6/1/e008859">Ebola</a> have been found in tissues of infected people months or years after initial infection. This viral persistence can <a href="https://www.ahajournals.org/doi/10.1161/circulationaha.105.548156">cause chronic illness</a>.</p> <p>Several studies have shown COVID can also reactivate the Epstein-Barr virus, which has remained in the body in a latent state. Research shows this has been <a href="https://www.jci.org/articles/view/163669">linked to</a> fatigue and problems with thinking and reasoning in <a href="https://www.mdpi.com/2076-0817/10/6/763">people with long COVID</a>.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/530287/original/file-20230606-15-u0ykc8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/530287/original/file-20230606-15-u0ykc8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/530287/original/file-20230606-15-u0ykc8.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/530287/original/file-20230606-15-u0ykc8.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/530287/original/file-20230606-15-u0ykc8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/530287/original/file-20230606-15-u0ykc8.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/530287/original/file-20230606-15-u0ykc8.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=3 2262w" alt="Man looks at laptop, confused" /><figcaption><span class="caption">Latent viruses can cause fatigue and problems with thinking and reasoning.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/4-EeTnaC1S4">Wes Hicks/Unsplash</a></span></figcaption></figure> <h2>How do we know COVID stays in the body?</h2> <p>Several studies have identified the genetic sequences of SARS-CoV-2 (RNA) as well as SARS-CoV-2 proteins in tissues and stool (poo) samples months following infection.</p> <p>These studies include multiple autopsy reports that <a href="https://www.nature.com/articles/s41586-022-05542-y">found viral RNA and protein in a variety of tissues</a> from people who died up to seven months after infection. SARS-CoV-2 RNA was detected in at least half the samples of heart, lymph glands, eye, nerve, brain and lung tissue tested.</p> <p>In people who survived, <a href="https://www.nature.com/articles/s41586-021-03207-w">viral RNA was found</a> four months after infection within intestinal tissues obtained through colonoscopy, when a thin tube is used to take tissue from the large intestine. These patients had asymptomatic COVID and were PCR-negative from swabs of the nose and throat at four months.</p> <p>A 2022 study found SARS-CoV-2 in the stool of about half of the participants in the first week after infection. At four months, there was no virus present in the respiratory tract but <a href="https://doi.org/10.1016/j.medj.2022.04.001">12.7% of stool samples were RNA positive</a>. A further 3.8% of faecal samples remained positive for RNA at seven months.</p> <p><a href="https://doi.org/10.1016/S2213-2600(21)00240-X">Initial studies</a> did not always suggest a strong relationship between the long-term detection of SARS-CoV-2 and long COVID symptoms.</p> <p>But more recently, the presence of SARS-CoV-2 RNA (or protein translated from RNA) in the <a href="https://academic.oup.com/cid/article/76/3/e487/6686531">blood</a> and gut tissue was found to <a href="https://doi.org/10.1053/j.gastro.2022.04.037">increase the likelihood</a> of developing long COVID symptoms.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/530289/original/file-20230606-27-p7vgd8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/530289/original/file-20230606-27-p7vgd8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=335&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/530289/original/file-20230606-27-p7vgd8.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=335&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/530289/original/file-20230606-27-p7vgd8.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=335&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/530289/original/file-20230606-27-p7vgd8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=421&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/530289/original/file-20230606-27-p7vgd8.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=421&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/530289/original/file-20230606-27-p7vgd8.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=421&amp;fit=crop&amp;dpr=3 2262w" alt="Person gets a blood test" /><figcaption><span class="caption">The presence of SARS-CoV-2 in the blood increases the likelihood of developing long COVID symptoms.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/ufwC2cmbaaI">Nguyễn Hiệp/Unsplash</a></span></figcaption></figure> <h2>How might the delay in clearing the virus impact people with long COVID?</h2> <p>Delayed clearance of SARS-CoV-2 particles in different parts of the body could drive illness through several potential processes:</p> <p><strong>1) Inflammation</strong>. The continued immune stimulation by viral proteins causes inflammation, makes our immune system tired, and alters how our immune cells work as time goes on.</p> <p><a href="https://www.nature.com/articles/s41590-021-01113-x">We have previously shown</a> immune dysfunction and inflammation persist up to eight months in people with long COVID that initially had mild to moderate disease.</p> <p><strong>2) Activation of other dormant viruses</strong>. The continued immune response to persistent SARS-CoV-2 can cause reactivation of latent viruses.</p> <p>Antibodies reactive to Epstein-Barr virus are elevated in people with long COVID suggesting Epstein-Barr virus <a href="https://doi.org/10.1101/2022.08.09.22278592">reactivation</a>, likely through activating the immune system.</p> <p>Other latent viruses, such as human endogenous retroviruses (HERVs; ancient viruses that have become a part of our DNA, like a genetic fossil) have recently been shown to become reactivated after infection. HERV proteins <a href="https://www.sciencedirect.com/science/article/pii/S2589004223006818">were detected</a> in blood cells and tissues of COVID patients.</p> <p>These proteins could potentially drive inflammatory processes in long COVID.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/530290/original/file-20230606-27-6s4g00.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/530290/original/file-20230606-27-6s4g00.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/530290/original/file-20230606-27-6s4g00.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/530290/original/file-20230606-27-6s4g00.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/530290/original/file-20230606-27-6s4g00.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/530290/original/file-20230606-27-6s4g00.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/530290/original/file-20230606-27-6s4g00.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=3 2262w" alt="3D illustration of the Epstein-Barr virus in green and red" /><figcaption><span class="caption">Reactivation of the Epstein-Barr virus could drive inflammation in long COVID.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/epsteinbarr-virus-ebv-herpes-which-causes-556379407">Shutterstock</a></span></figcaption></figure> <p><strong>3) Antibodies made by combating SARS-CoV-2 could become “self” reactive.</strong> These autoantibodies (antibodies produced by our immune system that mistakenly target and attack our own body’s tissues or organs) might cross-react with host receptors or proteins and <a href="https://www.nature.com/articles/s41577-020-00458-y">drive autoimmune</a> disease.</p> <p>Importantly, recent studies have shown new onset of autoimmune diseases (such as type 1 diabetes, inflammatory bowel disease and psoriasis) are significantly associated with SARS-CoV-2 infection and <a href="https://www.nature.com/articles/s41584-023-00964-y">a link between autoimmunity and long COVID</a> is plausible.</p> <p>This suggests COVID not only has immediate health impacts but could also potentially trigger long-term changes in the immune system.</p> <p>While the studies mentioned above provide initial evidence of persistence of SARS-CoV-2 long after initial infection, more studies are needed to show a convincing link between lingering virus and long COVID. This should include examination of viral RNA and protein in both blood and tissues in people with long COVID independent of disease severity. And it must involve well-developed cohort studies that track large groups of people internationally.</p> <p><a href="https://clinicaltrials.gov/ct2/show/NCT05668091">Several</a> <a href="https://clinicaltrials.gov/ct2/show/NCT05576662">trials are underway</a> to assess whether treating long COVID with antivirals such as Paxlovid may reduce viral antigens and improve symptoms, although this remains experimental.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/205025/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/stephen-kent-1283387">Stephen Kent</a>, Professor and Laboratory Head, <em><a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em> and <a href="https://theconversation.com/profiles/chansavath-phetsouphanh-1436741">Chansavath Phetsouphanh</a>, Senior Research Associate, Kirby Institute, <em><a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/long-covid-could-be-caused-by-the-virus-lingering-in-the-body-heres-what-the-science-says-205025">original article</a>.</em></p> <p><em>Images: Getty</em></p>

Body

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19 handy uses for toothpaste that have nothing to do with your teeth

<h2>Remove scuffs from shoes</h2> <p>A little toothpaste does an amazing job of removing scuffs from leather shoes. Just squirt a dab on the scuffed area and rub with a soft cloth. Wipe clean with a damp cloth. The leather will look like new.</p> <h2>Clean your piano keys</h2> <p>Has tickling the ivories left them a bit dingy? Clean them up with toothpaste and a toothbrush, then wipe them down with a damp cloth. Makes sense, since ivory is essentially elephant teeth. However, toothpaste will work just as well on modern pianos that usually have keys covered with plastic rather than real ivory.</p> <h2>Clean your sneakers</h2> <p>Want to clean and whiten the rubber part of your sneakers? Get out the non-gel toothpaste and an old toothbrush. After scrubbing, clean off the toothpaste with a damp cloth.</p> <h2>Clean your clothes iron</h2> <p>The mild abrasive in non-gel toothpaste is just the ticket for scrubbing the gunk off the bottom plate of your clothes iron. Apply the toothpaste to the cool iron, scrub with a rag, then rinse clean.</p> <h2>Polish a diamond ring</h2> <p>Put a little toothpaste on an old toothbrush and use it to make your diamond ring sparkle instead of your teeth. Clean off the residue with a damp cloth.</p> <h2>Deodorise baby bottles</h2> <p>Baby bottles inevitably pick up a sour-milk smell. Toothpaste will remove the odour in a jiffy. Just put some on your bottle brush and scrub away. Be sure to rinse thoroughly.</p> <h2>Prevent fogged goggles</h2> <p>Whether you are doing woodworking or going skiing or scuba diving, nothing is more frustrating (and sometimes dangerous) than fogged goggles. Prevent the problem by coating the goggles with toothpaste and then wiping them off.</p> <h2>Prevent bathroom mirrors from fogging</h2> <p>Ouch! You cut yourself shaving and it’s no wonder – you can’t see your face clearly in that fogged-up bathroom mirror. Next time, coat the mirror with non-gel toothpaste and wipe it off before you get in the shower. When you get out, the mirror won’t be fogged.</p> <h2>Shine bathroom and kitchen chrome</h2> <p>They make commercial cleaners with a very fine abrasive designed to shine up chrome, but if you don’t have any handy, the fine abrasive in non-gel toothpaste works just as well. Just smear on the toothpaste and polish with a soft, dry cloth.</p> <h2>Clean the bathroom sink</h2> <p>Non-gel toothpaste works as well as anything else to clean the bathroom sink. The tube’s sitting right there, so just squirt some in, scrub with a sponge, and rinse it out. Bonus: the toothpaste will kill any odours emanating from the drain trap.</p> <h2>Remove crayon from walls</h2> <p>Did crayon-toting kids get creative on your wall? Roll up your sleeves and grab a tube of non-gel toothpaste and a rag or – better yet – a scrub brush. Squirt the toothpaste on the wall and start scrubbing. The fine abrasive in the toothpaste will rub away the crayon every time. Rinse the wall with water.</p> <h2>Remove ink or lipstick stains from fabric</h2> <p>Oh no, a pen opened up in the pocket of your favourite shirt! This may or may not work, depending on the fabric and the ink, but it is certainly worth a try before consigning the shirt to the scrap bin. Put non-gel toothpaste on the stain and rub the fabric vigorously together. Rinse with water. Did some of the ink come out? Great! Repeat the process a few more times until you get rid of all the ink. The same process works for lipstick</p> <h2>Remove watermarks from furniture</h2> <p>You leave coasters around. But some people just won’t use them. To get rid of those telltale watermark rings left by sweating beverages, gently rub some non-gel toothpaste on the wood with a soft cloth. Then wipe it off with a damp cloth and let it dry before applying furniture polish.</p> <h2>Clear up pimples</h2> <p>Dab a bit of non-gel, non-whitening toothpaste on the offending spot, and it should be dried up by morning. The toothpaste dehydrates the pimple and absorbs the oil. This remedy works best on pimples that have come to a head. Caution: this remedy may be irritating to sensitive skin.</p> <h2>Clean smells from hands</h2> <p>The ingredients in toothpaste that deodorise your mouth will work on your hands as well. If you’ve gotten into something stinky, wash your hands with toothpaste, and they’ll smell great.</p> <h2>Stop bug bites from itching</h2> <p>Put toothpaste on your bug bite to keep it from itching. Dab a dime-sized amount onto your bug bite. This method also helps to cool down burns on your skin.</p> <h2>Remove a stain from the carpet</h2> <p>Rub toothpaste into the stain on the carpet with a toothbrush or sponge. Rinse with water and repeat until the stain comes up.</p> <h2>Clean your foggy headlights</h2> <p>Make the headlights on your car shine like new. Put toothpaste onto a sponge and scrub your headlight in circular motions. Wipe the toothpaste off with a damp cloth.</p> <h2>Remove small scratches from your phone screen</h2> <p>Rub toothpaste on the front or back of your phone (wherever there are scratches). The toothpaste will work to reduce the look of the scratches and make your phone screen look much better.</p> <p><em>Image credit: Shutterstock</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.co.nz/food-home-garden/diy-tips/19-handy-uses-for-toothpaste-that-have-nothing-to-do-with-your-teeth" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

Home Hints & Tips

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People with long COVID continue to experience medical gaslighting more than 3 years into the pandemic

<p><em><a href="https://theconversation.com/profiles/simran-purewal-1405366">Simran Purewal</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kaylee-byers-766226">Kaylee Byers</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kayli-jamieson-1431392">Kayli Jamieson</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>, and <a href="https://theconversation.com/profiles/neda-zolfaghari-1431577">Neda Zolfaghari</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a></em></p> <p>It’s increasingly clear that the <a href="https://www.worldometers.info/coronavirus/country/canada/">SARS-CoV-2 virus is not going away</a> any time soon. And for some patients, their symptoms haven’t gone away either.</p> <p>In January 2023, our team of researchers at the <a href="https://pipps.ca/">Pacific Institute on Pathogens, Pandemics and Society</a> published a <a href="https://pipps.cdn.prismic.io/pipps/bd160219-3281-4c5d-b8be-57c301e7f99b_Long+Covid+Brief+Feb+2023.pdf">research brief</a> about how people seek out information about long COVID. The brief was based on a scoping review, a type of study that assesses and summarizes available research. Our interdisciplinary team aims to understand the experiences of people with long COVID in order to identify opportunities to support health care and access to information.</p> <h2>Lingering long COVID</h2> <p>Long COVID (also called <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms/post-covid-19-condition.html">Post COVID-19 condition</a>) is an illness that occurs after infection with COVID-19, lasting weeks to months, and even years. First coined by a <a href="https://doi.org/10.1016%2Fj.socscimed.2020.113426">patient on Twitter</a>, the term also represents a collective movement of people experiencing the long-term effects of COVID-19 and advocating for care. <a href="https://science.gc.ca/site/science/sites/default/files/attachments/2023/Post-Covid-Condition_Report-2022.pdf">Around 15 per cent</a> of adults who have had COVID still have symptoms after three months or more.</p> <p>Long COVID affects systems <a href="https://doi.org/10.1016/j.socscimed.2021.114619">throughout the body</a>. However, symptom fluctuations and limited diagnostic tools make it challenging for health-care providers to diagnose, especially with <a href="https://doi.org/10.1038/s41579-022-00846-2">over 200 symptoms</a> that may present in patients. Perhaps because long COVID presents itself in many different ways, the illness has <a href="https://doi.org/10.1016/j.socscimed.2021.114619">been contested</a> across the medical field.</p> <p>To identify opportunities to reduce barriers to long COVID care, our team has explored how patients and their caregivers access <a href="https://pipps.cdn.prismic.io/pipps/bd160219-3281-4c5d-b8be-57c301e7f99b_Long+Covid+Brief+Feb+2023.pdf">information about long COVID</a>. We have found that one of the most significant barriers faced by patients is <a href="https://doi.org/10.1177/20552076211059649">medical gaslighting</a> by the people they have turned to for help.</p> <h2>Lack of validation leads to stigma</h2> <p><a href="https://doi.org/10.1136/bmj.o1974">Medical gaslighting</a> occurs when health-care practitioners dismiss or falsely blame patients for their symptoms. While new information about long COVID has become more readily available, some patients continue to face gaslighting and feel that their symptoms are <a href="https://doi.org/10.1016%2Fj.ssmqr.2022.100177">treated less seriously</a> by some health-care professionals.</p> <p>This dismissal can <a href="https://doi.org/10.1111/hex.13602">erode trust</a> in the health-care system and can also lead to <a href="https://doi.org/10.1111/hex.13518">stigma and shame</a>.</p> <p>Preliminary findings from our ongoing study with long COVID patients indicate that, when medical practitioners do not validate a patient’s condition, this extends into community networks of family and friends who may also dismiss their symptoms, contributing to further stigmatization at home.</p> <p>Medical gaslighting can present additional barriers to treatment, such as not being referred to specialists or long COVID clinics. This can, in turn, compound other symptoms such as fatigue, and <a href="https://doi.org/10.1192/bjo.2022.38">exacerbate the psychological symptoms of long COVID</a>, such as depression and anxiety.</p> <p>Medical gaslighting isn’t new. It has been documented by patients with other chronic conditions, such as <a href="https://doi.org/10.5772/intechopen.107936">myalgic encephalomyelitis or chronic fatigue syndrome</a>. And while this is common for patients with <a href="https://doi.org/10.1001/amajethics.2021.512">non-visible illnesses</a>, medical gaslighting is more commonly experienced by <a href="https://doi.org/10.1111/1467-9566.13367">women and racialized people</a>.</p> <p>Long COVID patients also note gender biases, as women with prolonged symptoms feel they are not believed. This is particularly worrisome, as studies have found that <a href="https://doi.org/10.1001/jama.2020.17709">women are disproportionately more likely to experience long COVID</a>.</p> <h2>Where do we go from here?</h2> <p>While long COVID information is constantly shifting, it’s clear that patients face many barriers, the first of which is having their illness minimized or disregarded by others. To ensure that patients have access to compassionate care, we suggest:</p> <p><strong>1. Educating physicians on long COVID</strong></p> <p>Because definitions of long COVID, and its presentation, vary widely, primary care physicians need support to recognize and acknowledge the condition. General practitioners (GPs) must also provide patients with information to help manage their symptoms. This requires actively listening to patients, documenting symptoms and <a href="https://doi.org/10.1136/bmj.m3489">paying close attention to symptoms that need further attention</a>.</p> <p>Training physicians on the full range of symptoms and referring patients to available supports would reduce stigma and assist physicians by reducing their need to gather information themselves.</p> <p><strong>2. Raise awareness about long COVID</strong></p> <p>To increase awareness of long COVID and reduce stigma, public health and community-based organizations must work collaboratively. This may include a public awareness and information campaign about long COVID symptoms, and making support available. Doing so has the potential to foster community support for patients and improve the mental health of patients and their caregivers.</p> <p><strong>3. Ensure information is accessible</strong></p> <p>In many health systems, GPs are <a href="https://doi.org/10.1186/s12913-019-4419-0">gatekeepers to specialists</a> and are considered trusted information sources. However, without established diagnostic guidelines, patients are left to <a href="https://doi.org/10.2196/37984">self-advocate</a> and prove their condition exists.</p> <p>Because of negative encounters with health-care professionals, patients turn to social media platforms, including long COVID <a href="https://doi.org/10.7861%2Fclinmed.2020-0962">online communities</a> on Facebook. While these platforms allow patients to validate experiences and discuss management strategies, patients should not rely only on social media given the <a href="https://doi.org/10.3389/fpubh.2022.937100">potential for misinformation</a>. As a result, it is crucial to ensure information about long COVID is multi-lingual and available in a wide range of formats such as videos, online media and physical printouts.</p> <p>The <a href="https://science.gc.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/post-covid-19-condition-canada-what-we-know-what-we-dont-know-and-framework-action">recent recommendations of the Chief Science Advisor of Canada</a> to establish diagnostic criteria, care pathways and a research framework for long COVID are a positive development, but we know patients need support now. Improving long COVID education and awareness won’t resolve all of the issues faced by patients, but they’re foundational to compassionate and evidence-based care.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/203744/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/simran-purewal-1405366">Simran Purewal</a>, Research Associate, Health Sciences, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kaylee-byers-766226">Kaylee Byers</a>, Regional Deputy Director, BC Node of the Canadian Wildlife Health Cooperative; Senior Scientist, Pacific Institute on Pathogens, Pandemics and Society, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kayli-jamieson-1431392">Kayli Jamieson</a>, Master's Student in Communication, Research Assistant for Pacific Institute on Pathogens, Pandemics and Society, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>, and <a href="https://theconversation.com/profiles/neda-zolfaghari-1431577">Neda Zolfaghari</a>, Project Coordinator, Pacific Institute on Pathogens, Pandemics and Society, and the Pandemics &amp; Borders Project, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/people-with-long-covid-continue-to-experience-medical-gaslighting-more-than-3-years-into-the-pandemic-203744">original article</a>.</em></p>

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Many people are tired of grappling with long COVID – here are some evidence-based ways to counter it

<p><a href="https://theconversation.com/profiles/kyle-b-enfield-1409764">Kyle B. Enfield</a>, <em><a href="https://theconversation.com/institutions/university-of-virginia-752">University of Virginia</a></em></p> <p>A patient of mine, once a marathon runner, now gets tired just walking around the block. She developed COVID-19 during the 2020 Christmas holiday and saw me during the summer of 2021. Previously, her primary care doctor had recommended a graded exercise program. But exercise exhausted her. After months of waiting, she finally had an appointment at our post-COVID-19 clinic at the University of Virginia.</p> <p>She is hardly alone in her extended search for answers. Studies suggest that <a href="https://doi.org/10.1016/S0140-6736(22)01214-4">from 10%</a> to <a href="https://doi.org/10.1016/j.eclinm.2022.101762">45% of COVID-19 survivors</a> have at least <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">one of the following symptoms three months after recovery</a>: fatigue, cough, shortness of breath, difficulty sleeping, difficulty with daily activities or mental fogginess, otherwise known as “brain fog.”</p> <p>There are many names for this condition: <a href="https://theconversation.com/long-covid-stemmed-from-mild-cases-of-covid-19-in-most-people-according-to-a-new-multicountry-study-195707">long COVID</a>, long-haul COVID, post-acute COVID-19 syndrome and chronic COVID. Patients report that their symptoms, or the severity of them, <a href="http://dx.doi.org/10.1136/bmjgh-2021-007004">fluctuate over time</a>, which <a href="https://theconversation.com/deciphering-the-symptoms-of-long-covid-19-is-slow-and-painstaking-for-both-sufferers-and-their-physicians-164754">makes diagnosis and treatment difficult</a>.</p> <h2>A response to infection</h2> <p>Researchers and doctors have seen <a href="https://doi.org/10.2340/16501977-2694">similar recovery patterns from other viruses</a>, including <a href="https://www.cdc.gov/vhf/ebola/about.html">Ebola</a> and Middle East Respiratory Syndrome, <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/middle-eastern-respiratory-syndrome-mers">or MERS</a>, which is another coronavirus.</p> <p>This suggests that the illness we see following a bout with COVID-19 may be part of a patient’s response to the infection. But doctors and researchers do not yet know why some patients go on to have persistent symptoms.</p> <p>My clinical practice and academic research <a href="https://scholar.google.com/scholar?as_ylo=2022&amp;q=Kyle+Enfield&amp;hl=en&amp;as_sdt=0,47">focus on critically ill patients</a>. Most of my patients now are people who had COVID-19 with various levels of severity.</p> <p>I often tell these patients that we are still learning about this disease, which wasn’t part of our vernacular before 2020. Part of what we do at the clinic is help patients understand what they can do at home to start improving.</p> <figure><iframe src="https://www.youtube.com/embed/ype9O4rD3Gk?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">For millions of Americans, COVID-19 is still a part of their lives.</span></figcaption></figure> <h2>Dealing with fatigue</h2> <p><a href="https://doi.org/10.1038/s41598-021-95565-8">Chronic fatigue</a> can greatly affect quality of life. Exercise limitations can have their roots in problems with the lung, heart, brain, muscles or all of the above.</p> <p>Graded exercise therapy works for some but not all patients. Graded exercise is the slow introduction of exercise, starting slowly and gradually increasing in load over time. Many are frustrated because they feel more exhausted after exercising or even doing the routine tasks of daily living. The lack of progress <a href="https://doi.org/10.1016/j.jpsychores.2019.109893">leads to feelings of depression</a>.</p> <p>The condition of feeling more exhausted after exercise <a href="https://www.cdc.gov/me-cfs/healthcare-providers/clinical-care-patients-mecfs/treating-most-disruptive-symptoms.html">is called post-exertional malaise</a>, which is defined as physical and mental exhaustion after an activity, often 24 hours later, that is out of proportion with the activity.</p> <p>For example, you feel good today and decide to go for a walk around the block. Afterward you are fine, but the next day your muscles ache and all you can do is lie on the couch. Some patients don’t even have the energy to answer emails. Rest or sleep do typically relieve the fatigue. There is no one-size-fits-all approach to treatment; the severity and frequency of post-exertional malaise varies from person to person.</p> <h2>Signs and symptoms</h2> <p>Fatigue following any illness is common, as is exercise intolerance. So when should you see a medical professional? Diagnostic testing for post-exertional malaise exists, but it’s not readily available to all patients. These questions may provide clues to whether or not you are experiencing it:</p> <ul> <li>Does it take more than one day to recover to your usual baseline activity?</li> <li>Do you feel unwell, weak, sleep poorly or have pain when recovering from activity?</li> <li>Are you feeling limited in your ability to do your daily tasks after activity?</li> <li>Does exercise activity affect you positively?</li> <li>Do you have soreness and fatigue after nonstrenuous days, or mental fatigue after strenuous or nonstrenuous activities?</li> </ul> <p>All of these can be clues to discuss with your primary care provider, who may want to do additional testing to confirm the diagnosis, such as a <a href="https://me-pedia.org/wiki/Two-day_cardiopulmonary_exercise_test">two-day cardiopulmonary exercise test</a>.</p> <p>Before your appointment, there are a few things you can do at home that may help.</p> <h2>Taking it easy</h2> <p>One of those techniques is pacing, or activity management, an approach that balances activities with rest.</p> <p>The <a href="https://www.rcot.co.uk/">Royal College of Occupational Therapists</a> and the <a href="https://ics.ac.uk/">Intensive Care Society</a>, both in the U.K., developed what they call the <a href="https://www.rcot.co.uk/conserving-energy">3Ps – Pace, Plan and Prioritize</a>.</p> <p>Pacing yourself means breaking down activities into smaller stretches with frequent breaks rather than doing it all at once. An example would be to climb a few steps and then rest for 30 seconds, instead of climbing all the stairs at once.</p> <p>Planning involves looking at the week’s activities to see how they can be spread out. Think about the ones that are particularly strenuous, and give yourself extra time to complete them.</p> <p>This helps with prioritizing – and recognizing those tasks that can be skipped or put off.</p> <h2>Focusing on the breathing</h2> <p>Some patients with long COVID develop abnormal breathing patterns, including shallow rapid breathing, known as hyperventilating, or breath-holding. Either of these patterns can make you feel short of breath.</p> <p>Symptoms of abnormal breathing patterns include frequent yawning, throat-clearing, experiencing pins-and-needles sensations, palpitations and chest pain. Don’t ignore these symptoms, because they can be signs of serious medical problems like <a href="https://www.cdc.gov/heartdisease/heart_attack.htm">heart attacks</a> and <a href="https://www.cdc.gov/heartdisease/atrial_fibrillation.htm">abnormal heart rhythms</a>. Once those are ruled out, it is possible to relearn to breathe properly.</p> <p>You can <a href="https://longcovid.physio/breathing-pattern-disorders">practice these techniques at home</a>. The simple version: Find a comfortable position – either lying down or sitting upright with your back supported. Place one hand on your chest and the other over your belly button. Exhale any stale air out of your lungs. Then breathe in through your nose and into your abdomen, creating a gentle rise in the belly.</p> <p>You should feel the hand resting on your belly button move up and down. Try to avoid short, shallow breaths into the upper chest. Slowly exhale all the air out of your lungs. The goal is to take around eight to 12 breaths per minute.</p> <p>Focus on a longer exhale than inhale. For example, inhale as described for a count of two, then exhale for a count of three, as a starting point. If you take one breath every five seconds, you will be breathing 12 breaths per minute. As you get more comfortable with this, you can increase the time to further reduce your breaths per minute.</p> <figure><iframe src="https://www.youtube.com/embed/tEmt1Znux58?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Box breathing is easy to learn and you can do it anywhere, anytime.</span></figcaption></figure> <p>A more advanced tool <a href="https://www.youtube.com/watch?v=a7uQXDkxEtM">is called box breathing</a>: Breathe in for a count of four to five, holding your breath for a count of four to five, breathing out for a count of four to five and hold that for a count of four to five.</p> <p>Long COVID patients who use these techniques show improvement in <a href="https://doi.org/10.1016/S2213-2600(22)00125-4">symptoms of breathlessness and sense of well-being</a>.</p> <h2>The road to recovery</h2> <p>The patient I referred to earlier did all of these things. As we worked with her, we discovered she had multiple reasons for her symptoms. In addition to overbreathing and symptoms of post-exertion malaise, she had a new cardiac problem, possibly related to her COVID-19 illness, that made her <a href="https://doi.org/10.1161/JAHA.121.024207">heart work less well during exercise</a>. Now she is recovering; while not back to marathon running, she is feeling better.</p> <p>Currently there is no cure for long COVID, though we hope research will lead to one. <a href="https://clinicaltrials.gov/ct2/results?cond=long+covid&amp;term=&amp;cntry=&amp;state=&amp;city=&amp;dist=">Clinical trials looking at potential therapies</a> are continuing. In the meantime, people should be cautious about using medications that are not proved to help – and if you’re having symptoms, get evaluated.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/201451/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/kyle-b-enfield-1409764">Kyle B. Enfield</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/university-of-virginia-752">University of Virginia</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/many-people-are-tired-of-grappling-with-long-covid-here-are-some-evidence-based-ways-to-counter-it-201451">original article</a>.</em></p> <p><em>Images: Getty</em></p>

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I’ve worked at an all-inclusive resort for 10 years – these are 19 mistakes every traveller should avoid

<p><strong>All-inclusive resort tips for the best trip ever</strong></p> <p>Heading to an inclusive resort is the best of both worlds: you get to go on an amazing holiday while someone else takes care of all the little details. But how do all those little details work, exactly? And how can you, as the guest, have an epic experience? As an entertainment director for more than a decade, I’ve gotten an insider look into nearly every aspect of these types of hotels, which means I know a few things that you’ll definitely want to know. My job may sound like a 24/7 party, but it’s a lot of work too. I joke that my ‘nightlife’ fills my entire day. But my lack of work-life balance is your gain, since my experience translates into all-inclusive resort tips that will help you have a blast and give you the most bang for your buck. Because let’s be honest, if you’re going to an all-inclusive resort, you’re spending a lot of money – and you deserve to get what you’re paying for.</p> <p>Over the years, I’ve seen thousands of guests, and there are some common mistakes people make – from the type of package they book to what they do (and don’t do) when staying at an all-inclusive. So memorise this advice because it can help you have the best holiday of your life.</p> <p><strong>Thinking that 'all-inclusive' means everything is included</strong></p> <p>Despite the title of ‘all-inclusive,’ most all-inclusive resorts don’t include everything. While the specifics will vary depending on the resort, your membership status and the package you booked, common exclusions include transportation to and from the airport, spa treatments, premium alcohol and Wi-Fi in your room (although it’s generally provided for free in common areas). Other amenities may be partially included. For instance, water sports may be included in your rate, but you might have to pay extra to rent motorised equipment like jet skis. While you’ll be told about extra charges when booking a service or activity, if you’re not really paying attention, you could end up with quite the surprise when you see the final bill at the end of your stay. This is also true of all-inclusive cruises.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: read the fine print of your package before you arrive (and ideally before you book), and be sure to ask staff if you’re unsure whether something’s included. You could easily add an extra 10 per cent or more to your bill if you don’t. You should also always ask whether resort fees – which can range from $25 to $100 a day, depending on the company – are included.</p> <p><strong>Not researching the resort before you go</strong></p> <p>Even within the same chain, every all-inclusive resort is different – from the culture and dining to the amenities and excursions – and the time to discover those differences is not the day you get there. Knowing what to expect can help you have a better experience, since you’ll know what you want to do and can jump on reservations quickly, as well as know what to pack for the weather and available activities. It’s also an important part of managing your expectations. Sometimes we have guests show up expecting everything under the sun and then are disappointed when all their expectations aren’t met – things they would have realised if they’d researched the resort first.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: Take an hour or so to check out the resources on the resort’s website, and go to online forums for that resort so you know what the can’t-miss things are. Come prepared with a list of activities, foods, cultural experiences and shows that you’re most excited about. Upon checking in, you can also talk to the concierge, entertainment director or other employees for their personal recommendations and for help making reservations.</p> <p><strong>Overtipping or undertipping</strong></p> <p>Tipping etiquette can be confusing no matter where you are, and the rules are different at all-inclusive resorts. One of the selling points of an all-inclusive resort is that gratuities are usually included in the package. But while this means guests aren’t expected to tip for regular services like housekeeping or dining, guests may still choose to tip for exceptional service or for special requests, such as having an item ordered online and delivered to them. Plus, certain ‘extra’ services – like spa treatments, deluxe excursions or butler service – may not be included in the all-inclusive package, which means that a tip wouldn’t be included either.</p> <p>In addition, tipping culture at resorts has changed since the pandemic, and even though tips for normal services aren’t required, in some countries and some resorts (for instance, in Mexico), they are now expected – even if it isn’t explicitly stated. That isn’t true everywhere, of course. In certain countries, tipping isn’t the norm. For example, in Japan, you shouldn’t tip at all at an all-inclusive resort.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: read the details of your package to understand which services are included and which require an additional tip. Bring $100 to $200 in cash for tipping, and ask the concierge upon arriving what is generally expected and appropriate. Some resort employees, especially those in poorer countries, depend on these tips to make a living wage, so while you may not have to tip them, it’s still the kind thing to do.</p> <p><strong>Overindulging in food and drinks</strong></p> <p>Just because you can eat a kilo of crab legs and a litre of ice cream, it doesn’t mean you should. (And yes, I saw someone do that!) Since most, if not all, food and drinks are included, some guests feel that the way to get their money’s worth is to overeat or drink to the point of inebriation. Unfortunately, I’ve seen guests stuck in bed for an entire day or two after a binge, making them miss out on all the other fun things.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: feel free to indulge, but be moderate in how much you eat and drink at once. Remember, it’s about enjoying the overall experience, and that’s about having fun while doing things you couldn’t do at home.</p> <p><strong>Staying at the resort the whole time</strong></p> <p>While you certainly can stay in your room and enjoy the peace and quiet, the draw of an all-inclusive resort is that it offers far more than just a place to relax. Yet you’d be surprised at how many guests don’t take advantage of all the resort and the surrounding area have to offer. Most resorts are in locations known for their beauty, culture, weather and opportunities for adventure, and it would be a mistake to not even check it all out.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: this is the perfect opportunity to get out of your comfort zone and try something new, whether that’s eating a local delicacy or going on a guided tour through ancient ruins. You might even make some new friends along the way. It’s exactly these types of things that will make your holiday fun and memorable.</p> <p><strong>Sticking to the standard buffet</strong></p> <p>We work hard to provide delicious, one-of-a-kind dining experiences that reflect the culture and flavours of the locale. This isn’t just about offering local delicacies; it may also include a special cooking method, watching the chef prepare your food, seeing where the food comes from or allowing you to participate in the dining experience in a unique way. Filling up on hamburgers and fries is fine, but the food is a big part of what you are paying for.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: look up the resort’s dining options in advance, and pick out a few adventures to try. Most resorts offer a chef’s tasting menu that encompasses the local cuisine – for example, in Bali, you can watch your fish caught fresh and then cooked on a traditional grill.</p> <p>Ask the chef or entertainment director for their suggestions for what’s best at the moment. And book your reservations as early as possible.</p> <p><strong>Not making a connection with the staff</strong></p> <p>Many guests are repeat visitors at specific resorts, and staff develop relationships with their favourites and will go out of their way to make sure you have everything you want and need. They might even provide little extras for free, like treats, drinks or early-access passes to shows. The employees are also an incredible resource for what to try in the surrounding areas, what you need to know about local cultural norms, how to prepare for certain excursions and other site-specific tips. But they can only do that if you’ve already built a good relationship with them.</p> <p>Even if you’ll only ever be at the resort once, a little kindness goes a long way with all the staff, ensuring that your stay is pleasant and that you feel taken care of. Honestly, a kind guest will find themselves being treated like a king or queen, so this is one of the all-inclusive resort tips that you really don’t want to skip!</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: start by acknowledging staff with a smile, remembering their names and asking how they are. Do not be rude to staff, even if you’re upset; you’re much more likely to get help when you’re kind and calm. Ask questions about the area or the resort – they are a wealth of insider information – but steer clear of overly personal questions that could come off as creepy. For instance, do not hit on the staff, ask where they live or for their private phone numbers. If you want to keep in touch, they can give you their company email address.</p> <p><strong>Being glued to your phone</strong></p> <p>I’ve seen too many people miss out on the joy of the moment because their eyes are constantly on their phone. You’re on holidays for a reason – to get a break from daily life – so let this be a magical experience. Take in the beauty of the surrounding nature, watch your children play, have a cocktail with your spouse, check out a performance, go dancing at the nightclub.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: use your phone to snap a few pictures or videos for memories, but otherwise try to keep your tech use to a minimum so you can be fully present. (Plus, you’ll avoid a lot of frustration, since internet service may be spotty and limited to certain areas.)</p> <p><strong>Not getting traveller's insurance</strong></p> <p>When it comes to holidays, you have to plan for the unexpected, and that includes making sure you have adequate insurance coverage and knowing how to access it. Insurance coverage depends on where you are and what you’re doing, but expect the resort’s insurance to cover only things under their direct control, such as mechanical malfunctions, equipment failures, schedule changes and cancellations. It generally won’t cover weather-related disasters, personal medical emergencies, accidents, injuries, flight cancellations and other things that could seriously mess up your trip (and your budget) if you’re not prepared.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: consider buying separate travel insurance for the trip, and read through it carefully so you know what’s covered. You will most likely be offered travel insurance as an extra when booking, either through a travel agent or directly through the resort. You can also purchase travel insurance as a rider to other insurance policies, like a homeowner’s policy, and many credit cards offer travel insurance as a perk when you pay for the trip with that card. Also make sure to check with your personal medical insurance about what they cover while you are away, especially if you are out of the country.</p> <p><strong>Dressing too casually</strong></p> <p>You’re on holidays at an all-inclusive resort in Hawaii, so it’s swimsuits and flip-flops 24/7, right? While that is true for some areas of the resort, many all-inclusive resorts have upscale dining and shows that require, at the very least, trousers or a sundress and real shoes. You will be turned away if you don’t meet that dress code.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: read up on the dress code before you start packing, and make sure to bring at least one outfit that goes beyond beachwear on your packing list. A pair of khakis or trousers and a collared shirt will likely suffice for men, while women should bring a dress (beyond the all-cotton beach cover-up) or nice pants and a blouse. Some resorts have formal nights where suits and formal dresses are required. And don’t forget to pack a pair of dress shoes!</p> <p><strong>Ignoring safety guidelines </strong></p> <p>Some guests think weather advisories, public-health mandates (like masks), staying out of roped-off areas, only swimming in designated spots, wearing life jackets and other safety rules are for everyone else but not them. But our safety guidelines aren’t there to mess up your fun – they are to keep you safe so you can have more fun. Ignoring these guidelines can put you in danger and ruin your holiday.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: follow the rules, and avoid endangering yourself or others. This is true even if you ‘already know how’ to do an activity (like snorkelling or skiing). Guests ignoring the rules have been caught in dangerous riptides, attacked by wildlife, taken jaw-dropping falls or been stranded on land that suddenly turns into an island when the tide comes in.</p> <p><strong>Getting dehydrated </strong></p> <p>Too many tropical holidays have been ruined by heat stroke! You have delicious beverages (both alcoholic and regular treats) at your fingertips, so it’s understandable that you might forget to drink enough water – something that can be compounded by being outdoors more than usual, forgetting sun protection like hats or umbrellas, and loading up on salty snacks. But getting dehydrated can make you feel tired and irritable at best, or gravely ill at worst. This is especially important if you are travelling to a climate that is significantly hotter or drier than you’re used to.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: balance out each alcoholic or sugary drink with a glass of water. Take a reusable water bottle and a sun hat with you on excursions, and be on the lookout for signs of dehydration like exhaustion, being overly sweaty or unable to sweat, becoming very red in the face or very pale, disorientation, muscle cramps and weakness.</p> <p><strong>Not consulting the schedule </strong></p> <p>Not only does the resorts daily tell you when things are happening – it’s also a great way to see what is happening. Even if you did some research ahead of time, it’s not uncommon for a resort to add even more shows, excursions or dining experiences. Some are first-come, first-serve, while others require an advance reservation. Certain activities, like a riverboat tour through the city, will always be popular and can be fully booked by the time breakfast is over. Be sure to note events that happen only once during your stay – like a special show performance – and prioritise booking those first.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: download the resort app, and check it daily, first thing in the morning. It’s a goldmine of information. It usually has schedules, tips, previews and menus, and many resorts offer special events or deals through it too. You can also check the flyer that lists the day’s schedules, posted in common areas, or the informational binder in your room. In general, travel apps can make your trip better in so many ways.</p> <p><strong>Forgetting medications or vaccinations</strong></p> <p>Resorts usually have doctors or medical staff onsite, but they’re there to handle normal vacation maladies or emergencies. You can’t expect them to have a supply of your prescription medication on hand, nor can they manage any chronic illnesses. Also be aware that some resorts have vaccine mandates, and for the vaccine to fully take effect, you need to get it some time before you arrive. For instance, a series of two typhoid vaccines are required for most countries in South Asia, and the vaccinations need to be completed at least one week before your arrival.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: check out the medical section of the resort’s website or app, and make sure to pack anything you need for your health – and pack it in your carry-on. As a precaution, in case you lose your medication, have your doctor email you an electronic copy of your prescription. If you have a chronic health condition, talk with your doctor before leaving about how to manage it on holidays.</p> <p><strong>Booking the first resort package you find </strong></p> <p>All-inclusive resorts are more expensive than regular resorts because they take the headache out of planning every detail of your vacation. However, that means you need to be extra careful in how you select the resort, the package and your membership level (if applicable). If you’re on a budget and you don’t comparison shop, you might end up paying more than you’d like because what you want isn’t included.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: book through a travel agent, they often have access to exclusive deals and know the ins and outs of different resort packages. Also try to book as early as possible. While there are good deals to be had at the last minute, you’re more likely to get what you want for a good price by booking early; many places offer discounts or promotions for early bookings.</p> <p><strong>Forgetting sunscreen</strong></p> <p>You know what will really ruin a romantic holiday or a girls’ weekend getaway? A blistering sunburn. One common issue: women (or men in Speedos) who neglect to put waterproof sunscreen on their bottoms where their suit doesn’t cover when snorkelling. Sunburns gotten over a day of swimming in the ocean – the sun not only beats down from above but is also reflected up from the surface – can be incredibly painful and may make sitting and sleeping miserable.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: bring sunscreen, and check to make sure it’s reef-safe if you’re going to be swimming in an ocean. Also bring insect repellents (and use them regularly). If you forget yours, definitely ask the staff, as the resort will likely have some on hand, or you can make a quick trip to town to pick up what you need.</p> <p><strong>Not using your points or miles</strong></p> <p>Perks at all-inclusive resorts are a common benefit of many credit card, airline, hotel, corporate or other rewards programs. You can get free upgrades, extra nights, bonus excursions, transportation and other fun freebies. But they only work if you remember to use them. If you’re not prompted to enter the info when booking, be sure to ask customer service to make sure they’ve got your membership details on file.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: know what your perks are and how to use them, especially since many must be activated before arrival. If you’re using a credit card to book the trip, the perks should be activated automatically at the time of booking (but check your account to make sure). If you’re using a corporate reward or hotel loyalty program, look up the details before booking. You will likely need to book through their site or provide a membership number during the booking process.</p> <p>If you arrive and notice that you didn’t receive the extras you signed up for, talk to the concierge to see if they are on file with your reservation. If not, you’ll need to contact customer service for the rewards company. Combining points is one of the top tips for how to travel for free.</p> <p><strong>Expecting the staff to babysit your kids</strong></p> <p>All-inclusive family resorts exist so that families with kids of all ages can holiday together … and also have some time apart. Many resorts offer childcare and/or classes for kids, but make sure you know the rules (like age restrictions) and the times they’re offered. Please know that just because something is labelled as a ‘family’ and ‘all-inclusive’ resort, it doesn’t mean that any staff member will watch your kids or that babysitting is available at all hours.</p> <p><span style="text-decoration: underline;"><em>Do this instead</em></span>: read all the details about what services and activities are offered for babies, young children, older kids and teens. Do not leave kids unattended, even in children’s areas, unless it is specified that they are being supervised by staff there. Bring your own baby monitor, as they generally aren’t provided, but do not leave young children alone in hotel rooms.</p> <p><strong>Not taking advantage of room service</strong></p> <p>You might skip room service at a normal hotel because of the price, but room service is one of the areas where all-inclusive resorts really shine. At most resorts, you can order anything off the menu 24/7 and have it delivered to your room for no extra charge. (Some items or services may incur an extra fee, like special meals, off-hours delivery or alcohol.) This is a huge bonus for families with young kids or people who like to have breakfast in bed.</p> <p><span style="text-decoration: underline;"><em>What to do instead</em></span>: check with the resort before arrival, since what’s included in room service varies. One etiquette-based resort tip, though: while tipping isn’t necessary, if you do order room service in the middle of the night, consider tipping the staff a few dollars when they bring it.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.co.nz/travel/ive-worked-at-an-all-inclusive-resort-for-10-years-these-are-19-mistakes-every-traveller-should-avoid?pages=1" target="_blank" rel="noopener">Reader's Digest</a>.</em> </p>

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COVID is officially no longer a global health emergency – here’s what that means (and what we’ve learned along the way)

<p>World Health Organisation (WHO) experts <a href="https://www.nytimes.com/2023/05/05/health/covid-who-emergency-end.html">have officially declared</a> that COVID <a href="https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic">no longer constitutes</a> a public health emergency of international concern (Pheic). This coincides with the WHO’s new <a href="https://www.who.int/publications/i/item/WHO-WHE-SPP-2023.1">strategy</a> to transition from an emergency response to longer-term sustained COVID disease management. </p> <p>This may not change too much practically. COVID will still have pandemic status, and countries will continue to have their own authority as to whether to treat COVID as an emergency within their territories (some countries, <a href="https://www.npr.org/2023/04/11/1169191865/biden-ends-covid-national-emergency">including the US</a>, have already declared an end to the national emergency).</p> <p>For the global public health community, however, this is an event of monumental importance, drawing to a close the emergency response period which commenced on <a href="https://www.who.int/publications/m/item/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum">January 30 2020</a>. </p> <p>At the same time, for a large portion of the general public, it may well pass by relatively unnoticed. For many people, it’s been a long time since they viewed COVID as an emergency. In the UK for example, COVID no longer features in the regular Office for National Statistics <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/publicopinionsandsocialtrendsgreatbritain/19aprilto1may2023">public opinion survey</a> that asks people what they think the key issues facing the country are. Even a year ago, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/publicopinionsandsocialtrendsgreatbritain/30marchto24april2022">only two in five Britons</a> were very or somewhat worried about COVID, according to the survey.</p> <p>Along with other behavioural scientists, I have been following <a href="https://www.swansea.ac.uk/research/research-highlights/health-innovation/public-during-pandemic/">public experiences of the pandemic</a> for the past three years. The results have yet to be peer reviewed but by summer 2022, many participants in <a href="https://psyarxiv.com/d6jcv">our research</a> described the pandemic as being like “a distant memory” or like it “never happened”.</p> <p>As we move into this next phase, it’s time to consider what we’ve learned about human behaviour during the pandemic, and what happens next.</p> <h2>Old habits die hard</h2> <p>In the early days of the pandemic, many behavioural scientists, myself included, wondered whether some of our pandemic habits <a href="https://theconversation.com/two-years-into-the-pandemic-which-of-our-newly-formed-habits-are-here-to-stay-178204">were here to stay</a>. Would <a href="https://www.itv.com/news/wales/2021-04-02/masks-to-stay-soldiering-on-through-the-common-cold-will-stop-and-the-nature-of-work-has-changed-forever-expert-says">face masks</a> become a regular wardrobe staple? Would people stop “soldiering on” and going into work when unwell?</p> <p>It turned out that for most people, the pandemic hasn’t permanently changed our behaviour and habits or created a “<a href="https://psyarxiv.com/d6jcv">new normal</a>”. Looking again at the UK, face mask use has consistently declined, with <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/publicopinionsandsocialtrendsgreatbritaincoronaviruscovid19andotherillnesses">figures from last month</a> suggesting that fewer than one in six adults had worn a face mask recently. Regular use is likely much less common. </p> <p>Social distancing has long since disappeared, except for a relatively small proportion of the public, in particular those most vulnerable to COVID.</p> <p>The COVID pandemic has taught us how adaptive behaviour can be, in particular how much people were willing to change their behaviour to keep themselves and others safe. Most people <a href="https://academic.oup.com/abm/article/56/8/781/6618645?login=false">followed the rules</a> during <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258781">the height of the pandemic</a>, no matter how difficult. COVID has reminded us <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/759BE02FFE73E5C05EA429A3E1547D78/S2056467821000050a.pdf/resilience_in_the_age_of_covid19.pdf">how resilient we humans can be</a>.</p> <p>These pandemic adaptions, and the fact that our pre-pandemic behaviour bounced back so quickly, shows how important social cues and social norms are to behaviour. Putting on a mask or keeping our distance from others were habits – <a href="https://www.sciencedirect.com/science/article/abs/pii/S002210311100254X">actions triggered automatically</a> in response to contextual cues, such as seeing signs with pictures of people socially distancing.</p> <p>Social norms – what we think others are doing – were key to <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277360">vaccine uptake</a> and to our uptake of <a href="https://www.nature.com/articles/s41562-020-0884-z">preventative measures in general</a>. As these contextual cues disappeared and the social norms started to change, and as vaccine coverage increased and the risk to the majority decreased, our behaviour changed.</p> <p>The pandemic has also demonstrated how important social connections and social, especially physical, contact can be. This is something <a href="https://theconversation.com/handshakes-and-hugs-are-good-for-you-its-vital-they-make-a-comeback-after-the-pandemic-158174">we have already argued</a> COVID couldn’t keep at bay forever. According to social safety theory, which sees stress and wellbeing as a product of biological, psychological and social factors, COVID <a href="https://www.sciencedirect.com/science/article/pii/S2352250X2200001X">posed a threat</a> to the “social fabric that makes humans resilient and keeps us alive and well”. </p> <p>It’s unsurprising that life satisfaction and happiness were <a href="https://bmjopen.bmj.com/content/10/7/e039334">lowest during lockdowns</a>, and <a href="https://www.covidsocialstudy.org/_files/ugd/064c8b_c525505ffa6b432f96dc41d6b6a985ea.pdf">recovered as people started to mix socially again</a>.</p> <h2>The emergency isn’t over for everyone</h2> <p>As we mark the end of the emergency phase it’s important to remember the <a href="https://covid19.who.int/">nearly seven million lives lost</a> due to COVID since 2020.</p> <p>And of course, we must consider that for some, especially those who are clinically vulnerable, the emergency is not yet over, and may never be.</p> <p>Although it’s no longer a Pheic, <a href="https://www.who.int/publications/i/item/WHO-WHE-SPP-2023.1">as the WHO reminds us</a>, COVID is still responsible for millions of infections and thousands of deaths each week around the world. Also, thanks to long COVID, hundreds of millions of people are in need of longer-term care.</p> <p>In the future, we need to move from relying on the resilience of individuals to building resilience in our institutions. We can all take measures to continue to protect ourselves and those around us from COVID and other respiratory viruses (such as by <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00021-1/fulltext">hand washing</a> and keeping up to date with vaccinations). But responsibility for preventing public health emergencies shouldn’t rest <a href="https://blogs.bmj.com/bmj/2020/03/17/uks-coronavirus-policy-places-too-much-responsibility-in-the-hands-of-the-public/">solely in the hands of the public</a></p> <p>Actions that governments, employers and health authorities can take now could <a href="https://www.theguardian.com/books/2022/may/11/preventable-by-devi-sridhar-review-a-resolutely-global-view-of-covid">protect against</a> future <a href="https://pubmed.ncbi.nlm.nih.gov/34872923/">public health emergencies</a>. Systematically <a href="https://joint-research-centre.ec.europa.eu/jrc-news/misinformation-covid-19-what-did-we-learn-2023-02-21_en">tackling misinformation</a>, <a href="https://www.who.int/publications/i/item/9789240021280">improving ventilation</a> in <a href="https://www.bmj.com/content/376/bmj.o327">schools</a>, workplaces and other public indoor spaces, and making longer-term improvements to paid sick leave are all good ways to start building more <a href="https://unsdg.un.org/resources/executive-summary-un-common-guidance-helping-build-resilient-societies">resilient societies</a> in preparation for the next pandemic. Hopefully this is something we will never see in our lifetimes.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/covid-is-officially-no-longer-a-global-health-emergency-heres-what-that-means-and-what-weve-learned-along-the-way-205080" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Caring

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What to eat when you have COVID – and why reaching for the chicken soup is not a bad idea

<p>Got COVID? Again?</p> <p>Deciding what to eat can be mentally taxing, especially when you are not feeling well. However, our diet plays a role in preventing and managing poor health, including COVID.</p> <p>Having a healthy diet is associated with a <a href="https://gut.bmj.com/content/70/11/2096">reduced risk of COVID</a>. And, if you do have COVID, a healthy diet is associated with <a href="https://gut.bmj.com/content/70/11/2096">milder symptoms</a>.</p> <h2>What should I eat during COVID infection?</h2> <p>When we are sick it can be challenging to even think about food. However, the best way to fight the infection is by providing your body with foods that best support you to <a href="https://www.emro.who.int/nutrition/covid-19/nutrition-advice-for-adults-during-the-covid-19-outbreak.html">heal</a>.</p> <p>Fresh fruit, vegetables, whole grains and various forms of protein are broken down into substances by the body to support your immune system. </p> <p><a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">The Australian Guide to Healthy Eating</a> suggests we eat a variety of fresh foods every day including:</p> <ul> <li> <p>two serves of fruit and five serves of vegetables</p> </li> <li> <p>whole grains, such as wholemeal pasta, brown rice or wholemeal bread</p> </li> <li> <p>healthy fats, such as avocado or olive oil </p> </li> <li> <p>meat and meat alternatives (such as lean beef, chicken, tofu or legumes) and dairy (such as cheese or milk). </p> </li> </ul> <p>Eating these kinds of foods every day helps provide our body with the nutrients required to fight infections and remain healthy. </p> <p><a href="https://doi.org/10.3390/nu10050587">Avoiding processed and ultra processed foods</a> is also encouraged due to the high levels of salt and sugar and lack of nutrition found in these types of foods.</p> <h2>What about chicken soup or similar?</h2> <p>A great way to get all the nutrition your body requires when sick with COVID is through homemade chicken soup, chicken avgolemono, chicken congee or other similar dishes. </p> <p>Why? Here are four good reasons:</p> <p>1. It’s easy and cheap to make</p> <p>The great thing about chicken soup is you can pop it in one pan (or into a slow cooker), throw all the ingredients in together and let it simmer away. </p> <p>While the ingredients in chicken soup pack a powerful nutritional punch, they don’t cost the Earth.</p> <p>2. It’s easy to absorb</p> <p>The boiling process releases the <a href="https://doi.org/10.3390/foods10071456">nutritional elements</a> found in the ingredients and aids in digestion and absorption of these vital nutrients. </p> <p>3. It’s full of vitamins and minerals</p> <p><a href="https://scuj.journals.ekb.eg/article_119478.html">Essential vitamins and minerals</a> found in chicken soup include: iron, magnesium, sodium, potassium, calcium, chromium, copper, zinc, vitamin A, vitamin C, vitamin B6 and vitamin B12. </p> <p>4. It’s flavoursome and powerful</p> <p>The tasty flavour of chicken soup is enhanced by the <a href="https://doi.org/10.1080/10942912.2017.1291678">seventeen different amino acids</a> found in chicken soup. These amino acids also provide strength for your <a href="https://pubmed.ncbi.nlm.nih.gov/17403271/">immune system.</a></p> <h2>Nutrition can support immune health but it’s not the only answer</h2> <p>The best way to treat and manage a COVID infection is to avoid it in the first place. So remember to practise good hygiene, like washing your hands regularly, and maintain your recommended <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/clinical-recommendations">vaccine schedule</a>. </p> <p>Practising a healthy lifestyle will also reduce your risks of not only contracting COVID, but also developing chronic disease. This includes not smoking or vaping, maintaining healthy physical activity habits, getting enough sleep and reducing alcohol consumption. </p> <p>The current <a href="https://www.health.gov.au/news/australian-alcohol-guidelines-revised#:%7E:text=To%20reduce%20the%20risk%20of,risk%20of%20harm%20from%20alcohol.">recommendation</a> for maximum alcohol intake is ten standard drinks in one week, and no more than four standard drinks in one day. </p> <h2>Don’t forget to drink plenty of water</h2> <p>Water is <a href="https://health-study.joinzoe.com/post/how-much-fluid-should-i-drink-if-i-have-covid-19">crucial</a> when you’re sick. </p> <p>Being dehydrated can enhance symptoms of colds and infections, including COVID. It is also associated with a higher risk of developing <a href="https://ccforum.biomedcentral.com/articles/10.1186/s13054-022-04203-w">long COVID</a>. </p> <p>Aim to drink at least two litres of water per day, even more if you have a high body weight or have been losing fluids through vomiting or sneezing/runny nose.</p> <p>If you don’t feel like having plain water, there are many healthy alternatives such as tea, broth or soup.</p> <h2>Let’s remember to eat healthy anyway</h2> <p>Eating a healthy and balanced diet is an important part of maintain good health and vitality.</p> <p>Getting caught up in fads or buying supplements can be expensive and there is <a href="https://theconversation.com/dont-listen-to-gwyneth-paltrow-ivs-are-not-a-shortcut-to-good-health-202621">controversy</a> around their effectiveness. </p> <p>In the long run, eating healthy will make you feel better and save you money.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/what-to-eat-when-you-have-covid-and-why-reaching-for-the-chicken-soup-is-not-a-bad-idea-202338" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Body