After a particularly vigorous workout or sports injury, many of us rely on ice packs to reduce soreness and swelling in our twanging muscles. But a cautionary new animal study finds that icing alters the molecular environment inside injured muscles in detrimental ways, slowing healing. The study involved mice, not people, but adds to mounting evidence that icing muscles after strenuous exercise is not just ineffective; it could be counterproductive.Check inside the freezers or coolers at most gyms, locker rooms or athletes’ kitchens and you will find ice packs. Nearly as common as water bottles, they are routinely strapped onto aching limbs after grueling exercise or possible injuries. The rationale for the chilling is obvious. Ice numbs the affected area, dulling pain, and keeps swelling and inflammation at bay, which many athletes believe helps their aching muscles heal more rapidly.But, in recent years, exercise scientists have started throwing cold water on the supposed benefits of icing. In a 2011 study, for example, people who iced a torn calf muscle felt just as much leg pain later as those who left their sore leg alone, and they were unable to return to work or other activities any sooner. Similarly, a 2012 scientific review concluded that athletes who iced sore muscles after strenuous exercise — or, for the masochistically minded, immersed themselves in ice baths — regained muscular strength and power more slowly than their unchilled teammates. And a sobering 2015 study of weight training found that men who regularly applied ice packs after workouts developed less muscular strength, size and endurance than those who recovered without ice.But little has been known about how icing really affects sore, damaged muscles at a microscopic level. What happens deep within those tissues when we ice them, and how do any molecular changes there affect and possibly impede the muscles’ recovery?So, for the new study, which was published in March in the Journal of Applied Physiology, researchers at Kobe University in Japan and other institutions, who long had been interested in muscle physiology, gathered 40 young, healthy, male mice. Then, using electrical stimulation of the animals’ lower legs to contract their calf muscles repeatedly, they simulated, in effect, a prolonged, exhausting and ultimately muscle-ripping leg day at the gym.Melody Melamed for The New York TimesRodents’ muscles, like ours, are made up of fibers that stretch and contract with any movement. Overload those fibers during unfamiliar or exceptionally strenuous activities and you damage them. After healing, the affected muscles and their fibers should grow stronger and better able to withstand those same forces the next time you work out.But it was the healing process itself that interested the researchers now, and whether icing would change it. So, they gathered muscle samples from some animals immediately after their simulated exertions and then strapped tiny ice packs onto the legs of about half of the mice, while leaving the rest unchilled. The scientists continued to collect muscle samples from members of both groups of mice every few hours and then days after their pseudo-workout, for the next two weeks.Then they microscopically scrutinized all of the tissues, with a particular focus on what might be going on with inflammatory cells. As most of us know, inflammation is the body’s first response to any infection or injury, with pro-inflammatory immune cells rushing to the afflicted area, where they fight off invading germs or mop up damaged bits of tissue and cellular debris. Anti-inflammatory cells then move in, quieting the inflammatory ruction, and encouraging healthy new tissue to form. But inflammation is often accompanied by pain and swelling, which many people understandably dislike and use ice to dampen.Looking at the mouse leg muscles, the researchers saw clear evidence of damage to many of the muscles’ fibers. They also noted, in the tissue that had not been iced, a rapid muster of pro-inflammatory cells. Within hours, these cells began busily removing cellular debris, until, by the third day after the contractions, most of the damaged fibers had been cleared away. At that point, anti-inflammatory cells showed up, together with specialized muscle cells that rebuild tissue, and by the end of two weeks, these muscles appeared fully healed.Melody Melamed for The New York TimesMelody Melamed for The New York TimesNot so in the iced muscle, where recovery seemed markedly delayed. It took seven days in these tissues to reach the same levels of pro-inflammatory cells as on day three in the unchilled muscle, with both the clearance of debris and arrival of anti-inflammatory cells similarly slowed. Even after two weeks, these muscles showed lingering molecular signs of tissue damage and incomplete healing.The upshot of this data is that “in our experimental situation, icing retards healthy inflammatory responses,” says Takamitsu Arakawa, a professor of medicine at Kobe University Graduate School of Health Sciences, who oversaw the new study.But, as Dr. Arakawa points out, their experimental model simulates serious muscle damage, such as a strain or tear, and not simple soreness or fatigue. The study also, obviously, involved mice, which are not people, even if our muscles share a similar makeup. In future studies, Dr. Arakawa and his colleagues plan to study gentler muscle damage in animals and people.But for now, his study’s findings suggest, he says, that damaged, aching muscles know how to heal themselves and our best response is to chill out and leave the ice packs in the cooler.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesAustralia has been one of the world’s success stories in its fight against Covid-19, but frustration is growing over its delayed vaccination rollout. The country has been slower than most others to immunise its population, with some high-risk groups crying out for protection.Last month, it fell 85% short of its own target – and the lack of clarity around the process has been criticised.Supply shortages and delivery problems have been blamed for the delays.And while steps have been taken to speed up the programme – such as mass immunisation hubs and investment in local production – the government is seeing its success so far in battling Covid tarnished by its sluggish vaccination effort. How many Australians have been vaccinated? The rollout began in February and so far 1.6 million vaccine doses have been administered nationwide in a population of 25 million. That’s well short of the four million dose goal originally set for March. After initially saying all Australians would be fully vaccinated by October, the government kept pushing its timeline. Now, it’s scrapped its target altogether. Prime Minister Scott Morrison said given the “many uncertainties involved” it was no longer possible to set an end-of-year vaccination goal.Covid map: Where are cases the highest?Australian PM is vaccinated as rollout begins’I grew up in a war – I’m not dying in a pandemic’Right now, Australia is in the initial phases of a staged rollout. Doses are currently being offered to people over 70, those in aged care homes, frontline health workers, emergency services workers, Aboriginal and Torres Strait Islander people over 55, and people with underlying health conditions.Still, many in those high-risk groups in the aged care and disability sector say they haven’t received doses. image copyrightGetty ImagesLast week, disability services provider Aruma, which runs about 350 group homes for people with severe disabilities, told the ABC that none of its residents or staff members had been vaccinated.A survey of 254 aged care workers by the United Workers Union found that 85% hadn’t even received their first dose.”Too much confusion… limited information from government,” one aged care worker from South Australia said. “I do not know of one single person or resident that has had a Covid shot.” How does Australia compare globally? A strict policy of lockdowns, border closures and quarantine controls has seen Australia keep infection levels low. The country has recorded 910 deaths and 29,559 cases since the pandemic began – far fewer than many other nations. On the vaccination front, however, it remains a laggard. According to the latest Our World data, Australia has delivered 6.2 doses per 100 people.That rate compares to 67.5 doses per 100 people in the UK, 63.3 in the US, and 26.7 in Germany. Australia is one of the worst performers in the Organisation for Economic Co-operation and Development (OECD), with only Japan, New Zealand and South Korea holding lower vaccination rates per 100 people.Why have there been delays?A big part of the problem has been access to supplies. Australia’s programme is most reliant on the AstraZeneca shot, though Pfizer and Novavax will also be a part of its larger rollout. The country’s initial efforts in securing vaccines appeared promising. It was among the first to announce an order with AstraZeneca, and also trumpeted its local manufacturing capacity with medical firm CSL.Early in the rollout, though, confusion over just how much stock Australia had began to circle. A tussle with the European Union led to part of the AstraZeneca order being held back. And a lack of clear, public information has made it difficult to assess supply levels. At the same time, domestic production hasn’t lived up to expectations. Manufacturing began in March, with the government saying it would soon pump out about one million doses a week. It has so far failed to hit those targets. Then, issues around a rare blood clotting disorder associated with the AstraZeneca jab, made the situation worse. A woman in her 40s, who had underlying health conditions, developed blood clots and later died after receiving the vaccine. The government now recommends people under 50 get a Pfizer vaccine. It has said Australia will receive 40 million doses of the Pfizer jab this year, but it’s unclear how many doses are available right now. image copyrightGetty ImagesNovavax, the last vaccine in the rollout mix, is yet to receive regulatory approval. Are there any other issues?Concerns about the AstraZeneca vaccine – the biggest part of its rollout plan – slowed things down and also contributed to some vaccine hesitancy. Supplies have also been an issue. Doctors administering vaccines at clinics have spoken out about shortages, while the nation’s general practitioners’ (GP) union had also raised concerns.AstraZeneca: Is there a blood clot risk?At the same time, state and federal government have argued over who is to blame for the delays. Two state governments – New South Wales and Queensland – have accused the federal government of failing to provide certainty over how many vaccines would be delivered. This, in turn, has slowed down scheduling appointments. There are reports of patients across Australia having difficulties booking slots. What is being done to speed up the rollout? The government says things are picking up. The health minister has boasted of a six-fold increase in total vaccinations in roughly a month since the GP rollout began. Mass vaccination centres have been opened to speed up delivery. More local production is also possible. The state of Victoria will inject A$50m toward a production facility to make mRNA vaccines – like the Pfizer jab – locally. Still, any facility would require much more funding and it would take at least a year before any doses could realistically be manufactured.What are the wider implications of the delays? Beyond the health concerns, the delay risks economic and social damage. While Australia has fought the battle against Covid in part due to hard border policies, vaccines have been held up as key to unlocking the gates once more. Sectors like tourism and aviation are relying on high levels of immunisation to revive business. Failure to get there risks jeopardising the newly opened Australia-New Zealand travel bubble, along with other potential travel hubs with countries such as Singapore. Australians stranded abroad, already struggling to make it home, may find it even more difficult to do so.

Federal regulators on Wednesday issued highly critical findings from their inspection of a Baltimore plant that was forced to throw out up to 15 million doses of Johnson & Johnson’s coronavirus vaccine and ordered to temporarily stop all production.The Food and Drug Administration cited a series of shortcomings at the massive plant, which is operated by Emergent BioSolutions. The inspection was triggered by reports that Emergent workers had contaminated a batch of Johnson & Johnson doses with the virus used to make AstraZeneca’s vaccine, which is also manufactured there.The violations included failure to properly disinfect the factory and its equipment, as well as failure to follow procedures designed to prevent contamination of doses and to ensure proper strength and purity of the vaccine manufactured there. In a 12-page report, the inspectors cited a total of nine violations, ranging from the design of the building to improperly trained employees. The inspection was finished on Tuesday.In a statement, the F.D.A. noted that it has not authorized Emergent to distribute any doses of Johnson & Johnson vaccine, and that no vaccine manufactured at the plant has been released for use in the United States.AstraZeneca’s vaccine is not yet authorized for use in the United States, and all the Johnson & Johnson doses that have been administered in the country so far were manufactured overseas. At the agency’s request, all production at the factory has been halted.“We will not allow the release of any product until we feel confident that it meets our expectations for quality,” the statement from Dr. Janet Woodcock, the F.D.A.’s acting commissioner, and Dr. Peter Marks, the agency’s top vaccine regulator, said.The agency said it was working with Emergent to fix the problems.

A coroner has called for a change in the law after air pollution led to the death of a nine-year-old girl.Ella Adoo-Kissi-Debrah, who lived near the South Circular Road in Lewisham, south-east London, died in 2013.Responding to the report, Ella’s mother Rosamund Adoo- Kissi-Debrah told the BBC:”All children have a right to breathe clean air, no matter where they live, or where they come from”.

Shift-work and irregular work schedules can cause several health-related issues and affect our defence against infection, according to new research from the University of Waterloo.
These health-related issues occur because the body’s natural clock, called the circadian clock, can be disrupted by inconsistent changes in the sleep-wake schedule and feeding patterns often caused by shift work. To study this, researchers at Waterloo developed a mathematical model to look at how a disruption in the circadian clock affects the immune system in fighting off illness.
“Because our immune system is affected by the circadian clock, our ability to mount an immune response changes during the day,” said Anita Layton, professor of Applied Mathematics, Computer Science, Pharmacy and Biology at Waterloo. “How likely are you to fight off an infection that occurs in the morning than midday? The answer depends on whether you are a man or a woman, and whether you are among quarter of the modern-day labour force that has an irregular work schedule.”
The researchers created new computational models, separately for men and women, which simulate the interplay between the circadian clock and the immune system. The model is composed of the core clock genes, their related proteins, and the regulatory mechanism of pro- and anti-inflammatory mediators. By adjusting the clock, the models can simulate male and female shift-workers.
The results of these computer simulations conclude that the immune response varies with the time of infection. Model simulation suggests that the time before we go to bed is the “worst” time to get an infection. That is the period of the day when our body is least prepared to produce the pro- and anti-inflammatory mediators needed during an infection. Just as importantly, an individual’s sex impacts the severity of the infection.
“Shift work likely affects men and women differently,” said Stéphanie Abo, a PhD candidate in Waterloo’s Department of Applied Mathematics. “Compared to females, the immune system in males is more prone to overactivation, which can increase their chances of sepsis following an ill-timed infection.”
The study, Modeling the circadian regulation of the immune system: sexually dimorphic effects of shift work, authored by Waterloo’s Faculty of Mathematics’ Layton and Abo, was recently published in the journal PLoS Computational Biology.
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Severe cases of COVID-19 can involve extensive inflammation in the body, and clinicians have wondered if this state is similar to what are called cytokine storm syndromes, in which the immune system produces too many inflammatory signals that can sometimes lead to organ failure and death. A new study published in Arthritis & Rheumatology indicates that different markers in the blood clearly differentiate excessive inflammation in critical COVID-19 from cytokine storm syndromes.
The research, which was led by investigators at University Children’s Hospital Muenster in Germany, will be useful when deciding which medications to use in different patients. For example, targeting some key molecules and pathways associated with cytokine storm syndromes may not be effective for treating patients with COVID-19.
“When we first became aware of a possible association of particularly critical COVID-19 with cytokine storm, this was intriguing for us, as in the field of autoinflammation we are treating and investigating such conditions on a regular basis,” said lead author Christoph Kessel, PhD.
“Our present research delivers broad insights on the nature and significance of systemic hyperinflammation following SARS-COV-2 infection,” added co-lead author Richard Vollenberg, MD. “We consider this relevant as we still lack proper angles of attack to treat critically ill patients.”
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While use of the gaming technology for improving physical ailments is still in the early stages, it shows promise — and it’s fun.This article is part of our new series on the Future of Health Care, which examines changes in the medical field.Four years ago, Michael Heinrich was riding his motorcycle on the University of Michigan campus when a rotted tree fell on him and snapped his neck, causing him to permanently lose use of the lower half of his body. He spent weeks in intensive care and then went to inpatient rehabilitation for more than two months,About halfway through his rehab stint, his occupational therapist asked whether he was interested in trying virtual reality for his therapy. Mr. Heinrich, now 26 — who is returning for his master’s at the university — was game.“What I really enjoyed was being an eagle trying to go through rings,” he said, describing a virtual reality experience. “From an emotional standpoint, coming off an injury where I lost the majority of the use of my body, V.R. pushed the boundaries of what I thought was possible.”Virtual reality, long used for gaming, has, over the past several years, moved into the health field for such things as pain management and relieving post-traumatic stress disorder.And now researchers and therapists say it has shown great promise for physical and occupational therapy.“I’ve been through P.T. for various injuries, and you know, sometimes I get home and I’m sort of like, well, I forget exactly what I was supposed to do,” said Brennan M. Spiegel, a professor of medicine and public health and director of health services research at Cedars-Sinai Medical Center in Los Angeles. “How am I supposed to set up my body for this? And also, do I have the motivation to do it right now? And V.R. can help both of those, both by reproducing precisely what that physical movement is supposed to be and hopefully providing some additional motivation to do the exercise.”Using virtual reality for rehabilitation was growing before the coronavirus pandemic for a variety of reasons, including rapid advances in hardware and software technology and a younger generation of practitioners more comfortable using such technology. But the greater acceptance of telehealth during the pandemic has further spurred its use.Brennan M. Spiegel, a professor of medicine and public health and director of health services research at Cedars-Sinai medical center in Los Angeles, with a patient using virtual reality.Cedars-SinaiFor one thing, it’s simply a lot more fun than traditional rehabilitation exercises. And “V.R. has this uncanny ability to kind of nudge the human brain in ways that other audiovisual media cannot,” said Dr. Spiegel, who is one of the foremost experts on the use of virtual reality in health. “The bottom line is it motivates us to do things that we might not be able to do.”That’s what Pamela Pleasants, 59, found when she started doing virtual reality therapy for an injured shoulder. An associate dean at an independent school outside Boston, she learned that she was eligible to get virtual physical therapy, which she did through a company, XRHealth.She did an intake over a video call with a physical therapist provided by the company, and then the V.R. headset arrived in the mail. Based on the intake, the therapist decided what applications — out of eight currently offered by the company — that Ms. Pleasants would use, as well as for how long and how frequently, and then trained her how to use them.The therapist could also adjust all the settings within a program. For example, when Ms. Pleasants found the range of motion in one application caused her too much pain, the therapist adjusted it lower. The patient can change programs either using a controller or by eye gaze.She loved the different programs, especially Balloon Blast, Ms. Pleasants said, which consisted of popping balloons with a virtual sword in each hand. “In the background was how high my range of motion should be.”Ms. Pleasants also found the programs geared to reduce stress, such as a guided meditation while walking through a forest, very useful for her shoulder and mental health. She continued meeting her physical therapist on video calls semiweekly.“After four months, my shoulder felt tremendously better,” she said.XRHealth is one of the few companies focused on providing V.R. physical and occupational therapy at home; based in Boston, it is covered by many insurance programs in Massachusetts and nationally by Medicare. The company is working to get more insurance companies to cover its services. Without insurance, people can pay $179 monthly for the headsets and two physical or occupational therapy appointments monthly from a panel of therapists the company provides.The company has all of its programs registered with the F.D.A., said Eran Orr, founder and chief executive.Not all the programs offered for V.R. rehab are games; some clinics allow a patient to virtually practice real-life skills they may have trouble doing, such as grocery shopping or dishwashing.To really push the use of virtual reality for physical and occupational therapy, “we’ll need to build a body of evidence that shows it’s effective, how we pay for it and how we can develop it in a way that’s easy to use,” said Matthew Stoudt, chief executive and a founder of Applied VR, which supplies therapeutic virtual reality. “We have to be able to demonstrate that we can bring down the cost of care, not just add to the cost paradigm.”While research specifically on V.R. use in physical and occupational therapy is in the early stages, an analysis of 27 studies, conducted by Matt C. Howard, an assistant professor of marketing and quantitative methods at the University of South Alabama, found that V.R. therapy is, in general, more effective than traditional programs.“Does it mean V.R. is better for everything? Of course not,” he said in an interview. “And there’s a lot we still don’t know about V.R. rehab.”Much of the research uses small samples with varying degrees of rigor, and more needs to be studied about how a patient’s activity in the virtual world translates into improved performance in the physical world, said Danielle Levac, an assistant professor in the department of physical therapy, movement and rehabilitation sciences at Northeastern University. Professor Levac researches the rational for using virtual reality systems in pediatric rehabilitation; many of the children she works with have cerebral palsy.“We have to consider the downside of a lack of one-on-one contact with therapists,” she said. “I view V.R. as a tool that has a lot of potential, but we should keep in mind it should fit in — and not replace — an overall program of care.”Robert Ferguson, a neurorehabilitation and therapeutic technology clinical specialist at Michigan Medicine, which is part of the University of Michigan, has treated numerous patients over the past four years doing in-hospital V.R. occupational therapy.In fact, his first patient to use virtual reality was Mr. Heinrich, who made him realize the potential of V.R. to get patients to move in a way they — and their therapists — didn’t think they could. But, he said, clinicians must be well- trained on how to use the technology in the most helpful and effective way.For example, he said, cardiac patients need to be closely monitored because people tend to work harder and longer on V.R. than in traditional therapy with a decreased awareness of pain, which could be dangerous for such patients.One of the great benefits of V.R. therapy is that it can provide a stream of specific data to the clinician and patient on how often and how well the patient accomplished each exercise and where adjustments are needed.A new V.R. headset from Oculus, which allows more degrees of freedom to interact with a virtual environment.Rozette Rago for The New York TimesAnd technology keeps pushing that boundary; a new headset by Oculus allows more degrees of freedom to interact with a virtual environment, and one just released by HP can track heart rate, pupil dilation and sweat.Such tracking matters, because a doctor or technician can adjust the amount of exertion delivered to a patient.While older people — who are more likely to suffer from strokes, Parkinson’s or simply falls, that will require physical or occupational therapy — may seem less able or more hesitant to use such technology, Mr. Ferguson and others say that typically isn’t the case.“We’ve treated people from 18 years old up to 90,” he added. And in fact, V.R. therapy has been shown it can be particularly helpful for those with Parkinson’s and other central nervous system disorders.And he has repeatedly found that people have unknowingly done things while using virtual reality that they didn’t think they could. He remembers a patient in his 50s whose leg had been amputated. He couldn’t balance when trying to do seemingly simple movements, such as pulling up his pants.The man was a hunter, and Mr. Ferguson suggested he try a virtual reality program involving bow hunting. As part of the program, the patient was standing on one leg “and changing his center of gravity all over,” something he had not been able to do in regular therapy.“When we showed him the video, he said, ‘I can’t do that,’ Mr. Ferguson recalled. “We said, ‘you just did.’”

Covid fuels the current virus pandemic, but the world is full of flu viruses waiting in the wings. And they keep changing unpredictably.When a bird flu virus struck a major poultry farm in Russia earlier this year, it was a reminder that the coronavirus causing the pandemic was not the only dangerous virus out there.The authorities quickly tested the birds and moved into high gear, killing 800,000 chickens, disposing of the carcasses and cleaning the farm to stop the potential spread to other chicken farms. But they were also concerned for humans.They tested the birds and sequenced the virus, determining that it was the H5N8 strain of avian flu, highly dangerous to both wild and domestic birds. It is established in Asia and has been increasingly causing deadly outbreaks in birds in Europe. H5N8 viruses have infected some poultry flocks in the United States, but the viruses come from a different though related lineage of virus, distinct from the current H5N8 viruses in Asia and Europe. Flu viruses combine and mutate frequently in unpredictable ways.In the short period from Dec. 25, 2020, to Jan. 14 of this year, more than seven million birds were lost to H5N8 outbreaks in Europe and Asia. Europe alone had 135 outbreaks among poultry and 35 among wild birds. Of course, to put the numbers in context, humans consume about 65 billion chickens each year, and one estimate puts the number of chickens on the globe at any one time at 23 billion.As damaging as H5N8 has been to birds, it had never infected people. Until February. The Russian health authorities also tested about 200 of the people involved in the cleanup of the farm in Astrakhan, using nasal swabs and later blood tests for antibodies. They reported that for the first time, H5N8 had jumped to people. Seven of the workers appeared to have been infected with the virus, although none of them became ill. Only one of those seven cases, however, was confirmed by genetically sequencing the virus.Nonetheless, the potential danger of the new virus and its jump to humans set off alarm bells for Dr. Daniel R. Lucey, a physician and a specialist in pandemics at Georgetown University.A duck breeding farm in Letavertes, Hungary, were birds were being culled after the H5N8 virus was detected there in January 2020.Zsolt Czegledi/MTI, via Associated PressHe began writing about the Astrakahn event in a blog for other infectious disease experts as soon as it was publicized. He reported that during a television interview, a Russian public health official said the H5N8 virus was likely to evolve into human-to-human transmission. That possibility was frightening.“The W.H.O. finally put out a report Feb. 26,” he said. But it did not frame the event as particularly alarming because the virus was not causing human disease, and the report judged the risk of human-to-human transmission as low, despite the Russian official’s comment.To Dr. Lucey, no one else seemed to be taking the infection of humans with H5N8 as “of any concern.” He added, “I think it’s of concern.”Other scientists said they were not as worried.Dr. Florian Krammer, a flu researcher at the Icahn School of Medicine at Mt. Sinai, said he was more concerned about other avian flu viruses like H5N1 that have already shown themselves to be dangerous to people. Another avian influenza virus, H7N9, infected people for the first time in 2013. There have been more than 1,500 confirmed cases and more than 600 deaths since then. Since 2017 there have been only three confirmed cases and the virus does not jump easily from person to person.It is always possible that any virus can evolve human-to-human transmission, as well as become more dangerous. But H5N8 would have both hurdles to jump. Compared to other viral threats, Dr. Krammer said, “I’m not worried.”Dr. Richard J. Webby, a flu specialist at the St. Jude Graduate School of Biomedical Sciences and director of the W.H.O.’s Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds, said that all of the H5 viruses are of concern because some of them have infected and killed people. But, he said, “They all have the same sort of binding capacity to human cells, which is limited,” he said. Flu viruses use a slightly different way to attach to cells in birds than to cells in humans and being good at one usually means not being good at the other.Dr. Webby also said that while seven infections would certainly be of concern, only one infection has been confirmed. The tests of the other six involved nasal swabs and blood antibody tests. In people with no symptoms, he said, nasal swabs can simply indicate that they had breathed in virus. That would not mean it had infected them.Blood antibody tests also have a potential for error, he said, and may not be able to distinguish exposure to one flu virus from another.Nor did he see any scientific basis for suggesting that H5N8 is more likely than any other bird flu to evolve human-to-human transmission. But any virus could evolve that ability.Dr. Lucey said that he was heartened to see that the U.S. Centers for Disease Control and Prevention had prepared a candidate vaccine for H5N8 before it had infected humans. Candidate vaccines are simply first steps in planning for potential problems, and have not been through any testing. They exist for many viruses.“Humans should be routinely tested those for the virus, right at the time of the outbreak in birds,” Dr. Lucey said. He favors the protocol followed in Astrakahn, and argues that for any outbreak among birds, public health authorities should test people who are exposed to sick birds with nasopharyngeal swabs and an antibody test, followed by other antibody tests a few weeks later.An upcoming editorial in the journal Travel Medicine and Infectious Disease also takes up the Astrakahn incident and calls for increased monitoring of all H5 viruses.

The past year has changed alcohol use patterns, especially among women. The impacts probably won’t be fully known for years.Even before the pandemic began, some Americans were drinking significantly more alcohol than they had in decades past — with damaging consequences. In 2020, researchers at the National Institute on Alcohol Abuse and Alcoholism (N.I.A.A.A.) found that from 1999 through 2017, per capita consumption increased by 8 percent and the number of alcohol-related deaths doubled, many caused by liver disease. The trends are particularly concerning for women: Whereas the number of men who reported any drinking stayed mostly the same, the proportion of women who did so increased 10 percent, and the number of women who reported binge drinking, or consuming roughly four or more drinks in about two hours, increased by 23 percent. (For men, binge drinking is about five or more drinks in that period.) Current dietary guidelines consider moderate drinking to be at most one drink a day for women and two for men.So researchers were understandably apprehensive when, early in the pandemic, alcohol sales spiked. They were especially concerned about women, because similar quantities of alcohol affect them more adversely than men, making them more likely to suffer injuries from accidents and to develop chronic illnesses like liver and heart disease and cancer. But it was unclear whether increased sales would translate into increased consumption. Perhaps Americans were hoarding alcohol as they were toilet paper.A growing body of research, however, has begun to confirm that Americans, and women in particular, are indeed drinking more in response to the pandemic. In December, researchers from Johns Hopkins Bloomberg School of Public Health and the University of Maryland, Baltimore County, published the results of a survey they conducted last May in The International Journal of Environmental Research and Public Health. They found that of the more than 800 respondents — those who replied to the online questionnaire were mostly white women — 60 percent were drinking more compared with before Covid-19 (13 percent were drinking less). More than 45 percent of participants said their reasons for drinking included increased stress. And those who reported feeling “very much” or “extreme” stress from the pandemic reported drinking more on more days than those who were less affected. Another survey conducted this February by the American Psychological Association found that nearly one in four adults reported drinking more to manage pandemic stress. Though stress has long been a common reason people turn to alcohol, the extent to which it appeared to cause increased consumption during the past year was startling, says George Koob, director of the N.I.A.A.A. “It shouldn’t have been a surprise, but it did surprise us, this drinking to cope.”That trend is especially alarming because previous research suggests that people who drink to cope — as opposed to doing so for pleasure — have a higher risk of developing an alcohol-use disorder, which is the inability to stop or control drinking even when it causes harm. Alcohol can be calming in the short term: It slows activity in the amygdala, the area of the brain that readies the body’s “fight or flight” response to real or imagined stress by increasing heart rate and blood pressure and amplifying our awareness of threatening stimuli. But over time, alcohol’s dampening effect on the amygdala decreases, while the region itself becomes “hyperactive in between bouts of drinking,” according to Aaron White, a senior scientific adviser at the N.I.A.A.A. Achieving the same level of relief requires drinking more, and more often.Illustration by Ori ToorThere are already indications that groups feeling the most pandemic-related stress are seeing greater increases in alcohol consumption. A survey of 12,000 physicians, for instance, found that more than 40 percent were experiencing burnout, very likely amplified by the pandemic, and of those, more than a quarter were drinking to deal with it. And though pre-pandemic research showed that parents were less likely than people without children to engage in risky levels of alcohol consumption, parents appear to be among those drinking more now — especially if their children are engaged in remote schooling.The most worrisome drinking behavior, as before the pandemic, appears to be among women, who have also borne more of the child-care burden created by school closures. A study published in October in The Journal of Addiction Medicine found that between February and April 2020, women had a greater increase in excessive drinking than men did. Respondents who are Black reported greater increases, too. A November study in the journal Addictive Behaviors, based on an April survey that asked about people’s drinking during the previous month, found that women drank more than men in response to pandemic stress, to the point that their intake levels were roughly equal. “I left that study with more questions than answers,” says Lindsey Rodriguez, the paper’s lead author and a psychologist at the University of South Florida. “Is it because of home-schooling? Uncertainty about the future? High pressure in more domains of life? Women were disproportionately affected by all things Covid-19. This is another way of showing the effects of that.”Previous disasters, including the 9/11 terrorist attacks, the 2003 SARS outbreak and Hurricane Katrina, have been followed by increases in alcohol abuse among those who experienced them and their aftermath. But researchers have never studied the impact on drinking behavior of a catastrophe that lasted as long and was as pervasive as the current pandemic. Nor did those earlier events increase social isolation while also initiating widespread changes in the availability of alcohol through takeout and delivery, as Covid-19 has. There has been more drinking at home, which is associated with domestic violence and child neglect, Carolina Barbosa, a behavioral health scientist at RTI International, a nonprofit research organization, points out. “So it’s not just the health of the person who is drinking that we are concerned with,” says Barbosa, the lead author of the Addiction Medicine study, “but it’s also the social impact on the family and society in general.”Those potential repercussions — on everything from individual health to poverty, crime and violence, which have previously been associated with the density of alcohol sellers in a given area — will take time to unfold and assess. Right now, most of the data available on people’s changes in drinking behavior are limited to small surveys. “This all suggests people are starting to put in place patterns of heavier drinking,” says Elyse Grossman, a policy fellow at Johns Hopkins and lead author of the International Journal article. She expects to start seeing the effects one to three years from now, which is when alcohol abuse increased following other catastrophes. (Already cases of alcoholic liver disease are up an estimated 30 percent over the past year in the University of Michigan’s health system, and many of those additional patients were young women.)Yet despite the worrying circumstances, at least 20 states are considering making permanent the relaxed alcohol rules they put in place during the pandemic. And alcohol manufacturers have exploited Covid-19 as a marketing tool to an extent that is “frustrating and surprising,” Grossman says. “They have used the pandemic to increase sales and oppose regulation. ‘You need time to yourself; you should be drinking. You need alcohol to relax; you need it to get through this pandemic.’” She adds: “It’s not an ordinary product, like coffee or pencils. It’s the third-leading cause of preventable death in the U.S.”On a population level, this past year’s drinking has already set in motion a cascade of consequences that would be difficult to reverse absent major policy changes. But individuals can take steps to avoid negative outcomes themselves. Koob says that the emergence of telehealth during the pandemic may be a “silver lining” that will allow physicians and support groups to reach more struggling people. Treatments exist on “a spectrum,” he notes. “Not everyone has to go into a 28-day detox.” Doctors and health officials should begin responding now, with initiatives like screening for people’s drinking patterns and “better messaging” on what is excessive drinking, Barbosa says. “There are more people who are going to need help.”Kim Tingley is a contributing writer for the magazine.

SharecloseShare pageCopy linkAbout sharingimage copyrightSumit KumarRajeshwari Devi, 58, died on Sunday after waiting for two days to get uninterrupted oxygen, an ambulance and a bed in a Covid-19 hospital.She kept waiting and gasping but it was too late by the time help arrived. She was taken to a hospital emergency room on 16 April after her oxygen saturation level dropped. Her CT scan showed that she had developed chronic pneumonia.But without her Covid report the hospital refused to admit her. She spent around 36 hours in the emergency room on oxygen support in the northern Indian district of Robertsganj. The staff there told her family they were running out of oxygen and she needed to be moved to a bigger hospital but there was no ambulance or any promise of a bed. The desperate family took her in their car to a hospital where a bed had become available after the intervention of a politician. She had no oxygen support in the car – she died minutes before she could be admitted to hospital. Ashish Agrahari, her son, says his mother “would have had a chance at survival if treatment was given in time”.Heartbreaking stories such as this are coming in from across India as a second Covid wave wreaks havoc. Data suggests that this wave is proving to be more infectious and deadlier in some states, although India’s death rate from the virus is still relatively low. But the county’s healthcare system is crumbling amid the surge in cases – doctors say it’s hard for them to “see the light at the end of the tunnel this time”. Sharp rise in casesThe rise in case numbers has been exponential in the second wave. On 18 June last year, India recorded 11,000 cases and in the next 60 days, it added 35,000 new cases on average every day. On 10 February, at the start of the second wave, India confirmed 11,000 cases – and in the next 50 days, the daily average was around 22,000 cases. But in the following 10 days, cases rose sharply with the daily average reaching 89,800.Experts say this rapid increase shows that the second wave is spreading much faster across the country. Dr A Fathahudeen, who is part of Kerala state’s Covid taskforce, said the rise was not entirely unexpected given that India let its guard down when daily infections in January fell to fewer than 20,000 from a peak of over 90,000 in September.Big religious gatherings, the reopening of most public places and crowded election rallies are being blamed for the uptick. Dr Fathahudeen said there were warning signs in February but “we did not get our act together”.”I said in February that Covid had not gone anywhere and a tsunami would hit us if urgent actions were not taken. Sadly, a tsunami has indeed hit us now,” he added.”A false sense of normalcy crept in and everybody, including people and officials, did not take measures to stop the second wave.”Shortage of bedsMany Indian cities are reporting a chronic shortage of hospital beds. It’s also evident in the desperate cries for help on social media platforms. Disturbing reports of people dying without getting timely treatment are coming from all over the country.Several state governments say they are creating new facilities but experts say it’s going to be hard to keep up with the pace of the rising number of infections.India has been consistently reporting more than 150,000 cases for days now. It reported 273,810 cases on Monday – the biggest daily spike since the pandemic began.Badly-affected cities like Delhi, Mumbai and Ahmedabad have almost run out of hospital beds. The situation is not very different in other cities, such as Lucknow, Bhopal, Kolkata, Allahabad and Surat. Public health expert Anant Bhan says officials did not use the lean period to boost facilities.”We didn’t learn any lesson from the first wave. We had reports of some cities running out of beds even in the first wave and that should have been a good enough reason to be prepared for the second wave,” he said.He adds that there appears to be a lack of co-ordination between states and the federal government over the supply of oxygen and essential drugs. “We need a consolidated response and resources should be shared between states.” The situation is much more dire when it comes to ICU beds. Several cities have just a few dozen ICU beds left and they are now frantically trying to build extra capacity in hotels and stadiums.But getting ICU beds up and running quickly is not easy. Dr Fathahudeen says adding beds alone is not enough. “We need to ensure that most of these beds have oxygen facility. We need more doctors and nurses to manage extra ICU beds,” he adds.He says it’s going to be a “daunting task” for the government to get such facilities up and running and ensure good quality of care in a short span of time.Unreported deathsThe number of daily deaths has risen sharply in the second wave. India reported 1,761 deaths on Monday, taking the toll to over 180,000 since the pandemic began.Crematoriums have been running day and night in several cities, and people have to wait for hours to get the deceased cremated or buried.Experts say this shows that the actual number of deaths could be much higher. Sanjeev Gupta, a photojournalist based in the central Indian city of Bhopal, reached one of the city’s crematoriums for what he thought was a usual assignment last week. Bhopal had reported only four Covid-related deaths on that day. But Mr Gupta was surprised to see dozens of funeral pyres burning. Additionally, several bodies were lined up to be cremated in the electric furnace. Mr Gupta says he was moved when a young man asked him to photograph the smoke coming out from the chimney of the electric crematorium. “He said the smoke represented his mother. It’s the most heartbreaking thing I have ever heard.”Another photojournalist in Lucknow, which is the capital of Uttar Pradesh state, told the BBC that he counted nearly 100 funeral pyres burning at one of the city’s crematoriums in the city on 14 April. The official death data for the whole state on that day was 85.”The sky had turned orange near the crematorium. I still get chills thinking about it. We are definitely not getting the right death data from the government,” he said.image copyrightEPAAnother photojournalist the BBC spoke to in Varanasi city in Uttar Pradesh state also talked about similar discrepancies in how deaths were being reported. Experts say there are several reasons for this. One of them is that many people are dying at home because they are not getting hospital beds or they are not being able to get tested for Covid. So, they don’t find a place as a Covid patient in the database managed by different states. Mr Bhan says testing facilities are still poor in smaller towns and even in some cities and “it’s possible we are missing many Covid-related deaths in these areas”.He adds that there seems to be an issue with recording Covid deaths in some states. There have been reports about administrative oversight as well but officials deny the allegation. “We need more transparency in numbers as it helps in managing the situation and also clearly tells you how severe the situation is,” Mr Bhan adds. Variants in playIndia on 25 March announced that a new “double mutant” variant of the coronavirus had been detected from samples collected from different states.Virologist Shahid Jameel explained that a “double mutation in key areas of the virus’s spike protein may make the virus more infectious and allow it to escape the immune system”.He says the change in the virus is the only “logical explanation” behind the surge. Health officials in the UK are now investigating whether a double mutant spreads more easily and evades vaccines.image copyrightSumit KumarDr Jameel adds that India started looking at mutations “fairly late”. “By December, India had done genome sequencing of only 5,000 samples. It wasn’t a concentrated effort.”In January, India put together a group of labs to speed up sequencing and these labs started functioning in February. “But unfortunately, the second wave started and the vision of sequencing roughly 5% of the total samples did not come through.”Sequencing becomes important in a pandemic as it allows scientists to monitor changes in the virus. “If you can catch a more infectious variant early on in a region, you can quickly put in public health measures to stop it from spreading wider in the community,” he explains.But it’s “never too late” to take measures. “We need to strengthen safety protocols and rapidly vaccinate people, and also keep an eye on mutations. If we do all this, we could reduce numbers significantly.”Read more stories by Vikas PandeyIndia’s Covid-19 patients turn to black market’Think about ICU workers before you party”I have cancer in my 30s, but can’t get a Covid jab’India in ‘delicate phase’ as Covid cases surgeThe vaccine pioneer the world forgot