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You Should Still Get Vaccinated Even If You’ve Already Had COVID-19, Study Shows

In one of the first large studies exploring immunity from natural infection with COVID-19, researchers in Denmark found some surprising trends—including evidence that even those who previously contracted the disease should still get vaccinated. In the study, published March 17 in medical journal The Lancet, researchers took advantage of repeated coronavirus test results from about 4 million people in order to track how often those previously infected with SARS-CoV-2—the virus that causes COVID-19—were reinfected. Since the test results were tied to people’s health records, the scientists could anonymize the data and compare those who tested positive during Denmark’s first COVID-19 wave last spring with those who tested positive during a second wave in the autumn. That revealed key findings about reinfection rates in the country.

In the spring, 2% of the 530,000-plus people who were tested for SARS-CoV-2 were positive. Among them, 0.65% tested positive again later that year, compared to 3.3% of those who had tested negative during the first wave. That suggests infection with SARS-CoV-2 provides about 80% protection against reinfection. What’s more, there was no evidence that this immunity waned over the study’s six month follow-up period. But when the researchers broke down the data by age, they learned that this protection wasn’t uniform—protection was only 47% for people over 65 years old. “The result in the elderly surprised me,” says lead researcher Steen Ethelberg of the Statens Serum Institut, Denmark’s equivalent of the U.S. Centers for Disease Control and Prevention. “That was, ‘wow, this is actually important; we have to communicate this because you can obviously not count on being protected if you are a senior citizen and have the disease.’” To adjust for the possibility that the tests were picking up the same infection twice, Ethelberg’s team analyzed the results with differing times between the testing. But it came up with similar results, showing previous infection provided about 80-82% protection from reinfection for most adults. The team’s data was collected through last year, before major new SARS-CoV-2 variants emerged, so the findings don’t apply to immunity after infection from these strains. However, Ethelberg is planning to repeat the study with more recent data to see if similar patterns hold up for those infected with the variants. For now, the findings strongly suggest that even if people over age 65 years have experienced COVID-19, they still need to be vaccinated, since their protection from their natural infection may not be sufficient on its own. “They need to take care, and shouldn’t believe that they are immune and still protect themselves,” says Ethelberg. While less urgent, that also goes for anyone of any age who has recovered from COVID-19. “It’s well known that coronavirus infection do not induce 100% immunity,” he says.

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These 29 Numbers Show How the COVID-19 Pandemic Changed Our Lives Over the Last Year

It was a year ago that COVID-19 pandemic seized control of our lives. While essential workers remained on the job, the rest of America, confined to quarters, tried to come to terms with a life on pause. Working, learning and passing the time almost entirely from home meant changes in habits, health, relationships and plans for the future. Numbers don’t tell the whole story, of course, but the following statistics outline the contours of the lives we lived.

—With reporting by Patrick Lucas Austin, Judy Berman, Melissa Chan, Jamie Ducharme, Alejandro de la Garza, Tara Law, Belinda Luscombe and Katie Reilly

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Why Countries Around the World Are Suspending Use of AstraZeneca’s COVID-19 Vaccine

It’s the last thing public health officials want to see in the midst of a pandemic: more than two months after pharmaceutical giant AstraZeneca and Oxford University scientists released their COVID-19 vaccine, countries in Europe and elsewhere are pausing its use amid disconcerting reports that a small number of recipients have experienced blood clots, some of them fatal. If that weren’t enough, a new study also showed the vaccine was not effective in protecting people from a variant of the COVID-19 virus that originated in South Africa and is slowly gaining ground in other parts of the world. In the report published in the New England Journal of Medicine, scientists in South Africa found that two doses of the AstraZeneca vaccine were about 22% efficacious in protecting people from getting sick sick with COVID-19 from the new variant of the virus, known as B.1.351. While there were no severe cases of COVID-19 report among the more than 2000 people in the study, that efficacy is not sufficient enough protection since similar percentages of people who got the vaccine as who received the placebo became sick. That means that the utility of the AstraZeneca vaccine, including against B.1.351, needs to be carefully weighed against the burden of the pandemic to determine if the vaccine is worth using in areas where the variant is spreading quickly.

More immediately, the company is also contending with continued fallout from reports of blood clots among people who have been vaccinated with its shot. The European Medicines Agency, which oversees drugs and vaccines in Europe, is expected to issue a guidance on March 18 about whether the side effects were related to the vaccine after reviewing these reports; in the meantime, it says the benefits of the shot outweigh any potential risks. Despite that reassurance, European countries including France, Germany, Italy and more have suspended vaccinations with the AstraZeneca shot. Venezuela, which has not yet authorized the AstraZeneca vaccine, now says it will not do so. “What we’re seeing is a domino effect,” says Dr. Anna Durbin, professor of international health at Johns Hopkins Bloomberg School of Public Health. “Nobody wants to be the country that didn’t stop [vaccinating] and then find out that the side effects are really related [to the vaccine].” It’s not clear yet whether the blood clots are related to the vaccine or not—that’s what regulatory agencies in the various countries are now investigating. It’s expected that side effects will emerge after large numbers of people are immunized with a new vaccine. The key is to determine if these events would have occurred anyway if people hadn’t received the shot, or whether they are more intimately related to the vaccine. “When this occurs, it’s incumbent on public health agencies to quickly determine whether or not that vaccine adverse event is occurring more commonly in the vaccinated group than the unvaccinated group,” says Dr. Paul Offit, professor of pediatrics and director of the vaccine education center at Children’s Hospital of Philadelphia, and a member of the U.S. Food and Drug Administration’s vaccine advisory committee. On March 14, AstraZeneca released a statement standing by its vaccine, noting that a “careful review” of data from the 17 million people vaccinated in the E.U. and U.K. with its shot so far “has shown no evidence of an increased risk of pulmonary embolism, deep vein thrombosis, (DVT) or thrombocytopenia, in any defined age group, gender, batch or in any particular country.” The company also noted that so far, among the millions vaccinated in the E.U. and U.K., just 15 have developed DVT, or blood clots in vein blood vessels, and 22 have developed clots in the lungs that originated elsewhere and traveled to pulmonary arteries. Those figures, AstraZeneca said, are much lower than the number of cases expected to occur naturally in that population. The company also said there were no issues relating to compromised batches of the shot. AstraZeneca did not immediately respond to TIME’s requests for comment on the temporary halts of vaccination programs, or their plans for addressing skepticism about the safety of the shot.

Many countries pausing use of the AstraZeneca vaccine are dealing with rising COVID-19 cases and are just starting their vaccination programs — the suspension will only hamper those efforts. Among E.U. countries, only 9% of the population has received at least one dose of the several two-dose vaccines currently available to them. Furthermore, Offit argues the stoppage may seed more doubt about the safety and efficacy of all coronavirus vaccines in the minds of an already skeptical public. “When you scare people, it’s hard to un-scare them,” he says. “I would argue that in the face of a pandemic, especially when [vaccination] is the only chance of being protected, the halts are not a conservative thing to do, but a radical thing to do.” Offit points to data from AstraZeneca’s Phase 3 clinical trials in the U.K., Brazil, and South Africa, where no serious side effects were reported among more than 17,000 participants. Those trials showed that the vaccine was 67% efficacious in protecting people against COVID-19 disease after 14 days, and 82% efficacious after 12 weeks. Researchers did not report concerning incidents of blood clots or other side effects beyond those occurring at expected rates in the study population. So why the uproar? It’s likely a combination of numerous factors, beginning with the early days of AstraZeneca’s late stage human testing. Public health experts found the data from the company’s Phase 3 trial—which were used to gain authorization in the U.K.—hard to interpret, since the researchers pooled several studies into one, and changes were made after the study began in both the doses people received and the timing of the shots. For example, mistakes in the doses of the vaccine led some participants to receive the planned two full doses, spaced one month apart, while others received a half dose and then a full dose. Some also had their doses spaced one month apart, while others ended up waiting three months for their second shot due to supply delays. On top of those changes, people in different countries received different placebos. Whether any of these factors affects the vaccine’s safety isn’t clear, but they have led some to be wary of the shot. “The skepticism and increased scrutiny on the AstraZeneca vaccine has a lot to do with how early things were handled by both Oxford and the company in terms of how they reported things,” says Durbin. “The early stumbles out of the gate has affected the perception of the vaccine without a doubt.”

A U.S. study of the vaccine, which began in September, was completed in January (Durbin led one of the study sites at Johns Hopkins). Given the confusing interpretations of the U.K.-based trial results, a lot is riding on those findings. Dr. Ann Falsey, professor of medicine at the University of Rochester who was involved in designing the U.S. trial, hopes the results will clarify some of the confusion generated by the earlier U.K.-based study. “It was large, it was rigorously designed, ahead of time, and there were no changes that happened during the study,” she says. All participants were randomly assigned to either receive two full doses of the vaccine, one month apart, or a placebo. The company is currently analyzing the data and is expected to submit a request for FDA authorization soon. Adding to the concerns is that AstraZeneca’s previous vaccine trial was put on hold last September after a report of a serious adverse event occurring in a study participant. The study was halted for three days in the U.K., and resumed there after the company determined the unexplained illness was not related to its vaccine. The study was resumed in Brazil and South Africa about a month later, while the U.S. trial restarted on Oct. 23. AstraZeneca’s confusing trial results and the study’s temporary suspension led to a crisis of confidence that convinced governments around the world to hit the breaks on its vaccine when the blood clotting reports surfaced. “The reports do seem to have taken off more than the [side effect] reports from the other vaccines,” says Offit. Still, Falsey says “there is no reason to panic.” “To judge the outcome now would be very premature,” she adds. “I do think the bulk of data shows the vaccine is very safe.” If AstraZeneca’s shot stays on the sidelines for long, it could reshape the global battle against the pandemic. The company has committed to providing a large supply of its COVID-19 shot to underserved countries and those who can’t afford to purchase them through the COVAX program. The company has separately agreed to provide 3 billion doses to countries including Russia, India, South Korea, Japan, China, Latin America and Brazil. In these countries and elsewhere, convincing people that the AstraZeneca vaccine—as well as other COIVD-19 inoculations—is safe and effective will be critical to ensuring that the shots find their ways into arms, which is the only way to finally slow the virus and curb the pandemic.

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A Year Into the Pandemic, Long COVID Is Still Burdening Patients—and Their Caregivers

When Ghenya Grondin starts rattling off the symptoms she still experiences a year after getting sick with what she believes was COVID-19, she has to pause to consult a list she keeps on her phone for occasions like this one. Exhaustion. Fevers. Headaches. Body aches. Chest pain and shortness of breath. Nausea and gastrointestinal problems. Dry eyes. Brain fog and memory loss—hence her need for a digital list, which goes on and on. While Grondin’s physical symptoms are bad enough to keep her mostly homebound and unable to do her work as a postpartum doula, the constant mental fogginess has hit her hard emotionally. “I was always the friend and the sister and the cousin who remembered birthdays…and that has changed,” says Grondin, 42. “Balls are constantly being dropped in our household.”

That’s not for lack of trying, Grondin says. It’s just that all the responsibilities of what was once a two-parent, two-job household have fallen on the shoulders of her 42-year-old husband, Jonathan. Each day, Jonathan does his best to juggle his full-time job as a creative director; parenting three boys ages four to 14; maintaining the family’s home in Waltham, Mass.; and caring for Ghenya, who is so sick Jonathan doesn’t like leaving her alone for longer than an hour at a time. His wife now needs help with almost everything, from preparing meals to booking and attending doctor’s appointments to even walking from the bedroom to the bathroom. “Every second I am awake, I am doing something to run the house,” Jonathan says. He can’t shake the feeling that, in trying to balance all of his tasks, he is succeeding at none. He worries he’s not emotionally present enough for Ghenya. He worries he’s falling behind at work. He worries the kids are eating too much junk food. Perhaps most of all, he worries about money; between losing Ghenya’s salary and paying for her slew of medical appointments, the family has accrued about $40,000 in debt. And all of this is happening while Jonathan grieves for the woman he married—a woman full of energy and life whose presence commanded every room she entered, and who now needs help with the most basic facets of daily life. “After a year,” Jonathan says, “it’s hard to remember when it was different.” Twelve months into the U.S.’ COVID-19 epidemic, the Grondins’ story is striking not because it is unique, but because it is not. Researchers estimate that somewhere around 10% of COVID-19 patients, if not more, will develop long-term symptoms of some degree. These symptoms run the gamut from neurological issues to chronic pain, and they’re often totally different from the symptoms typically associated with acute COVID-19. Doctors aren’t entirely sure why patients with Long COVID, sometimes also called long-haulers, don’t fully recover, nor how they should be treated. But experts do know that they don’t suffer in a vacuum. For each person who wakes up day after day with a running list of symptoms, there is often a loved one—or multiple loved ones—waking up ready to care for them.

In many cases, that’s a spouse or partner. But for other patients, care has come from more unexpected sources. Forty-seven-year-old Lyss Stern, an author and entrepreneur who lives in New York City and initially got sick last March, says her kids have stepped up to keep the household running, with her teenage son largely taking over food shopping and cooking. Netta Wang, a 23-year-old senior at Stanford University who has had symptoms for about six months, gets help from her roommates, who created a spreadsheet to divvy up her care—a sacrifice that is not lost on Wang. “No one wants to be sick in their 20s,” she says, “but also no one wants to be a caretaker in their 20s.” The burden of Long COVID caretaking is creating a little-discussed crisis within a crisis. It is well-established that amateur caregivers often neglect their own health and well-being in the course of tending to a loved one, and that unpaid caretaking can become an unsustainable drain on a family’s finances. If around 10% of the nearly 30 million U.S. COVID-19 patients diagnosed so far require some level of care for long-term symptoms, that means millions of families around the country are living lives dominated by Long COVID. Dr. Ronald Adelman, a geriatrician at New York-Presbyterian Hospital/Weill Cornell Medical Center who studies caregiving, says the uncertainty of long-lasting disease—not knowing when, or if, it will let up—adds to the stress on families. “Can you afford the mortgage? Do you have more kids?” he says. “It could be quite a nightmare for people who have lost their economic pathway and aren’t feeling well. It could be quite disastrous.” Dr. Zijian Chen wishes he had an explanation. As the medical director of the Center for Post-COVID Care at New York City’s Mount Sinai health system, Chen is one of the U.S.’ top experts in this new specialty. For all his expertise, Chen still has no idea why some patients get better and others don’t, or whether there are risk factors that predispose someone to Long COVID. “I want to say something to answer your questions, but I don’t really have an answer,” Chen says. “I don’t know.”

One of the leading theories in the field is that some patients have an abnormal immune or inflammatory response, such that the immune system revs into overdrive, attacking the body in the process. Another hypothesis is that Long COVID is not a unique disease, but rather that a COVID-19 infection is a new trigger for myalgic encephalomyelitis/chronic fatigue syndrome, a post-viral syndrome that comes with similarly long-lasting and debilitating—and baffling—symptoms. The National Institutes of Health in February announced that—with the help of more than $1 billion in Congressional funding—it would coordinate new research into Long COVID. The agency hopes to determine who is at risk and why and, ideally, develop new treatments. But right now, researchers don’t even know with certainty how many people have the condition or who is likely to get it. Most existing studies are based on reports from specific medical centers that have kept records, which include whatever patients happened to seek care at a given center. That means researchers can’t really generalize from those data. However, from these anecdotal reports, researchers have extrapolated a few hypotheses. For example, it seems that many patients are younger than 50, and that many initially had relatively mild cases of COVID-19. There is also some evidence, albeit preliminary, that women are more likely to develop Long COVID than men. One French hospital system found that female patients outnumbered male patients by about four to one. Chen says that in his clinic, about two-thirds of patients are women. Other U.S. hospitals have reported gender breakdowns closer to a 50-50 split, but usually with a slight overrepresentation of women. (It’s possible, however, that women are simply more likely to seek care or document their symptoms, as opposed to having a biological predisposition to the condition.) Given that women still take on the bulk of domestic labor and child care in many American households, that disparity has especially large ramifications for caretaking. “She did everything,” Jonathan Grondin says of his wife. “She kept track of all the school stuff, teachers, doctors, dentists.” Those are all things he has had to take on, now that she can’t.

That transfer hasn’t been smooth for everyone. Chimére L. Smith, a 38-year-old English teacher from Baltimore, broke up with her boyfriend of two years after getting sick last March. “He didn’t believe that I had COVID,” Smith says. “I couldn’t quite deal with doctors telling me I was fine and [then] coming home to deal with a relationship and a partner who didn’t believe me.” When Smith got sick, COVID-19 testing wasn’t widely available, and she was never formally diagnosed with the disease. As her symptoms piled up over the following months—vision problems, fatigue, light sensitivity, memory loss and more—doctor after doctor dismissed her concerns. Some asked if her symptoms might be related to drug use; one suggested a stay in an inpatient psychiatric facility. It took about six months for any physician to take seriously her supposition that her symptoms were the fallout from a COVID-19 infection. “As a Black woman, I understand the history of discrimination when it comes to health care in this country, sadly,” Smith says. “But I never really quite knew until it knocked on my door.” Sick as she was, the experience prompted Smith to write to hospitals, researchers and local politicians, begging them to help spread the word about Long COVID—and the discrimination she and many other women of color face when they seek care. There was one person who never doubted her, Smith says: her godmother, Paula Murray, a church pastor in her 60s whose house Smith moved into well before the pandemic hit. As Smith’s symptoms accumulated, Murray balanced her church responsibilities—like delivering food and other supplies to members who couldn’t go out—with becoming Smith’s primary caregiver, convincing her to eat when she had no appetite and nursing her back to “some semblance of health” during the months on end when she barely left the darkness of her basement bedroom. Even now, a year into her illness, Smith is too sick to work and needs her godmother’s help to travel to medical appointments and take care of chores like cooking. “It’s really, really showing me who’s in my circle,” Smith says. “She definitely deserves a vacation and a medal.”

Unpaid caregiving can take such a toll, it’s commonly referred to in medical literature as a “burden.” Studies have repeatedly shown that family caregivers often experience chronic stress related to their duties, and are at risk of depression and other mental health issues; they may also experience physical health problems related to poor diet and sleep or skipped medical appointments. Their work is also expensive. One 2013 study estimated that the average dementia caretaker loses more than $14,000 per year in forgone wages, to say nothing of the roughly $7,000 per year the AARP estimates the average caregiver spends out-of-pocket for related expenses. Nationally, according to a the AARP, family caregivers provide about 34 billion hours of unpaid care each year, worth $470 billion. And yet, there’s been little discussion about the ramifications of Long COVID on caretakers. Adelman, the geriatrician, says that’s nothing new. “We talk about the caregiver as the silent patient,” he says. Actively assessing the caregiver’s needs, and including them in the patient’s medical appointments, can improve outcomes for both the patient and the caregiver, Adelman says. But when money and time is tight, it can feel like a cruel joke to recommend that someone caring for a chronically ill loved one squeeze in yoga classes or sessions with a therapist for themselves. To truly support caregivers, Adelman says the government should provide support like expanded insurance benefits (which could help pay for professional health aids) or paid leave for caregivers. The U.S.’ Family and Medical Leave Act, which provides up to 12 weeks of leave to care for an ailing relative, does not come with pay. Even the Families First Corona­virus Response Act, meant to provide paid leave during the pandemic, has narrow eligibility requirements that mostly apply to parents caring for their children; it also expires after a maximum of 12 weeks. Beyond online support groups, there’s little specific help for Long COVID patients and their caregivers. Zachary Klipowicz, a 40-year-old engineer from Colorado who is caring for his wife, Sherri, while she battles Long COVID, has so far made the arrangement work through a combination of teleworking and family leave offered by his employer. While his situation has worked fairly well so far, Klipowicz knows that is not the case for most people—and even for him, it’s not a long-term solution. “Right now employers aren’t understanding it. The government is not understanding that these people are unable to work; they are pretty much disabled,” he says. “I don’t think the U.S. is prepared for that in any way.”

Ghenya Grondin is painfully aware of these realities. As grateful as she is to her husband, and despite the ways in which his care has brought them closer, she worries about the toll it takes on him and their family. The couple sees a therapist, but she still feels anxiety over the burden she feels she’s placed on Jonathan. “It’s till-death-do-us-part,” she says, “but that comes with a really heavy weight for everybody in my household.”

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